Federal and State Vaccine Policies Diverge Amid Major Changes

A growing divergence between federal and state vaccine policies has emerged following the Trump administration's revision of the CDC's childhood immunization schedule and Colorado's passage of a law allowing the state to follow independent medical guidance. These developments have prompted responses from medical organizations, state governments, and legal entities.

Federal Policy Changes

On January 5, the Acting CDC Director signed a memorandum reducing the number of universally recommended childhood vaccines from 17 diseases to 11. This change was implemented without the traditional public comment process or input from the CDC's Advisory Committee on Immunization Practices (ACIP), the expert panel historically responsible for such recommendations.

Under the revised federal schedule, six vaccines were reclassified from universal recommendations to either high-risk groups or "shared clinical decision-making"—a process requiring families to consult with healthcare providers to assess a vaccine's appropriateness. The affected vaccines protect against:

• Hepatitis A
• Hepatitis B
• Rotavirus
• Respiratory Syncytial Virus (RSV)
• Meningococcal disease
• Influenza (Flu)
• COVID-19

The CDC maintained universal recommendations for 11 childhood vaccines, including those for measles, mumps, rubella (MMR); whooping cough, tetanus, diphtheria (DTaP); bacterial disease Hib; pneumonia; polio; chickenpox; and human papillomavirus (HPV).

Rationale

The decision followed a presidential memorandum issued December 5 directing HHS and the CDC to compare U.S. childhood vaccine recommendations with those of "peer, developed countries." HHS officials stated that a comparison with 20 peer nations concluded that the United States' previous recommendations were an "outlier."

"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."
— Health Secretary Robert F. Kennedy Jr.

Kennedy cited Denmark as a model, though vaccine schedules in most European countries are generally closer to the previous U.S. standard.

HHS officials confirmed the changes were intended to increase public confidence in the vaccine schedule, citing declining vaccination rates as indicators of reduced public trust.

Medical Organizations' Response

The American Academy of Pediatrics (AAP) released its own 2026 vaccine schedule on January 26, recommending vaccines against 18 diseases, including COVID-19. This schedule was endorsed by twelve major medical organizations. The AAP stated that the CDC schedule "no longer offers the optimal way to prevent illnesses in children."

A group of 15 Democratic governors, and ultimately a majority of U.S. states, formally adopted the AAP's recommended vaccine schedule. Pediatricians nationwide continue to follow AAP guidance as the professional standard of care.

Colorado State Law

Colorado Governor Jared Polis signed a law allowing the state to follow recommendations from national medical groups rather than federal guidance when making vaccine-related decisions, such as purchasing vaccines for the Medicaid program. The law also codifies pharmacists' ability to prescribe and administer vaccines independently and increases legal protections for healthcare workers who administer vaccines.

The legislation was sponsored by state Senator Kyle Mullica, a registered nurse. Republican state Senator John Carson voted against the bill.

Statements

"We are insulating our state from the dysfunction coming out of Washington. We're going to rely on science."
— Senator Kyle Mullica

"From fighting during the pandemic for Coloradans to get vaccines as quickly as possible, to combating the Trump Administration's barriers to getting vaccinated, we have expanded access to vaccines for Coloradans who want them."
— Governor Jared Polis

"I just want to make sure we're not just getting into a big political dispute between the federal recommendations, the CDC and so forth and different political views in Colorado here."
— Senator John Carson

Colorado is one of 29 states (plus D.C.) taking steps to bypass new federal recommendations.

ACIP Membership Changes

On January 13, Kennedy appointed two new members to ACIP: Dr. Adam Urato and Dr. Kimberly Biss, both obstetrician-gynecologists. Urato has previously questioned vaccine safety during pregnancy, and Biss testified in 2023 about an unproven increase in miscarriage rates following COVID-19 vaccines.

The new Kennedy-appointed ACIP chair, Kirk Milhoan, stated in interviews that the committee is "reevaluating all of the vaccine products" and suggested current measles outbreaks could be an "opportunity to observe" the effects on unvaccinated individuals. The January 5 schedule overhaul occurred without consultation from ACIP.

Legal Challenges

A lawsuit, AAP v. Kennedy, was filed by the American Academy of Pediatrics and other medical organizations, arguing that the administration overstepped its authority in rewriting vaccine recommendations and replacing ACIP experts. A federal judge denied the government's attempt to dismiss the case in January, allowing it to proceed.

Conflicts of Interest Allegations

Senators Warren, Markey, Blumenthal, and Alsobrooks sent a letter to Kennedy regarding his ties to Wisner Baum, a law firm suing Merck over the HPV vaccine Gardasil. Kennedy had reportedly referred vaccine injury cases to the firm since 2018, entitling him to a 10% share of successful judgments, which he later transferred to his son. Kennedy has refused to recuse himself from HHS decisions involving the vaccine.

Vaccine Injury Compensation Program (VICP)

Congress established the VICP in 1986 to manage rare vaccine injury cases through a federal process, offering compensation while protecting manufacturers from civil lawsuits. The program uses a "vaccine injury table" to determine compensation eligibility, with an advisory panel providing input for changes.

Kennedy has reportedly fired at least half of this panel's members. Concerns have been raised that filling the panel with allies could lead to adding conditions like autism to the table, despite a lack of scientific evidence connecting vaccines to autism.

Experts warn this could exhaust the program's $4 billion reserve, push cases into civil court, and potentially threaten the vaccine supply.

The advisory panel met only once in 2025, consolidating four required quarterly meetings into a single day, and has no meetings scheduled for 2026.

State-Level Vaccine Policy Developments

Federal schedule changes have been cited by anti-vaccine groups as an argument against state vaccine requirements. A Stateline analysis found that at least 33 states are now below herd immunity thresholds for kindergartners.

Specific State Actions

Texas: Attorney General Ken Paxton launched an investigation into pediatricians who vaccinate children, alleging an illegal financial incentive scheme. This follows a measles outbreak in the state that resulted in two deaths and a decline in Dallas County's kindergarten vaccination coverage.

Florida: A bill to expand vaccine exemptions narrowly passed committee, retaining MMR, DTaP, and polio requirements but adding "conscience" as an opt-out reason. Separately, the health department is moving to drop requirements for chickenpox, hepatitis B, Hib, and pneumococcal vaccines through rulemaking. Three measles cases have been reported in the state this year.

New Hampshire: A public hearing was held on a bill that would eliminate mandatory vaccinations for school and daycare, along with companion bills to restrict school-based clinics and ban state spending on vaccine outreach.

Idaho: The state has already banned schools from enforcing vaccine requirements and has the lowest kindergarten vaccination rate in the country at about 80%.

Iowa: House lawmakers advanced a bill that would remove all vaccine requirements for school entry.

Mississippi and West Virginia: Both states, once leaders in kindergarten vaccination, now allow religious exemptions (Mississippi by court order, West Virginia by executive action) and are experiencing declining rates. Mississippi is seeing its highest whooping cough numbers in a decade, including a recent death.

The Medical Freedom Act Coalition, which includes Kennedy's Children's Health Defense, is collaborating with lawmakers in nearly a dozen states and plans to expand to all 50, aiming to eliminate vaccine mandates at the state level.

Public Health Context

These developments occur amidst a surge in measles cases (588 reported this year), a severe flu season with at least 52 pediatric deaths, and three measles-related child deaths in the past year. Medical organizations continue to uphold existing standards, courts are addressing legal challenges, and some state legislators are opposing these changes.

Insurance and Accessibility

HHS officials clarified that no vaccines were removed from the schedule; rather, their status was reclassified. They stated that vaccines would remain free and accessible to individuals who choose them, with insurance coverage facilitated through shared clinical decision-making between a patient (or guardian) and their health care provider. Federal and private insurance will continue to cover vaccines affected by the updated guidance.

Expert Reactions

Epidemiologist Michael Osterholm, of the Vaccine Integrity Project and director of the University of Minnesota's Center for Infectious Disease Research and Policy, issued a statement:

"Eliminating vital U.S. childhood vaccine recommendations without public discussion of the potential impacts on children in this country, or a transparent review of the data on which the changes were based, is a radical and dangerous decision. This wildly irresponsible decision will sow further doubt and confusion among parents and put children's lives at risk."

Paul Offit, director of the Vaccine Education Center at the Children's Hospital of Philadelphia, highlighted the past effectiveness of U.S. vaccination against rotavirus. Before routine vaccination began in 2006, approximately 70,000 young children were hospitalized and 50 died each year from the virus.

Lori Handy, a pediatric infectious disease specialist, noted that the new approach may not align with established science due to the proven protective benefits of these vaccines for the general population. She also stressed that vaccines undergo rigorous safety research.

Pediatrician Eric Ball expressed concern that the change could confuse parents, leading them to question vaccine safety, despite "shared clinical decision-making" not being related to safety concerns.

Future Research

HHS officials announced upcoming placebo-controlled trials designed to investigate the timing and long-term effects of vaccines. These trials have commenced at the CDC and are being initiated at the FDA and the National Institutes of Health. Specifics regarding the cost or exact timeline of these trials were not provided, but officials indicated that follow-up would extend over "many, many years" and require "quite some time."