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The recent childhood vaccine changes in the USA, which substantially reduce the number of routine childhood vaccines, will sow more seeds of doubt and confusion in the community about the safety, efficacy and even the need of vaccines. We should not follow the opinions of politicians and of unsubstantiated antivaccine groups, but follow the science.
Vaccines play a critical role in maintaining public health by preventing serious infectious diseases. The continuing negative and loud cadence of antivaccine activists, spearheaded in the USA by some politicians such as Robert F. Kennedy Jnr. and his new personally appointed Advisory Committee on Immunisation Practices (ACIP), will worryingly undermine well established childhood and adolescent vaccination programs. This is already leading to an uptick in disease in the USA and endangering herd immunity, resulting in an increase in hospitalisations, adverse outcomes, challenges to health systems, community impacts, increased risks to those with underlying medical conditions, an increase in subclinical infections, and subsequent economic loss. Children will be the most impacted.
Changes are sowing confusion
Under political directives rather than scientific imperatives, the USA has revised its childhood immunisation schedule, effective from January 2026, without convincing scientific justification, resulting in fewer recommended childhood vaccines, supposedly to restore public trust.
The Centers for Disease Control and Prevention (CDC), through its ACIP committee, has reclassified vaccines for meningococcal disease (MenACYW and MenB), rotavirus, influenza, hepatitis A, hepatitis B and COVID-19 from being routinely recommended/given, to a new potentially confusing category — ‘shared clinical decision-making’ (SCDM). This means a decision whether or not to vaccinate is made jointly by the immunisation provider and the parent/guardian.
The use of respiratory syncytial virus monoclonal antibodies in infants and young children has also been reclassified for the high-risk groups only, but Hepatitis A, Hepatitis B and Meningococcal vaccines have been included in this category as well as the SCDM category. Such changes will cause confusion and create doubt among consumers and health providers.
For the moment, vaccines against measles, mumps, rubella, tetanus, diphtheria, polio, Haemophilus influenzae type b, pertussis, chickenpox, and human papillomavirus (HPV) remain universally recommended in the US, although the HPV recommendation has been adjusted to a single dose. However, the new chair of the ACIP committee has alarmingly suggested that all vaccines should be reclassified as SCDM or similar, in which case there would be no universal recommendations.
This overhaul has ignited considerable controversy, resulting in immediate strong condemnation from various expert groups including the American Academy of Pediatrics. It is clear that the current CDC/ACIP guidance is not driven by scientific consensus but by a political decision to reduce the number of vaccines to align with the schedules of a few other developed nations. This is despite fundamental differences in public health contexts, need, costs and infrastructure. These changes also risk further lowering overall vaccine uptake in the US, which is already tracking below 95% for kindergartens in 75% of states.
Vaccine decrease means disease increase
Alarmingly, looking at US data for measles, there were 50 outbreaks in the US in 2025 with 2258 confirmed cases in 45 states, and 1281 cases of measles have already been reported at March 5, 2026.
Unsurprisingly, rates of whooping cough (pertussis) have also risen as fewer children are being vaccinated, in addition to the cyclical nature of pertussis infections (3-4 year peaks in vaccinated populations). In 2024 there were 35 493 cases of pertussis in the US, representing a 5-fold increase on cases reported in 2023 and for 2025 through to January 3 2026, there were 28 783 cumulative pertussis cases.
It is clear that the increase in prevalence of measles and pertussis has come hand in hand with falling uptake of childhood vaccines, exacerbated by anti-vaccination misinformation and confusing CDC/ACIP recommendations (eg SCDM) that make it easier for parents to opt out of childhood vaccination programs.
In addition, outpatient visits for respiratory or “flu-like” illness are at their highest in nearly 30 years in the US, and paediatric deaths have increased over time from 187 in the 2022/23 influenza season to 289 in 2024/25, with 71 deaths so far in the early part of the 2025/26 season. 90% of eligible children who died were unvaccinated. Influenza is a vaccine preventable disease and vaccines are available for children aged at least six months.
Moreover, modelling studies confirm that even small reductions in vaccination coverage can have disproportionate deleterious effects on the disease burden in children. Studies suggest that a 10% reduction in MMR vaccination could result in millions of additional cases of measles over the next 25 years. Larger reductions could allow the re-emergence of diseases previously eliminated in the US (eg polio, rubella).
The need for a strong childhood vaccination program
Scientific evidence consistently shows that high vaccination coverage dramatically reduces disease incidence for multiple pathogens (eg, tetanus, pertussis, polio, Haemophilus influenzae type b, measles and rubella) and prevents millions of cases of serious illness annually. Routine immunisation for children permanently reduces incidence of many infectious diseases by almost 100% (such as diphtheria and polio) and leads to the prevention of millions of cases, with dramatic declines across all targeted diseases.
To protect children from serious diseases, vaccines are essential. They have demonstrably curtailed the spread and severity of these diseases, making significant contributions to child health and overall public health outcomes. The US decision to shift some diseases from a universal recommendation to SCDM or ‘high-risk’ categories, contrary to the counsel of numerous public health experts and institutions, carries the inherent risk of increased disease incidence, morbidity and mortality.
Meanwhile…. in Australia
Until COVID-19, Australia had high childhood vaccination coverage, but now some rates are below the national targets needed for herd immunity for childhood diseases.
The coverage rate for all children at five years is 93.2%. Only 91.5% of Australian one-year-olds and 89.6% of Australian two-year-olds are fully vaccinated.
Measles cases are recently on the rise, the greatest risks coming from incoming overseas travellers, Australians travelling overseas and under-vaccination in Australia. Pertussis cases are at their highest levels in 35 years with 82,513 cases reported in 2024-2025.
To maintain herd immunity against serious disease and protect children there is a need to continue to strive for at least 95% vaccine uptake under the National Immunisation Program (NIP). Some States and areas in Australia have fallen well below this target. While most vaccines are free under the NIP, a recent Australian survey showed that parents still face many barriers including; feeling distressed about vaccinating their children, concerns about safety, not trusting information from a doctor or nurse, difficulty in booking appointments, and cost barriers due to consultation fees.
The same survey also highlights a shift in factors influencing decision-making by Australian parents, including the role of international vaccine commentary and social media. The survey concludes by emphasising the importance of trust, support for healthcare providers to address concerns, and ensuring accessible and responsive vaccination services.
Australia has already achieved critical goals in strengthening and implementing the National Immunisation Strategy, and enhancing policy that supports uptake, like ‘no jab, no pay’ and ‘no jab, no play’, which connect vaccine benefits to both child protection and economic productivity.
Vaccine Hesitancy and Misinformation
Registered vaccines are safe, are remarkably successful, and also cost-effective, but vaccines are currently under attack mainly due to eroding trust and misinformation amplified by global social media trends and opiniated scepticism providing a barrier to achieving this goal.
These changes by ACIP to childhood vaccine recommendations present a formidable risk to the community and are poised to exacerbate vaccine hesitancy and the proliferation of misinformation via social media platforms. It is well known that anti-vaccine narratives frequently exploit perceived inconsistencies or alterations in vaccine recommendations, or differences in programs between countries, to sow doubt in those not fully informed. This leads to erosion of public confidence in vaccine programs. Unfortunately, social media is susceptible to such manipulation by misinformation, fear, doubt, dubious science, superstition, and/or political agendas, which leads to declining vaccine coverage especially in children. Geographic clustering of non-medical exemptions (eg, for personal or religious beliefs) has also expanded the size of under-vaccinated communities.
Prioritising such bloviating influences over evidence-based findings will diminish vaccine uptake and precipitate an uptick in disease outbreaks, as now seen with increases in pertussis and measles.
It is also noteworthy that literacy is an issue in the US, adding to the complexities of SCDM as a way of getting the best health outcomes for children. In 2024, 21% of US adults were reported as illiterate with 54% of adults having a literacy below a 6th-grade level (20% are below 5th-grade level).
Antivaccine groups often publish disinformation implying an association between vaccines and autism, and potential health issues with alum, various adjuvants, or thiomersal, to discredit or cast doubt on vaccination practices. All such disinformation has been scientifically discredited. There is no evidence for an association between vaccines and autism. A study showed no evidence supporting any increased risk for autoimmune, atopic or allergic, or neurodevelopmental disorders associated with early childhood exposure to aluminium-adsorbed vaccines and multiple studies have found no evidence that thiomersal in vaccines causes harm. Moreover, in clinical trials of vaccines using oil-in-water adjuvants, like ASO3, and those using lipid nanoparticles (LNPs), which are used for the delivery of Covid mRNA vaccines, have also been shown to be safe in clinical studies.
There is light at the end of the tunnel
Recently, in mid-March, a successful legal challenge was brought by six medical organisations against the changes implemented by the US ACIP committee. The US court in Massachusetts also reversed all decisions made by the ACIP members that Robert F Kennedy Jnr. had appointed. This ruling will bring a temporary halt to the changes made. The judge noted that the arbitrary and capricious changes made to the childhood vaccine schedule bypassed the careful, evidence-based practice, that in the past underpinned recommendations.
Conclusion
The importance of adherence to scientific evidence over public opinion in the formulation of public health policy cannot be overstated. Scientific evidence, initially gathered through rigorous research and robust epidemiological data, offers the most reliable foundation for safeguarding population health. Any proposed vaccine research and production requires ethics approval, careful animal studies, rigorous human clinical trials, the highest quality standards by industry and a strong regulatory program conducting audits and ensuring adequate pharmacovigilance to assure safety.
Moreover, a robust pandemic response relies on the commitment of vaccine manufacturers and community confidence in vaccines. There is also a need for nationwide policies to support the entire vaccine value chain, from vaccine development to commercialisation, with an emphasis on safety and practical outcomes.
Professor Gary Grohmann is a Board member and a member of the Scientific Advisory Committee of the Immunisation coalition. He is a former Director of Immunobiology at the Therapeutic Goods Administration and currently works as an independent consultant.
Professor Robert Booy is an infectious diseases paediatrician. He is a Senior Professorial Fellow at the University of Sydney Children’s Hospital Westmead Clinical School and a member of the Scientific Advisory Committee of the Immunisation Coalition.
Acknowledgement: Gratitude to Dr John McEwen for reviewing the manuscript.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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