Key facts
- President Donald Trump signed an executive order reducing routine childhood vaccinations from 18 to 11 diseases.
- The order moves vaccines for COVID-19, flu, rotavirus, hepatitis A and B, meningitis, and RSV into 'high-risk' or 'shared clinical decision-making' categories.
- It directs the Justice Department to challenge state laws that conflict with parental authority and vaccine exemptions.
- Medical groups, including the American Academy of Pediatrics, rejected the order, citing decades of scientific evidence showing no link between vaccines and autism and the benefits of immunization.
- Splitting the MMR vaccine into single-disease shots is not currently feasible as standalone vaccines are not licensed in the U.S.
President Donald Trump signed an executive order on Monday that aims to reduce routine childhood vaccinations and challenges state vaccine laws. The order, which physicians and vaccine makers have rejected, advances a long-standing goal of Health Secretary Robert F. Kennedy Jr. and reaffirms a previous vaccine schedule overhaul that was halted by a federal court.
The executive order recommends universal childhood immunization against 11 diseases, a reduction from the 18 diseases previously recommended by the U.S. CDC in late 2024. Vaccines for COVID-19, the flu, rotavirus, hepatitis A, hepatitis B, bacterial meningitis, and RSV are moved to a "high-risk groups or populations" category or a "shared clinical decision-making" category, recommended only for children with underlying conditions or in consultation with a doctor. The order also suggests splitting the combination measles, mumps, and rubella (MMR) vaccine into three single-disease shots and spreading immunizations across separate visits.
Legally, the order instructs the attorney general to sue over state laws that are perceived to conflict with parental authority, religious freedom, disability accommodations, and equal protection, including religious and medical exemptions from vaccine mandates. The immediate impact on families is expected to be minimal, as parents can still request the shifted vaccines, and the White House stated the order does not affect the Vaccines for Children program. However, splitting shots across more visits could lead to increased appointments and potential out-of-pocket costs, with officials not specifying how these would be covered. Pediatricians warn that the conflicting federal message may cause some parents to delay or skip vaccinations.
Some elements of the order cannot be implemented immediately. Splitting the MMR vaccine is not currently possible because no company sells licensed standalone measles, mumps, or rubella vaccines in the United States. Officials indicated the federal health department would work with manufacturers on a solution within 90 days. The order pressures states to adopt the narrower schedule, as states, not Washington, set school-entry requirements, supported by the Justice Department's directive to sue over exemption laws.
Major medical groups have broadly rejected the order, stating that no new science justifies the changes. The American Academy of Pediatrics warned that the order would sow parental confusion and delay vaccination, reiterating that decades of studies show no link between vaccines and autism. They estimate that replacing the combined MMR shot with single-disease versions would take about a decade. Other groups, including the Infectious Diseases Society of America and the National Foundation for Infectious Diseases, expressed concern that the order would expose more children to preventable illness and death.
Public health experts build vaccine schedules based on disease spread, age-specific risks, and effectiveness. The timing and combination of shots are designed to protect children at the safest and most effective times, typically within the first 12 to 18 months of life. The AAP states that multiple vaccines do not overwhelm a child's immune system. While the previous U.S. schedule targeted 18 diseases, which is comparable to countries like South Korea and Brazil, it was higher than the average of about 14 across comparable nations.