28 states reject the CDC’s new childhood vaccine schedule, KFF finds

The United States no longer has a single, de facto childhood vaccine schedule.

A growing majority of states are breaking with the Centers for Disease Control and Prevention’s (CDC’s) newly narrowed childhood vaccine schedule, turning instead to prior recommendations, state recommendations or those of medical societies like the American Academy of Pediatrics (AAP).

In the months since the Trump administration ordered federal officials to narrow the list of routine childhood immunizations, and in anticipation of that order, more than half the country has moved in the opposite direction.

As of Jan. 20, 2026, 28 states, including the District of Columbia, have announced they will not follow the CDC’s revised childhood vaccine recommendations for at least some shots, according to a new analysis from KFF.

For primary care physicians and pediatric practices, that means families could see one schedule from Washington, another from their state health department and a third from pediatric professional societies – all for the same child.

“I think science is under attack,” said Paul A. Offit, M.D., director of the Vaccine Education Center and a professor of pediatrics in the Division of Infectious Diseases at Children’s Hospital of Philadelphia. “In many ways, public health is under siege.”

• Related content: “Medicine under attack: How physicians can help their patients navigate the disinformation age”

Federal rollback set the stage

The state-level split traces back to a series of decisions by Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. and the CDC’s Advisory Committee on Immunization Practices (ACIP) that began in May 2025 and culminated in a Jan. 5, 2026, announcement.

Collectively, those changes reduced the number of diseases targeted by routine childhood vaccination from 17 to 11 and the number of routine vaccines from 13 to 7. Six vaccines are no longer recommended as routine for all children: COVID-19, hepatitis B, rotavirus, influenza, hepatitis A and meningococcal ACWY. The recommended number of human papillomavirus (HPV) doses was cut from two or three, depending on age, to one.

The federal government also stopped recommending the combined MMRV product and multi-dose influenza vaccine with thimerosal.

Under the new framework, the CDC continues to recommend universal vaccination against measles, mumps, rubella, polio, pertussis, tetanus, diphtheria, Haemophilus influenzae type b, pneumococcal disease, HPV and varicella. Many other shots – including respiratory syncytial virus (RSV), hepatitis A and B, dengue and meningococcal disease – are now categorized as high-risk or “shared clinical decision-making,” with clinicians expected to weigh benefits and risks for each child.

Kennedy has argued that the shift will align the U.S. closer with “international consensus,” helping rebuild public trust in immunization.

“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. This decision protects children, respects families and rebuilds trust in public health,” Kennedy said when the changes were announced.

Insurance coverage for all vaccines on the CDC schedule remains unchanged, according to HHS and the Centers for Medicare & Medicaid Services (CMS).

Major physician groups, however, have sharply criticized both the process and the substance of the federal revisions.

“Changes of this magnitude require careful review, expert and public input, and clear scientific justification. That level of rigor and transparency was not part of this decision,” said Sandra Adamson Fryhofer, M.D., a trustee of the American Medical Association (AMA). “When longstanding recommendations are altered without a robust, evidence-based process, it undermines public trust and puts children at unnecessary risk of preventable disease.”

AAP President Andrew D. Racine, M.D., Ph.D., has said the decision to stop recommending several vaccines as routine is “dangerous and unnecessary,” arguing that the longstanding U.S. process for updating the childhood schedule “remains the best way to keep children healthy and protect against health complications and hospitalizations.”

The AAP has kept its own 2026 schedule intact, recommending a broader slate of routine immunizations than the CDC and publishing it as an alternative roadmap for pediatricians.

KFF: 28 states step away from CDC

In September 2025, the organization found that 22 states had taken some step away from CDC/ACIP recommendations for childhood vaccines. At that point, most of the activity was limited to COVID-19, which was the first vaccine removed from the routine list. Only nine states had announced they would no longer follow federal guidance for the full childhood schedule.

By Jan. 20, 2026, the picture had changed.

According to KFF, 28 states, including D.C., now say they will not follow the new CDC childhood vaccine recommendations for at least some vaccines, instead relying on prior state schedules, state-developed recommendations or external entities.

Twenty-five of those 28 have said they will use nonfederal guidance for all routine childhood vaccines.

Most of those states have pointed directly to the AAP’s recommendations as their primary reference. Two longstanding regional groups – the West Coast Health Alliance, which includes California, Hawaii, Oregon and Washington, and the Northeast Public Health Collaborative, which includes 10 states and New York City – have reaffirmed that they will follow AAP guidance rather than the new CDC schedule.

Three states have taken narrower positions. Alaska and Mississippi have announced that they will continue to recommend a birth dose of hepatitis B vaccine for all infants, even when a mother tests negative for the virus, despite the CDC no longer recommending that dose as routine. Arizona has said it will continue to recommend the hepatitis B birth dose and COVID-19 vaccines for children based on guidance from outside experts.

KFF notes that this all represents a significant increase from last fall and that the departures have broadened as the federal government has moved beyond COVID-19 to change recommendations for hepatitis B and several additional vaccines.

The AAP’s schedule, which remains more expansive than the CDC’s, gives states that want to keep a wider net of protection a relatively straightforward alternative. But it also widens the gap between what federal agencies say is routine and what many clinicians are being told to do by their own states and specialty societies.

Red-blue borders

KFF reports that all blue states — those with Democratic governors — have now departed from the new CDC childhood vaccine guidelines, at least in part.

The brief notes one caveat: Virginia swore in a Democratic governor on Jan. 17, just days before KFF’s cutoff date, and may yet change its position.

Four states with Republican governors — Alaska, Mississippi, New Hampshire and Vermont — have also broken with the federal schedule for at least some childhood vaccines.

Jason Goldman, M.D., MACP, president of the American College of Physicians (ACP), said that dynamic is reshaping scientific debates.

“Science is not political. Medicine is not political,” Goldman said. He spoke to Medical Economics in late 2025 about vaccine misinformation. “We want to seek truth. We want answers, and we want to take care of patients. Unfortunately, it’s become the opposite. It’s become polarized.”

The problem with shared decision-making

On paper, the new federal schedule is designed to push more vaccine decisions into a shared clinical decision-making model: physicians and families weigh risks and benefits and decide together whether to proceed. In practice, survey data suggest the public is not always clear on what that means.

An analysis from the Annenberg Public Policy Center, based on two nationally representative survey waves in 2025, found that 68% of adults understood that shared decision-making means reviewing their or their child’s medical history with a health care provider before deciding whether a vaccine is appropriate.

More than 40% interpreted shared decision-making as an opt-out frame, saying it was simply up to the individual whether to consult a clinician at all.

The Annenberg survey also found confusion about who qualifies as a “health care provider” in this context. While most respondents identified physicians, smaller shares named nurse practitioners, physician assistants or pharmacists, even though all are part of the federal definition for vaccine counseling.

In an environment where federal guidance has become more conditional, those gaps in understanding add yet another layer for primary care physicians to manage.

“An individual’s physician is still the most trusted information source for vaccines and a lot of these questions that we have around our health right now,” said David Higgins, M.D., a pediatrician and author who writes about vaccine science and misinformation.

Physicians say that trust is now being tested by a steady stream of conflicting reports, political rhetoric and social media claims.

“I think science is losing its place as a source of truth,” Offit said. “People are simply declaring their own truths, including people in prominent positions of leadership.”

What this means

KFF’s brief emphasizes that the full impact of the shifts might not be clear until later this year, when states translate their vaccine recommendations into school-entry requirements and exemption rules for the 2026-27 academic year.

Historically, ACIP and CDC recommendations have heavily influenced which shots are required for kindergarten and middle school and which are left to parental discretion. Now, states that have stuck with the AAP schedule or their own expert panels will have to decide whether to require vaccines that federal officials have shifted into high-risk or shared decision-making categories.

That debate is unfolding against a backdrop of already falling childhood vaccination rates in some regions and persistent gaps by geography and income.

At the same time, CMS has told states it will no longer require them to report childhood vaccination levels for Medicaid and the Children’s Health Insurance Program (CHIP) while it develops alternative immunization measures, potentially changing how coverage programs track performance.

For primary care physicians and pediatricians, the result is a more fragmented immunization landscape than at any point in recent memory, with a new, narrower federal routine schedule that pushes more vaccines into individualized decision buckets, a broader pediatric schedule from the AAP and allied medical groups, and a growing patchwork of state-level guidance and school rules that may follow one or the other, or neither.

Offit, a former member of ACIP, said he understands why states and medical societies are stepping in, even as the system becomes more complex.

“I really applaud those states that have stood up for the children in their state and are basically putting out their own guidelines based on solid data,” he said.

Despite all of this, families walking into exam rooms won’t see policy architecture or federal debates. They will see a child due for shots and a physician they still trust to explain which ones are recommended, which ones are required and why.