Doctors bypass new federal vaccine guidance, choosing to follow the science — and that decision is reshaping how children across the United States may be protected from infectious diseases.
The American Academy of Pediatrics (AAP) released its annual childhood vaccination recommendations this week, a routine update that usually attracts little attention. This year, however, the guidance carries unusual weight. With controversy surrounding a newly revised schedule from the US Centers for Disease Control and Prevention (CDC), many physicians and state health agencies are now leaning on the AAP’s advice instead of the federal government’s.
The AAP’s updated schedule includes the addition of a new immunization against respiratory syncytial virus (RSV) and a handful of modest adjustments. In contrast, the CDC’s latest update introduced sweeping changes that narrowed recommendations for several long-standing vaccines and shifted others to a “shared clinical decision-making” model, requiring families to consult a doctor before proceeding.
Although the CDC schedule has long served as the national standard, pediatricians say the evidence behind vaccination has not changed.
“The science hasn’t changed,” said Dr. Claudia Hoyen, a pediatric infectious disease specialist at UH Rainbow Babies and Children’s Hospital in Cleveland. “We will continue to follow the science.”
The AAP continues to broadly recommend routine immunization against RSV, hepatitis A, hepatitis B, rotavirus, influenza and meningococcal disease. Its guidance is backed by twelve major medical organizations, including the American Medical Association and the American Academy of Family Physicians.
By contrast, the CDC’s revised schedule limits meningococcal, hepatitis A and hepatitis B vaccines to children considered at higher risk. It also suggests that decisions about flu, Covid-19 and rotavirus vaccines be made through shared discussions between families and clinicians.
After announcing the update, Health and Human Services Secretary Robert F. Kennedy Jr. said the new approach was designed to align with international standards and emphasize transparency and informed consent. But doctors note there were no new safety concerns or research findings to justify removing or restricting vaccines that have been standard for decades.
“For now, unfortunately, we have to ignore everything about vaccines that is coming from our federal government,” said Dr. Sean O’Leary, chair of the AAP’s Committee on Infectious Diseases. “Parents should trust their pediatrician and trust professional societies like the American Academy of Pediatrics.”
Many frontline clinicians agree. Pediatricians interviewed across the country said they plan to continue following the AAP schedule.
Dr. Sarah Elizabeth DeRoo, a pediatrician at Children’s National in Washington, DC, said she remains open and direct with families about vaccine safety and effectiveness. But she acknowledged that the sudden change from the CDC has unsettled parents.
“We’re seeing families who have always accepted vaccines asking whether this new recommendation is evidence-based,” she said. “We’re telling them we’re continuing to follow the AAP’s evidence-based schedule.”
The conflicting guidance has fueled confusion — and anxiety — among families.
“We’re hearing more fear and seeing more misinformation online,” said Dr. Nina Alfieri of Lurie Children’s Pediatrics in Chicago. “We want families to feel welcome bringing their questions.”
Dr. Adam Ratner, a pediatric infectious disease specialist at NYU, said parents’ uncertainty is understandable.
“For many years, the CDC was a reliable, consistent source,” he said. “It makes sense that families are confused now.”
The divide is also playing out at the state level. According to an analysis by KFF, 28 states are now offering vaccine advice that departs from federal guidance for at least some childhood immunizations. All states led by Democratic governors have announced they will not follow the CDC’s revised schedule, while only four Republican-led states have done the same.
“For the first time, we’re going to see laws, policies and attitudes about vaccines vary sharply based on geography,” said Jen Kates, a co-author of the KFF analysis. “It’s a major shift in public health policy.”
Veteran physicians warn that stepping away from routine immunization risks reviving diseases that once caused widespread suffering.
Hoyen, who has practiced pediatrics for three decades, remembers when meningitis and mumps were common. Before the Hib vaccine became available in 1987, spinal taps and emergency hospitalizations were routine.
“There’s a reason these vaccines exist,” she said. “They were created to help children thrive and avoid serious complications.”
O’Leary recalled training in the 1990s, before a rotavirus vaccine was available.
“In winter, we had flu season, RSV season and rotavirus season,” he said. “Hospitals were overwhelmed. Now, rotavirus season is gone, and RSV is already declining with new vaccines.”
Younger physicians, too, are preparing for a future that could look uncomfortably like the past.
“We have to rethink how we approach sick children, in case they’re not fully immunized,” DeRoo said.
Ratner noted that a measles outbreak in New York several years ago was the first time many doctors had ever seen the disease firsthand.
“I think that’s likely to change,” he said. “Going backwards is horrifying. This isn’t abstract — it’s about real children and real families.”
As the nation debates policy and politics, one message from doctors remains consistent: vaccines remain safe, effective and essential. And for now, many clinicians are making their choice clear — Doctors bypass new federal vaccine guidance, choosing to follow the science.
