A Vacuum of Evidence: HHS Changes to Childhood Immunization Recommendations

Yesterday, the US Department of Health and Human Services (HHS) announced changes to the Centers for Disease Control and Prevention’s (CDC’s) childhood immunization recommendations, reducing the number of recommended vaccinations from 17 to 11. Unlike the recommendations that were replaced, these were not subject to a transparent, evidence-based process. As an organization dedicated to evidence-based policymaking, the Milbank Memorial Fund is concerned about this lack of rigor and transparency. HHS’s actions introduce the risk of illness to all children and families, chaos and inefficiency into health care practices, and distrust into longstanding provider-patient relationships.  

According to HHS, the new guidance is based on a review of immunization schedules in other countries. However, the US population, disease burden, and health care system are not the same as those in other nations, which is why the US has its own process for recommendations. Federal recommendations should be based on the needs and circumstances of US children, and evidence on effectiveness, safety, harms, and benefits should be debated openly with public input, not simply downgraded with the stroke of a pen.   

While the announcement refers to past US vaccine mandates, CDC recommendations have never been mandates; they are vetted, evidence-based recommendations that are used within state and local contexts to make decisions about requirements to protect both population health and individual choice. Obtaining parents’ informed consent for vaccinations has always been integral to vaccine administration. It is not a new part of the patient experience or a substitute for evidence-based population-level recommendations. 

HHS’s decision to follow other nations’ recommendations, and to forgo a public process that reviews US-based evidence, leaves state and local leaders without the strong foundation they need to make policies that benefit their communities’ health. For now, state policymakers and clinicians can turn to organizations such as immunize.org or professional associations like the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists for evidence-based  recommendations. Nonetheless, America’s children deserve consistent national-level recommendations tailored to their needs and developed with participation from clinicians, scientific experts, and patient advocates. We at Milbank will continue to support state and local policymakers by disseminating evidence, highlighting best practices, and connecting leaders with each other.