Reading the revised schedule gave me an immediate sense of the change to a "precision medicine" paradigm for public health. While this allows for more personalization, it raises my concern about the effect on trust in public health. When prior, evidence-based recommendations suddenly become classified as "selective", it may unknowingly affirm fears against vaccination and adds additional obstacles in a clinician's relationship with their patients by converting established preventive healthcare into a negotiating process. The most concerning change from my perspective is the removal of universal recommendations regarding HPV vaccination at younger ages. Universal recommendations are typically the strongest inducement to increase the uptake of a vaccine; moving this discussion to being "selective" puts the outcome at serious risk of a substantial decline in completion rates for a vaccine series that has a strong epidemiological history of preventing several forms of cancer. Therefore, I believe that the result of this change will lead to a higher incidence of preventable cancer in the future. Medically, the recommendations in the new schedule seem to be disconnected from the growing patterns of viral transmission we are seeing today. Schools and childcare facilities are the location of greatest viral dissemination, yet the new guidelines are focused on a more conservative use of "broad spectrum" vaccination that does not match the reality of the surge in pediatric viruses that are occurring this winter. The removal of universal recommendations places a large burden on clinicians to do a more detailed analysis of risks/benefits of the vaccine for each patient. The new recommendations force clinicians to weigh social, economic, and environmental issues much heavier, thus leading to unconscious bias when making decisions about vaccination. Since there is no universal baseline for preventive behavior, it is getting harder to ensure that every child receives an equal and fair opportunity for preventive care. Concerning the influenza vaccine, I guide families to consider the systemic benefits of vaccinating. I explain to families that vaccination is not simply an individual's choice, but acts as a "safety net" for their household and broader community. I stress to families that the clinical data continues to support vaccination as the most effective way to prevent severe illness or hospitalization, even if the new administration has classified it differently.
I found the revised recommendations very concerning, particularly in terms of parents being confused about what to do and how this will lead to the erosion of preventive care as we have known it to date. Having vaccines move from being routine enough to just receive to having a model of "Shared Clinical Decision-Making" places a significant communication burden on healthcare providers and also increases the demands placed on families to understand vaccine risk/benefit relationships—and this is probably not an even distribution across all patient populations. Reclassifying the Hepatitis B series is of most concern to me in practice. Because Hepatitis B is frequently a child's first vaccination protecting them from a potentially chronic, life-threatening illness, moving it to a selective vaccine may mean children are not receiving this vaccination due to missed opportunities during the birth period. If we lose a large number of children to this opportunity, we will see a resurgence in preventable liver disease, thus creating public health gaps over decades to come. The new recommendations were not in full alignment with the high volume of respiratory distress cases our clinics are currently seeing this season. The viral surge of Respiratory Syncytial Virus and influenza has had a significant impact on pediatric health facilities; thus, making influenza a "non-default" vaccination does not feel consistent with the current clinical demands we have for preventive vaccines. Having broad recommendations for influenza and RSV has fundamentally changed the way I will assess the risk of giving these vaccines in the future, requiring a more granular epidemiological assessment for every patient encounter. I will now need to consider household-level variables such as daycare attendance or multi-generational family living in order to justify why this vaccine should be given. The net effect will be lowering the margin for error in protecting children in the long term who may not fit the conventional "high" risk categories but are still biologically at risk. I am still advising patients and families to move forward with getting their annual influenza vaccination, as the biological risk for developing severe complications has not changed due to the reclassification by the federal government. As such, I continue to highly recommend that children older than six months of age receive the influenza vaccination in order to provide the best protection over the winter months.
Founder & Medical Director at New York Cosmetic Skin & Laser Surgery Center
Answered 2 months ago
When I read the revised HHS childhood schedule, I thought of parent confusion. In my dermatology practice I see many kids with asthma, eczema, and immune issues. The schedule keeps 11 vaccines as routine, but moves influenza, hepatitis A and B, rotavirus, RSV, and meningococcal into high risk or shared decision categories. The change that worries me most is stepping back from broad flu guidance. Flu still hits hard this winter. CDC data from October 2024 to February 2025 found vaccine effectiveness in children was 32% to 60% for outpatient illness and 63% to 78% against flu hospitalization. I use those numbers with families. If your child has asthma, is on immune affecting meds for eczema, or has a newborn at home, I recommend the shot and talk timing