President Donald Trump issued an executive order Monday that aims to reduce the number of universally recommended vaccines for children — a move that reaffirms the dramatic overhaul Health Secretary Robert F. Kennedy Jr. announced this year, which has been blocked in court.
Similar to that vaccine schedule change, the new order recommends dropping the list of diseases that all children should be vaccinated against from 18 to 11. The other shots would be recommended for high-risk groups or subject to so-called shared clinical decision-making between parents and their children’s doctors.
The proposed changes, in theory, would not prohibit access to vaccines or limit insurance coverage. Rather, Kennedy said Monday that they are meant to give parents choices. The recommended childhood immunization schedule in the U.S. is not a mandate, though many schools and daycare centers follow the guidelines in crafting their own requirements.
The new order recommends that vaccines for Covid, rotavirus, the flu, hepatitis A, hepatitis B and bacterial meningitis be administered based on shared clinical decision-making.
A separate set of vaccines will remain recommended universally: those for measles, mumps, rubella, diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type B (Hib), pneumococcal disease, HPV and chickenpox.
For certain high-risk groups, the order says, shots for RSV, hepatitis A, hepatitis B, dengue and two types of bacterial meningitis are recommended, as well.
In addition, the order recommends that childhood immunizations be administered at separate medical visits, which in practice could more than double the number of doctor appointments for children — and could mean more copays, as well.
It also suggests that the combined measles, mumps and rubella (MMR) vaccine be separated into three shots, given individually. No such individual vaccines are Food and Drug Administration-approved or available, and no published evidence shows any benefit in separating them, according to the Centers for Disease Control and Prevention.
Nonetheless, the order tasks Kennedy with coming up with options to make separate shots available. That plan is due, the order says, within 90 days, giving Kennedy a deadline just after the midterm elections.
Merck, the pharmaceutical company that manufactures the combined MMR vaccine, said its vaccine is “supported by decades of clinical and real-world evidence” and that separating the shots may result in delayed or missed immunizations.
The executive order drew sharp criticism from the medical community, with many doctors saying it could cause concern and confusion for parents.
Dr. Andrew Racine, president of the American Academy of Pediatrics, said on a call with reporters that spreading vaccines out over more visits could make it more difficult for parents to vaccinate their children.
“The more visits you have to do, the more time you have to take off from work, more time you have to take children out of school if they happen to be school age,” he said.
The academy’s lawsuit challenging Kennedy’s vaccine recommendation changes is what led a judge to block the overhaul.
Heidi Overton, deputy assistant to the president for domestic policy, said during the announcement Monday that because the previous changes are held up in court, Trump is “correcting that wrong” with this executive order.
Richard Hughes, the academy’s lead counsel, said AAP is “evaluating our next steps.”
Sen. Bill Cassidy, R-La., a physician and chair of the Senate Health, Education, Labor and Pensions Committee, wrote on X that Trump lacked the expertise to make such changes.
“Parents should listen to their child’s pediatrician about vaccines rather than listening to an inaccurate executive order. This is so wrong,” Cassidy wrote. Cassidy cast the deciding vote for Kennedy to become health secretary, saying at the time that Kennedy had promised he would not change the childhood vaccine schedule.
In his second term, Trump has repeatedly suggested that babies get too many vaccinations and that the combined measles shot is less safe than individual ones. Those concerns are not backed by scientific research, but Trump nonetheless reiterated them at the signing event, saying he had heard the combined measles shot could be “quite lethal.” Trump presented no evidence to support his statement; the CDC says the vaccine is “very safe.”
Trump also drew a link between vaccines and rising rates of autism, despite decades of research showing there is no association. He alluded, as well, to an unfounded notion that giving too many vaccines at once could overwhelm a baby’s immune system.
“In many cases, we’re requiring 72 jabs for our beautiful, healthy, lovely, delicate, little children,” Trump said. He added that “large amounts, like vats, of vaccine are currently pumped into your child’s body.”
Experts refute these claims, saying that modern vaccines actually target fewer antigens (immune-stimulating proteins) than older versions and that kids are exposed to far more antigens in their daily lives. The 72 number that Trump referred to seems to count combined vaccines as separate jabs and to include all the yearly Covid and flu shots given through age 18. The American Academy of Pediatrics said 30 vaccinations is more accurate.
The academy also says it bases its vaccine schedule — which generally aligns with the guidance the CDC issued before Kennedy took office — on when vaccines will work best with children’s immune systems and when they most need protection from given diseases.
The combined MMR vaccine, recommended for children at 12 to 15 months and 4 to 6 years, has been available since 1971, in part to reduce the number of injections children receive. Breaking up the shots would mean children would get six injections instead of two.
Measles cases in the U.S. this year are already higher than the annual totals recorded in any of the last 35 years.
Independent legal experts said it’s unlikely that the changes outlined in the executive order will come to pass.
“It will not go into effect and will almost certainly be blocked by the courts,” said Lawrence Gostin, a professor at Georgetown Law.
Dorit Reiss, a vaccine policy expert at University of California Law San Francisco, said the CDC does not have to revise its vaccine schedule to match Trump’s order. Normally, vaccine recommendations go through the CDC’s Advisory Committee on Immunization Practices before the agency can adopt them.
However, Reiss said the executive order may encourage some red states to alter their vaccine recommendations or school immunization requirements.
“We’re about to lose our measles elimination status. Is this really the time when you want less MMR coverage?” she said.
The new executive order builds on an earlier one aimed at aligning the childhood vaccine recommendations in the U.S. with those of peer developed countries.
Some current and former Trump administration officials have pointed to Denmark, where vaccines for the flu, Covid, RSV, chickenpox and several others are not in the universal childhood schedule. However, many public health experts say the burden of infectious diseases is different in the U.S. given the size and diversity of its population. Denmark also has a universal healthcare system, while the U.S. does not.
