American Academy of Pediatrics splits with CDC, releases its own immunization schedule

On Tuesday August 19, the American Academy of Pediatrics (AAP) released its updated immunization schedule, breaking with the U.S. Centers for Disease Control and Prevention (CDC) for the first time in 30 years.

The group’s recommendations explicitly call for COVID-19 vaccination of children ages 6 months to 23 months and risk-based vaccination for older children — guidance that directly contrasts with federal policy under Health and Human Services (HHS) Secretary Robert F. Kennedy Jr.

The CDC currently frames pediatric COVID-19 vaccination as a matter of “shared clinical decision-making,” stopping short of a broad recommendation for healthy children. The AAP, by contrast, is urging pediatricians to prioritize vaccination of the youngest children, who remain at the highest risk for severe illness and hospitalization.

“The AAP will continue to provide recommendation for immunizations that are rooted in science and are in the best interest of the health of infants, children and adolescents,” said AAP President Susan J. Kressly, M.D., FAAP. “Pediatricians know how important routine childhood immunizations are in keeping children, families and their communities healthy and thriving.”

What’s behind the split

The break comes amid ongoing changes to federal vaccine policy under Health Secretary Kennedy. In June, Kennedy dismissed the CDC’s long-standing Advisory Committee on Immunization Practices (ACIP), replacing its 17 members with a smaller panel that includes noted vaccine skeptics.

AAP and dozens of other medical groups were subsequently cut off from their liaison roles to ACIP.

Sean O’Leary, M.D., FAAP, chair of the AAP Committee on Infectious Diseases, said the organization views the restructured panel as “illegitimate.”

“What we heard in this meeting was really a false narrative that the current vaccine policies are flawed and that they need fixing. That’s completely false. These policies have saved millions of lives, trillions of dollars,” O’Leary said after AAP boycotted the June ACIP meeting.

Pediatric care experts say the overhaul has eroded trust in federal recommendations.

“It is going to be somewhat confusing. But our opinion is we need to make the right choices for children to protect them,” said James Campbell, M.D., FAAP, vice chair of the AAP Infectious Disease Committee.

COVID-19 and beyond

The AAP’s new vaccine schedule recommends:

• Universal vaccination for all children 6 through 23 months old.
• Risk-based vaccination for children 2 through 18 who are medically vulnerable, unvaccinated, in congregate settings or living with high-risk family members.
• Optional vaccination for other children at parental discretion.

“It’s clear they are very safe for all populations,” O’Leary said of the vaccines. “Among the reasons we decided to move to a risk-based recommendation for healthy older children is the fact that the hospitalization rate for young children and children with underlying medical conditions remains high, in line with rates for many of the other vaccine-preventable diseases for which we vaccinate.”

The schedule also updates influenza and RSV guidance.

The AAP continues to recommend annual flu vaccination for all children over 6 months, regardless of whether doses contain thimerosal — diverging from the new federal vaccine panel’s call for preservative-free shots.

For RSV, it supports maternal vaccination during pregnancy and monoclonal antibody products for infants and high-risk toddlers.

Kennedy’s response

Secretary Kennedy responded promptly on Tuesday evening, accusing the AAP of acting on behalf of pharmaceutical donors. In a post on the social media platform X, he called the recommendations a “pay-to-play scheme to promote commercial ambitions of AAP’s Big Pharma benefactors,” and warned that guidance diverging from the CDC’s official list may not be shielded under the 1986 Vaccine Injury Act.

HHS spokesperson Andrew Nixon echoed the criticism, according to CNN Health, saying AAP was “undermining national immunization policymaking with baseless political attacks.”

AAP leaders rejected those claims, with Kressly pointing to the fact that the academy has been making vaccine recommendations for longer than ACIP has been around. “AAP’s recommendations are based only in the science, the needs of children and the care that pediatricians have for the children in every community,” she said.

Industry reaction

The clash has reverberated beyond politics.

The Vaccine Integrity Project of the Center for Infectious Disease Research and Policy (CIDRAP), an independent consortium led by University of Minnesota epidemiologist Michael Osterholm, Ph.D., M.P.H., reviewed thousands of studies and concluded that AAP’s position is consistent with available evidence. According to Osterholm, there is no scientific evidence to support HHS’s changes.

Meanwhile, Kennedy’s overhaul has unsettled insurance coverage rules, since ACIP recommendations carry statutory weight under the Affordable Care Act (ACA). The AAP has urged insurers to cover all vaccines in its schedule, despite the split.

“AAP is committed to working with our partners at the local, state and federal levels to make sure every child, in every community has access to vaccines,” Kressly said.

The rift is indicative of deepening mistrust between the nation’s pediatric leaders and federal health officials as the fall respiratory virus season bears its head. With children returning to schools and clinics bracing for COVID-19, flu and RSV, physicians will face a fractured landscape of vaccine guidance — and parents will be looking to their doctors for clarity.