‘An end run around ACIP’: Trump shifts strategy on reducing kids’ vaccinations

This week saw a new chapter in the push from the Donald J. Trump administration and the Make America Healthy Again movement to reduce routine childhood vaccinations, after earlier efforts stalled in court following challenges from states and physician groups.

In contrast to earlier efforts that focused on the US Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP), an executive order signed Monday calls for the whole of government to recognize a diminished vaccination schedule that would offer children protection against fewer pathogens. In addition, the president directs federal agencies to support medical and religious exemptions from vaccination and empowers a committee within the Department of Health and Human Services (HHS) to develop new vaccine adjuvants and separate combination vaccines into shots against single diseases.

Public health groups and the World Health Organization reiterated their objection to these moves. “As measles cases reach a 35-year high in the U.S. and with cold and flu season quickly approaching, today’s executive order on vaccines is not only disheartening but dangerous,” American Academy of Pediatrics president Andrew Racine says in a statement. Racine adds that there is “no new evidence to justify significant changes” to children’s health care.

But whether the administration’s new moves will in fact cause significant changes to vaccine availability is unclear, Joshua Michaud, associate director for global and public health policy at KFF, writes in an email to C&EN. States and private insurance companies are more influential than the federal government when it comes to the treatment children actually receive. The order recommends, but cannot require, that state health authorities adopt the stripped-down schedule.

Even within the sphere of federal control, Michaud adds, the executive order cannot set health policy on its own; instead, it delegates authority to a committee within HHS. “But that doesn’t necessarily mean any new guidance that emerges will actually be adopted, especially if it’s an end run around ACIP,” Michaud writes, adding that new legal challenges are likely to emerge.

The White House did not respond to C&EN’s request for clarification on its policies.

A new executive order calls for fewer childhood vaccines

In a signing event that included multiple false claims about vaccines, such as exaggerations of the number and volume of shots children routinely receive and a purported link to autism that many clinical studies have shown does not exist, the president took new action against a half-dozen routinely administered shots his administration has previously sought to limit.

Citing a January report by former Food and Drug Administration official Tracy Beth Høeg and vaccine-opposed epidemiologist Martin Kulldorff, the order recommends 11 vaccines for all children, and says the rest should be removed from the routine schedule. Those vaccines—including immunizations against hepatitis A and B, bacteria that cause meningitis, respiratory syncytial virus, influenza, COVID-19, and rotavirus—should be recommended only to groups at high risk or subject to a process called shared clinical decision-making, the order says.

Large clinical studies have repeatedly shown that those shots are safe and that skipping them is risky. The US has seen a resurgence of vaccine-preventable infections this year, including several measles outbreaks and a moderately severe flu season.

Høeg and Kulldorff cite vaccine policy in other countries, especially Denmark, as a model to follow for childhood vaccinations. But “simply imposing a narrower schedule by importing recommendations from foreign countries wouldn’t reflect gold standard science,” Michael Ybarra, chief medical officer of the trade group Pharmaceutical Research and Manufacturers of America, says in a statement, borrowing one of the administration’s oft-used phrases. “It would mean accepting a lower bar of protection against diseases that remain serious and, in some cases, life-threatening for children in the United States.”

Reformulation of vaccines unlikely, industry says

The president also instructed a group called the Task Force on Safer Vaccines to investigate ways to separate combination vaccines into individual shots, starting with the measles, mumps, and rubella vaccine, and to evaluate new adjuvants, vaccine ingredients that boost the immune response. The order does not offer justification for either of these changes, and the White House did not respond to a request for its reasoning.

Ben Kasstan-Dabush, a professor of global health at the London School of Hygiene and Tropical Medicine, says in a statement, “This move will further obstruct efforts to contain measles outbreaks” that have sickened thousands and killed three in the US so far this year.

At present, no individual vaccine for measles, mumps, or rubella is licensed for use in the US; Kasstan-Dabush says that no other country includes single vaccines as part of its nationally recommended schedule. In 2009, after Merck stopped making those individual shots, infectious disease pediatrician David Kimberlin noted that using monovalent vaccines in place of a combination would delay complete vaccination and leave children at risk of infection.

Making and testing separate shots for all three infections would require substantial investment from vaccine makers; Michaud estimates it could cost millions of dollars. In a statement to Reuters, Merck & Co. defended its combined measles, mumps, and rubella shot and said the approval and commercialization process for separate alternatives could take up to a decade. And the administration’s previous policy moves have added risk to the development of new vaccines; for example, Moderna CEO Stéphane Bancel told investors in January that the company would not launch new late-stage vaccine trials in the foreseeable future.

A new strategy to circumvent legal challenges?

The American Academy of Pediatrics currently recommends that healthy children receive immunization against 17 infectious diseases (Pediatrics 2026, DOI:10.1542/peds.2025-075754). Its schedule is endorsed by 12 other medical associations and followed by 28 states.

Until 2024, ACIP set federal vaccine policy according to an evidence-based policy framework. But in 2025, HHS secretary Robert F Kennedy Jr. fired all the members of that committee and replaced them with members allied to his longstanding antipathy to vaccines.

In a January directive from the CDC that bypassed ACIP consultation as well as a May executive order directed at that committee, Trump and administration officials sought to remove six vaccines from the US childhood vaccination schedule. Those efforts are being challenged in court, and injunctions issued during those lawsuits are currently keeping the 2025 vaccine schedule in place. A June analysis from the Congressional Research Service says it’s unclear whether enough active ACIP members remain to carry out the directives of the May 2026 executive order.

The executive order from Monday bypasses ACIP and delegates authority on childhood vaccine policy to an HHS task force.

Meanwhile, a notice published in the Federal Register on Wednesday calls for nominations to a third vaccine policy committee, the National Vaccine Advisory Committee (PDF). That body reports to the HHS’s assistant secretary for health, and historically, according to KFF, it has recommended ways to increase vaccination rates. But it has not met since 2024, and according to the organization’s website, the last of its members’ terms expired in February of this year. According to an analysis by the University of Minnesota’s Center for Infectious Disease Research and Policy, before calling for nominees, the HHS rewrote the group’s charter to promote “non-immunization strategies” such as dietary supplements.