Alaan Ayaz, 13, receives a shot at a vaccine clinic in Bowie, Maryland, in August. Public experts are concerned that the Trump administration’s new recommendations will hurt vaccine uptake.
Photo by Sarah Voisin, courtesy of The Washington Post/Getty Images
In 2024, federal investigators reported alarming news. Looking at the past few years, they found that vaccination coverage for American children was declining.
Compared to children just two years older, children born in 2020 or 2021 were less likely to have completed their full series of vaccinations and flu shots by age 2, they shared in a study in Weekly Morbidity and Mortality Report.
Deep disparities also emerged: Black, Hispanic, American Indian and Alaska Native children were significantly less likely to have full coverage. Children who lacked health insurance, lived in rural areas, and were poor also had lower vaccine uptake, putting them at higher risk of serious illness and death.
With the Trump administration’s new, weaker federal vaccination recommendations now in place, public health experts fear those disparities will get even worse.
Instead of the Trump administration’s vaccination schedule, which eliminates one-third of vaccines, parents are encouraged to follow the AAP’s science-based schedule.
Photo by Ddagana991, courtesy of iStockphoto
In January, Trump administration health officials cut the number of routine childhood vaccines recommended by more than a third. Despite decades of science demonstrating the benefits of vaccines against hepatitis A, hepatitis B, RSV, meningitis, rotavirus and influenza, all were removed without scientific justification from the federal childhood vaccine schedule.
APHA and other medical and public health leaders immediately denounced the changes.
“This release is detrimental to good public health practices as well as clinical healthcare,” Dr. Georges Benjamin, executive director of the APHA, said in a news release. “This is poor health policy practice at the highest level and must be reversed before children and families across the country suffer.”
While parents, caregivers and health professionals are free to ignore the Trump administration’s advice and follow evidence-based recommendations, public health experts worry that conflicting information will cause confusion.
“Ultimately, this chaos and ongoing revisions to established, data-driven health policies may impact children’s health and increase the risk and prevalence of vaccine-preventable diseases,” the Los Angeles County Department of Public Health said in a statement.
Trump administration health officials are also now recommending parents engage in “shared decision-making” with their health care team before vaccinating their children. That step, which could turn a quick stop at the pharmacy or community vaccination clinic into a full-fledged doctor’s appointment, could cause some people to forgo vaccines altogether, public health leaders warn.
The National Medical Association said the changes would have “serious implications” for black children.
“These changes shift the burden of decision-making onto families and pediatricians without clear guidance, resources, or time—a reality that disproportionately harms communities that already face barriers to care,” Brandi Freeman, MD, president-elect of the NMA, said in a news release.
“These changes shift the burden of decision-making onto families and pediatricians without clear guidance, resources or time, a reality that disproportionately harms communities that already face barriers to care.”
– Brandi Freeman
While insurance coverage remains in place for all vaccines on the old schedule, over time, providers are less likely to fund vaccines not recommended by federal policy, according to Sean O’Leary, MD, MPH, chair of the American Academy of Pediatrics’ Committee on Infectious Diseases. Given that research already shows that children without health coverage are less likely to receive all of their vaccines, the implications could be dire.
“This makes access more difficult for many families, particularly those who already have difficulty accessing care,” O’Leary said. The Health of the Nation.
The AAP continues to publish its own science-backed schedule of recommended vaccines, in line with the previous schedule, that health care workers and parents can follow to protect children. The organization’s 2026 calendar, which is supported by APHA and a variety of leading medical groups, was released in January.
“All the vaccines included in the schedule were there for a very good reason: because they save lives,” O’Leary said.
Some states step forward to fill the void
The recent cuts were foreshadowed by the Trump administration’s removal of COVID-19 from the childhood vaccine schedule last May. Seven months later, a federal advisory committee, packed with members hand-picked by the Trump administration, ended federal recommendations that all babies be vaccinated against hepatitis B.
In response, some states have begun to strengthen vaccination protections and adopt their own policies. Minnesota and Wisconsin are among states that have broken with the Trump administration’s guidelines and adopted science-based vaccination schedules from the AAP and other respected health and medical organizations.
Simplifying access remains critical to vaccine equity. Along with 25 other states, Massachusetts allows pharmacists to administer COVID-19 vaccines without a prescription, a policy upheld by its public health department after the Trump administration’s policy created barriers to access.
Massachusetts has also worked to expand vaccine equity, according to Robbie Goldstein, MD, PhD, commissioner of the Massachusetts Department of Public Health. During the early years of the COVID-19 pandemic, the state’s Vaccine Disparity Initiative set out to increase trust and establish and improve acceptance through mobile vaccine clinics in underserved communities. As a result, vaccination increased by 216% in those communities.
“We were able to reduce some of the disparities in vaccine administration and acceptance, and I think we did it in a way that was a model for other states,” Goldstein said. The Health of the Nation.
Massachusetts applied its COVID-19 model to proactively administer vaccines during the 2024-2025 flu season in Black communities, resulting in a roughly 20% drop in flu cases despite higher cases nationally, Goldstein said.
“The best way to vaccinate people is to do it locally,” Goldstein said. “You want to be where the people are, engage with them in the conversation, and hope that they accept taking a vaccine.”
The Southern California Public Health Alliance, a coalition of 11 local health departments, is also actively working to increase health equity. In addition to equity-building tasks, such as identifying sites for mobile clinics in vulnerable neighborhoods, the alliance explores the finer points of vaccine messaging.
Personalized messaging is a must in a diverse region like Southern California, said Tracy Delaney, PhD, founding director of the alliance. Drawing on research from the FrameWorks Institute and the AAP, the alliance formed strategies to reach diverse groups on vaccine adoption. Adoption was understood to be about more than just trust in vaccines: cultural factors and systemic barriers also play an important role.
Photo by Comzeal, courtesy of iStockphoto
And when it comes to changing people’s minds about vaccines, one message doesn’t fit all groups. For example, most recommendations advise avoiding images of war when talking about vaccines and the immune system, but the images can be powerful for American Indian populations who embrace a “warrior spirit,” Delaney said.
“There are a lot more nuances within various populations,” he said. The Health of the Nation.
In Colorado, lawmakers passed a new law requiring state-regulated insurance companies to cover vaccines that were on the 2024 childhood vaccination schedule. The law ensures that insurance companies cannot stop covering vaccines that were abandoned by the Trump administration. Colorado also passed a law allowing its Board of Health to consider vaccine schedule recommendations from respected professional medical associations instead of the Trump administration’s advisory panel.
Public confusion over conflicting state and federal timelines will likely reduce vaccine acceptance, as will rising health insurance premiums, upcoming Medicaid cuts, and ongoing anti-vaccine rhetoric, according to Jane Delgado, PhD, MS, director of the National Alliance for Hispanic Health.
“When you give people a confusing message, their reaction is to do nothing,” he said. The Health of the Nation. “And in the case of vaccines, that can be deadly.”
For the AAP’s 2026 childhood immunization schedule, visit www.aap.org.
APHA asks courts to block revised vaccination schedule
In a swift move to protect America’s public health, APHA joined the American Academy of Pediatrics and a host of other major health groups to stop the federal government from reducing childhood vaccination recommendations by more than a third.
The organizations filed a preliminary injunction in January to overturn the revised federal childhood vaccination schedule implemented by the Trump administration that month.
Advocates were also trying to legally block the Advisory Committee on Immunization Practices from holding a meeting on vaccines in February, arguing that it has repeatedly used poor science and research to justify its decisions under the Trump administration. While the ACIP was long considered the gold standard for immunization recommendations, administration leaders fired respected and vetted members of the committee last year and replaced them with hand-picked participants with dubious qualifications.
“We are confident that we will demonstrate in court that this administration has acted arbitrarily and capriciously in revisions to the childhood immunization schedule and, further, that the current ACIP will continue this destructive pattern if it is allowed to continue meeting,” Richard Hughes, the plaintiff’s attorney, said in a statement.
APHA has openly denounced decisions by the Trump administration over the past year that have ignored science in favor of politics.
“Ignoring the scientific process to accelerate partisan policy changes through a new vaccine schedule will lead to increased illness and suffering for children and their families,” Dr. Georges Benjamin, APHA executive director, said in a news release.
- Copyright The Nation’s Health, American Public Health Association
