Alaan Ayaz, 13, receives a shot at vaccine clinic in Bowie, Maryland, in August. Public experts are concerned new Trump administration recommendations will harm vaccine uptake.
Photo by Sarah Voisin, courtesy The Washington Post/Getty Images
In 2024, federal researchers reported alarming news. Looking back over the past few years, they found immunization coverage for U.S. children was falling.
Compared with children just two years older, kids born in 2020 or 2021 were less likely to have completed their full vaccine series and flu shots by age 2, they shared in a study in Morbidity and Mortality Weekly Report.
Deep disparities also emerged, with Black, Hispanic and American Indian and Alaska Native children significantly less likely to have complete coverage. Kids who lacked health insurance, lived in rural areas and were poor also had lower vaccine uptake, putting them at higher risk for serious disease and death.
With new, weaker federal immunization recommendations from the Trump administration now in place, public health experts are worried those disparities will worsen even further.
Instead of the Trump administration immunization schedule, which drops a third of vaccines, parents are advised to follow AAP's science-based schedule.
Photo by Ddagana991, courtesy iStockphoto
In January, Trump administration health officials cut the number of recommended routine childhood immunizations by more than a third. Despite decades of science showing the benefits of hepatitis A, hepatitis B, RSV, meningitis, rotavirus and influenza vaccines, all were removed without scientific justification from the federal child vaccine schedule.
APHA and other public health and medical leaders immediately denounced the changes.
“This rollout is disruptive to good public health practices as well as clinical medical care,” Georges Benjamin, MD, APHA CEO, said in a news release. “This is health policy malpractice 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 disregard Trump administration advice and follow evidence-based recommendations, public health experts are concerned the conflicting information will cause confusion.
“Ultimately, this chaos and ongoing revisions to established and data-driven health policies may affect the health of children 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 also now advise parents to engage in “shared decisionmaking” with their health care team before obtaining vaccinations for their children. That step, which could turn a quick stop at the pharmacy or community vaccine clinic into a full-fledged doctor's appointment, could cause some people to forgo shots 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 decisionmaking 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, NMA president-elect, said in a news release.
“These changes shift the burden of decisionmaking 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 former schedule, in time providers may be less likely to fund vaccines not recommended by federal policy, according to Sean O'Leary, MD, MPH, chair of the Committee on Infectious Diseases at the American Academy of Pediatrics. With research already showing that kids without health coverage are less likely to have all their vaccinations, the implications could be dire.
“This makes access more difficult for a lot of families, particularly those who already are having challenges getting access to care,” O'Leary told The Nation's Health.
AAP is continuing to publish its own science-backed schedule of recommended vaccines — in line with the previous schedule — that health workers and parents can follow to safeguard children. The organization's 2026 schedule, which is endorsed by APHA and a range of leading medical groups, was released in January.
“All of the vaccines on the schedule were there for a very good reason — because they save lives,” O'Leary said.
Some states stepping up to fill the gap
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 — stacked with members handpicked by the Trump administration — ended federal recommendations that all infants be vaccinated for hepatitis B.
In response, some states have begun strengthening vaccination protections and adopting their own policies. Minnesota and Wisconsin are among states that have broken with the Trump administration's guidance, embracing science-based immunization schedules from AAP and other respected health and medical organizations.
Simplifying access remains paramount for vaccine equity. Along with 25 other states, Massachusetts allows pharmacists to administer COVID-19 vaccines without a prescription, a policy ratified by its public health department after Trump administration policy created barriers to access.
Massachusetts has also worked to broaden 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 Inequity Initiative set out to increase trust and establish and improve uptake through mobile vaccine clinics in disadvantaged communities. As a result, vaccination increased 216% in those communities.
“We were able to decrease some of the disparities in vaccine administration and vaccine uptake, and I think we did so in a way that was a model for other states,” Goldstein told The Nation's Health.
Massachusetts applied its COVID-19 model to proactively administer vaccines during the 2024-2025 flu season in Black communities, resulting in about a 20% drop in flu cases despite higher cases nationally, Goldstein said.
“The best way to get people vaccinated is to do it at that local level,” Goldstein said. “You want to be where people are, engage with them in the conversation, and hope that they'll agree to the administration of a vaccine.”
The Public Health Alliance of Southern California, a coalition of 11 local health department, is also actively working to increase health equity. Along with equity-building tasks such as pinpointing sites for mobile clinics in vulnerable neighborhoods, the alliance explores the finer points of vaccine messaging.
Tailored messaging is a must in a diverse region such as Southern California, said Tracy Delaney, PhD, founding director of the alliance. Relying on research from the FrameWorks Institute and AAP, the alliance formed strategies to reach diverse groups on vaccine uptake. It understood that uptake is about more than vaccine confidence: Cultural factors and systemic barriers also play a major role.
Photo by Comzeal, courtesy iStockphoto
And when it comes to changing people's minds about vaccines, one message does not fit all groups. For example, most recommendations advise that war imagery be avoided when talking about vaccines and the immune system, but the imagery can be powerful for American Indian populations who embrace a “warrior spirit,” Delaney said.
“There's a lot more nuance within various populations,” she told The Nation's Health.
In Colorado, legislators passed a new law that requires state-regulated insurance companies cover vaccines that were on the 2024 childhood immunization schedule. The law ensures that insurance companies cannot back out on covering vaccines that the Trump administration dropped. Colorado also passed a law that allows its Board of Health to consider vaccine schedule recommendations from respected professional medical associations rather than the Trump administration's advisory panel.
Public confusion over conflicting state and federal schedules will likely reduce vaccine uptake, 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,” she told The Nation's Health. “And in the case of vaccines, that can be deadly.”
For the 2026 childhood immunization schedule from AAP, visit www.aap.org.
APHA calls on courts to block revised immunization schedule
In a swift move to protect U.S. public health, APHA joined with the American Academy of Pediatrics and an host of other leading health groups to stop the federal government from trimming childhood immunization recommendations by more than a third.
The organizations filed a preliminary injunction in January to overturn the revised federal childhood vaccine schedule put into place by the Trump administration that month.
The advocates were also trying to legally prevent the Advisory Committee for Immunization Practices from holding a February meeting on vaccines, arguing that it has repeatedly used bad science and research to justify its decisions under the Trump administration. While ACIP was long considered the gold standard for immunization recommendations, administration leaders fired respected, vetted members of the committee last year and replaced them with handpicked participants with dubious qualifications.
“We are confident that we will demonstrate for the court that this administration has acted arbitrarily and capriciously in revisions to the childhood immunization schedule and, furthermore, that the current ACIP will continue this destructive pattern if allowed to continue meeting,” Richard Hughes, the plaintiff's attorney, said in a statement.
APHA has been vocal in denouncing decisions by the Trump administration over the past year that have disregarding science in favor of politics.
“Disregarding the scientific process to fast-track partisan policy changes through a new vaccine schedule will lead to increased illness and suffering by children and their families,” Georges Benjamin, MD, APHA CEO, said in a news release.
- Copyright The Nation’s Health, American Public Health Association
