On Jan. 5, the Centers for Disease Control and Prevention (CDC) made a major change to the childhood vaccine schedule in the United States. Acting CDC Director Jim O’Neill signed a memo that removed several long-standing vaccines from the list recommended for all children.
As a result, the number of vaccines routinely recommended for every child dropped from 17 to 11. Vaccines for influenza, rotavirus, hepatitis A, hepatitis B in some infants and meningococcal disease were moved to “shared clinical decision-making” or limited to high-risk groups.
Federal leaders said the change was meant to follow “international best practices,” pointing to Denmark’s vaccine schedule as a model. But it did not follow the usual public process or come from the CDC advisory committee that typically reviews evidence and hears public input. Instead, the decision was made quickly and from the top down.
There are serious reasons to question whether Denmark’s approach makes sense for the United States.
Denmark is a small country of about 6 million people with universal health care, strong public health systems and reliable follow-up for pregnant women and infants. Nearly all pregnant women are screened for hepatitis B, and results are automatically linked to the infant’s medical record.
The United States is very different. We have 330 million people, major gaps in health care access and a fragmented system. About 27 million Americans are uninsured. Many pregnancies are not screened for hepatitis B, and test results are often delayed or lost. The U.S. vaccine schedule was designed for this reality. Universal recommendations exist because targeted approaches leave too many children unprotected.
It is also worth noting what the U.S. does not vaccinate against and why. Diseases such as Japanese encephalitis, tuberculosis and yellow fever are not included in the routine childhood schedule because they are not endemic here. This reflects how vaccine policy is meant to work. National immunization schedules are based on local disease prevalence and real-world risk.
Denmark is also not the global standard. Many comparable countries recommend more childhood vaccines. The United Kingdom, Canada, Australia and Germany all have broader schedules. Denmark is the exception, not the rule.
Another concern is the growing use of “shared clinical decision-making.” While the term sounds reasonable, in practice, it creates confusion.
Shared decision-making was intended for limited cases where benefits depend heavily on individual risk. Most routine childhood vaccines do not fall into that category. Polls show many Americans do not understand what the term means. Some interpret it as a signal that a vaccine may be unsafe or unnecessary, while others are unsure which providers can even offer it.
Routine recommendations serve an important function. They trigger reminders in medical records, allow nurses and pharmacists to vaccinate without delay, and support clear guidance from providers. When vaccines are removed from the routine category, these systems weaken. Vaccination rates fall, especially among families already facing barriers to care.
History shows why this matters. Before the hepatitis B vaccine was routinely given to infants, many babies were infected because their mothers were not identified as high risk. Universal vaccination decreased acute cases of hepatitis B in children by 99%. Similar evidence supports routine vaccination against influenza, rotavirus and meningococcal disease, all of which can cause severe illness or death.
The science behind childhood vaccines has not suddenly changed. What has changed is how decisions are being made and how clearly recommendations are communicated.
The United States has a long-standing process for updating vaccine guidance that is meant to be careful, transparent and based on evidence. That process is now being weakened, which risks more confusion and less trust.
Parents, you should stay informed and keep talking with your health care providers about vaccines. Ask questions. Do not assume that a change in wording means a vaccine is no longer important. At the same time, federal health leaders should slow down, be transparent, and include the public and medical community in decisions that affect every child.
Clear, consistent guidance saves lives. Children deserve a system that protects them, not one that makes protection harder to reach.