After the nation’s top health officials announced an updated schedule of recommended vaccinations for children last week, questions quickly started rolling in from Hays County pediatrician Dr. Marjan Linnell’s patients: did this news change which vaccines their children should get?
“It came up three times today,” Linnell said on Wednesday. “They said, ‘Have you heard about this new CDC thing?’”
The Centers for Disease Control and Prevention now recommends childhood vaccinations against 11 diseases, a sharp reduction from the previously recommended 17. Still on the list of “core vaccines” recommended for all kids are shots that protect against measles, polio, whooping cough, HPV, chickenpox and several others.
Vaccines that were slashed from that “core” list are now recommended for children at high risk of serious illness, or for patients who have consulted directly with a health care provider — a provision referred to as "shared clinical decision-making." Those include hepatitis A and B, meningitis, flu, COVID-19 and rotavirus. Officials said those vaccines will still be accessible and covered by insurance for those who want them.
“After an exhaustive review of the evidence, we are aligning the U.S. childhood vaccine schedule with international consensus while strengthening transparency and informed consent," said U.S. Secretary of Health and Human Services Robert F. Kennedy Jr., a long-time critic of many vaccines, in a statement.
The CDC’s recommended vaccine schedule isn’t a requirement — states make their own requirements for kids enrolling in schools and childcare facilities, often referencing the CDC’s guidance. Texas currently requires several vaccines that the CDC has changed the status of, including hepatitis A and B for younger children enrolling in school and the meningococcal vaccine for older students.
Lara Anton, a press officer for the Texas Department of State Health Services, said DSHS “is currently reviewing the changes the CDC made to the recommended vaccine schedule.”
Meanwhile, physicians like Linnell are navigating a flood of questions from parents about what these changes mean, often infused with confusion about misinformation they have encountered on social media.
“Unfortunately, I think the confusion is starting to make it really difficult for parents to know where to look for advice, but my job is to wade through the confusion with them and go where the science and the safety is,” Linnell said.
What’s behind the changes
The CDC’s new schedule comes after President Trump issued a memorandum directing the Department of Health and Human Services and the CDC to study vaccine practices in “peer, developed countries” and consider adjusting vaccine recommendations in the U.S. The resulting assessment considers the vaccine schedules from 20 other countries; Denmark, which recommends just 10 vaccines, was often cited as a point of comparison. But some experts have argued that the two counties have different health care systems and population health needs.
This process was a departure from the way changes to the vaccine schedule have typically been rolled out; NPR confirmed that the changes were made without input from vaccine manufacturers or formal input from the CDC’s Advisory Committee on Immunization Practices.
Linnell said the CDC’s announcement left her with questions and concerns about why specific changes were made.
“I went down a pretty intense rabbit hole just trying to understand, like, ‘What have I missed? Where is the new scientific evidence? Why did we pick these [vaccines]?’” she said. “We have a robust amount of peer-reviewed scientific evidence that shows the schedule as it was prior to these changes this week was safe and works for kids in our country.”
The assessment cited by the CDC does not present new evidence about specific vaccines. Rather, it focuses on identifying “consensus vaccines” that are widely recommended across developed countries. It also focuses on the idea that recommending a greater number of vaccines could erode trust in vaccine recommendations overall, citing dropping vaccine uptake in the U.S.
A pediatrician’s advice
The CDC’s new approach gives Linnell pause, because risk for specific illnesses may be greater in some countries and regions than others. For instance, the U.S. saw a hepatitis A outbreak linked to produce from Mexico in 2022. She is also confident that the 17 vaccines previously included on the vaccine schedule are safe, both in quantity and the schedule of the doses, based on existing research.
“One of the most common questions we get is, ‘Well, this feels like too many shots for my baby,” she said. “Like, ‘Look at their cute little chunky thigh. How are they going to handle this?’”
Linnell points patients to studies and data to answer these questions — one of her favorite resources for families is the online Vaccine Education Center from the Children’s Hospital of Pennsylvania. She also tries to put things in perspective. She explains that vaccines work by introducing a small part of a virus called an antigen into the body, which our immune systems recognize as a threat and form a defense to. Kids also encounter antigens in the wild all the time — playing in the dirt, touching grocery carts at H-E-B, sucking their thumbs, you name it.
“It's a good thing. Your immune system gets exposed and needs to get exposed to build immunity,” she said. “If the concern is this is too many things [in vaccines], it pales in comparison to what a child runs into in their environment every single day.”
Right now, Linnell is using the recommended vaccine schedule from the American Academy of Pediatrics, which aligns with the previous recommendations from the CDC. That’s in line with the position of many Texas pediatric facilities, such as Texan Children’s and Austin Regional Clinic Pediatrics.
Linnell said her priority is making sure parents are comfortable with their child’s care, which means answering any questions they may have. These days, those questions are a lot more nuanced than they used to be.
“I say, ‘Look, I'm a mom before I'm a doctor, but I am also a doctor. I've had extensive training in immunology,’” she said. “We know these vaccines are safe. I trust them, but I want you to be comfortable with what we're doing for your child. So whatever you have heard, whatever specific thing you've heard, I want you to ask me about it, and I will answer it. If I don't know the answer, I will find you that answer.”
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