CDC's Historic Overhaul of Childhood Vaccine Framework

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Policy Pulse

I normally cover a policy issue related to the Center for Medicare and Medicaid Services, the CMS Innovation Center (CMMI), or Congressional activity related to healthcare delivery. But this week, I want to share what happened at the Centers for Disease Control and Prevention (CDC).

The Centers for Disease Control and Prevention Acting Director Jim O’Neill has updated the U.S. childhood immunization schedule. The change follows a Presidential Memo for the Secretary of Health and Human Services instructing Secretary Kennedy in “Aligning United States Core Childhood Vaccine Recommendations with Best Practices from Peer, Developed Countries.”

You may read “updated” and think “tweaked.” The changes are unprecedented. In researching updates in the past, there has been no comparably significant change in the decades leading up to the 2020s.

There have been incremental additions, like:

• HPV added in 2005

• Rotavirus added in 2006

• Meningococcal B added in 2015

• COVID-19 added in 2023

Key Changes Made in January 2026:

CDC’s universal recommendations no longer include vaccines against flu, COVID-19, rotavirus, hepatitis A, hepatitis B, or meningococcal meningitis, and only one dose of HPV is now universally recommended instead of two. This drops the recommended vaccines from 17 to 11.

Moving forward, these shots will still be available through a process of “shared clinical decision-making” between physicians and parents.

If you are asking “So what’s the problem? The vaccines are still available, so isn’t this just a technical issue?” 👇️ That may be a dangerous simplification of something thought by most experts to be a serious concern.

Physicians and public health experts are warning that the change will create confusion and preventable illnesses will spread as vaccination rates fall. The American Academy of Pediatrics is not changing its recommendations to align with the CDC.

Many Experts are Worried About Confusion, Misinterpretation, and Erosion of Trust Will Lead to Negative Consequences for Public Health

(Note: all references can be found here.)

• Parents may interpret the downgrade of certain vaccines as meaning they are “not important or necessary.”

• The changes to the recommendations warn that they are likely to “undermine confidence in long-standing immunization guidance.”

• Some states are rejecting the new CDC recommendations and will follow the recommendations of the American Academy of Pediatrics. The dueling scheduling can create more confusion.

• Fewer parents may choose vaccines now labeled “shared decision-making,” which can lead to lower uptake of vaccines that can prevent serious illness in children like flu, rotavirus, hepatitis A/B, and meningococcal disease

• Confusion may cause parents to delay decision, especially for infants, leaving infants exposed to life-threatening but preventable illnesses

• There’s likely to be more variability in how strongly clinicians recommend the “shared decision-making” vaccines or how much time they take or have the time to take with parents who are hesitant

• Lower uptake of vaccines will lead to more hospitalizations and deaths

• Healthcare systems will have to meet the higher capacity needs of sick children in ERs and admitted to hospitals, and there will be more loss of school and of work for parents

• Families with limited access to care and in rural and underserved communities may be disproportionately affected

The bottom line:

A major change to the vaccine schedule, especially one made without widespread consensus, can increase risks to public health and cause a rise in preventable diseases. There are many prominent scientific and medical experts concerned about public interpretation, behavioral changes, and negative impacts on population health because of these changes.

Additional listening 👇️ 

Here, the Johns Hopkins Bloomberg School of Public Health speaks to Dr. Josh Sharfstein, MD, when this announcement came out.

Find all sources and additional context here.

Career Moves

Most clinicians who are hoping or planning to exit full-time patient care are planning it because they have outgrown the box they were trained to stay inside. If you are feeling that pull, or the sense that you’re meant to contribute in a different way, take heart!

You don’t need another degree or a five-year plan. Instead, do this:

• Develop a few foundational skills to function in non-clinical roles

• Learn how the healthcare ecosystem works, where the incentives are, and why the healthcare economy is so complicated and unlike any other

• Be willing to see yourself as someone whose value extends far beyond a treatment table or exam room

Embrace and capitalize on this universal truth: everything is sales, and sales isn’t a dirty word.

Even what you do every day as a treating clinician involves sales.

And every significant career move you make involves sales.

Sales should be very human.

When you build rapport with a patient, explain and align on a plan of care, or help someone believe they can get better and help them find ways to activate motivation in the toughest moments, you are “selling.”

Transitioning out of clinical care means learning to sell yourself with the same clarity, confidence, and compassion you’ve always used to advocate for your patients. Once you understand that, the whole landscape opens up.

Here are a handful of other foundation skills to develop. You will notice you have many of these skills already and can consider how you can develop them further.

Each week, I’ll dive into a foundation skill:

• Personal positioning and a career narrative (building further on the “sales” skill)

• Translating clinical expertise into business language

• Problem framing and critical thinking

• Communication and storytelling

• Project and process skills

• Basic data literacy

• Systems thinking

This Week, Try This

Read this quick article in Med City News by Victoria Adinkra on January 4, 2026, entitled “Housing is the Next Frontier in Proactive Care. Here’s How Health Plans Can Help.” Clinicians frequently don’t have time to think about or ask about non-medical drivers of health. Part of the reason is often attributed to not knowing how to help someone if they DO identify a problem. But these drivers have real consequence on health and on the healthcare system, and more can be done by a variety of stakeholders.

Here’s the TL/DR 👇️ 

Non-medical drivers of health like housing instability can be a trigger for a clinical crisis, which the health system is blind to what’s happening until an emergency happens. Housing insecurity can be a linchpin social determinant of health because it creates a ripple effect across almost every other aspect of health.

The article suggest payers incorporate routine screening for housing insecurity and that supportive housing tied to Medicaid reduces ER visits, inpatient stays, and total costs. The author frames housing as a core social determinant of health and recommends integrating housing risk into assessments and benefit design to prevent worse health outcomes and higher system costs.

Want a little more depth of knowledge on the topic? Here’s a good article from April 2025 from the Milbank Quarterly entitled “Without Affordable, Accessible, and Adequate Housing, Health Has No Foundation.” Even the article’s references are a rich information source.

As a clinician, do you routinely screen for non-medical drivers of health such as housing instability, food insecurity, transportation access, and education access and quality? If so, what do you do when you identify one or more?

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