Deputy Secretary of Health and Human Services Jim O’Neill, currently serving as Acting Director of the Centers for Disease Control and Prevention (CDC), has signed a decision memorandum to update the U.S. childhood immunization schedule. This action follows a directive from President Trump issued on December 5, 2025, which called for a review of how other developed countries structure their vaccination schedules for children and an evaluation of the supporting scientific evidence.
The presidential memorandum instructed health officials to consider international practices and adopt changes if superior approaches were identified abroad, while ensuring continued access to vaccines already available in the United States.
A comprehensive assessment was conducted by consulting with health ministries from peer nations and reviewing findings presented by National Institutes of Health Director Dr. Jay Bhattacharya, Food and Drug Commissioner Dr. Marty Makary, and CMS Administrator Dr. Mehmet Oz. Following this process, Acting Director O’Neill accepted the recommendations and directed the CDC to begin implementation.
“President Trump directed us to examine how other developed nations protect their children and to take action if they are doing better,” said Secretary Robert F. Kennedy Jr. “After an exhaustive review of the evidence, we are aligning the U.S. childhood vaccine schedule with international consensus while strengthening transparency and informed consent. This decision protects children, respects families, and rebuilds trust in public health.”
The assessment compared U.S. childhood immunization practices with those in 20 other developed countries. It found that the United States recommends vaccines against more diseases than any peer nation but does not achieve higher vaccination rates than these countries. Many peer nations have fewer recommended vaccines yet maintain high vaccination rates through public trust initiatives rather than mandates; Denmark immunizes against 10 diseases compared to 18 covered by the U.S. schedule in 2024.
“After reviewing the evidence, I signed a decision memorandum accepting the assessment’s recommendations,” said Acting CDC Director Jim O’Neill. “The data support a more focused schedule that protects children from the most serious infectious diseases while improving clarity, adherence, and public confidence.”
Under these recommendations, the CDC will continue categorizing vaccines into three groups: those recommended for all children; those recommended for certain high-risk groups or populations; and those based on shared clinical decision-making between parents or guardians and healthcare providers—all categories must be covered by insurance without cost-sharing.
Vaccines remaining in the first category include measles, mumps, rubella, polio, pertussis (whooping cough), tetanus, diphtheria, Haemophilus influenzae type B (Hib), pneumococcal disease, human papillomavirus (HPV), and varicella (chickenpox).
“All vaccines currently recommended by CDC will remain covered by insurance without cost sharing,” Dr. Oz said. “No family will lose access. This framework empowers parents and physicians to make individualized decisions based on risk while maintaining strong protection against serious disease.”
The assessment also highlighted declining public trust in health care institutions between 2020-2024 along with falling childhood vaccination rates during that period.
“Public health works only when people trust it,” Dr. Makary said. “That trust depends on transparency, rigorous science, and respect for families. This decision recommits HHS to all three.”
Recommendations call for increased research using gold standard methods—such as placebo-controlled randomized trials—and long-term observational studies regarding vaccine benefits and risks.
“Science demands continuous evaluation,” Dr. Jay Bhattacharya said. “This decision commits NIH, CDC, and FDA to gold standard science greater transparency—and ongoing reassessment as new data emerge.”
HHS agencies will work alongside state health departments physician organizations—and other partners—to implement updated guidance educate clinicians parents about changes.
