US committee is reconsidering all vaccine recommendations | US healthcare

All vaccine recommendations are being reviewed by the U.S. Vaccine Committee, according to its top adviser, who in recent interviews has criticized vaccination requirements for attending school and said vaccines should be taken on the advice of each individual’s doctor.

The position of Kirk Milhoan, chairman of the Advisory Committee on Immunization Practices (ACIP), represents a sea change for the group tasked with making U.S. vaccine recommendations for decades, signaling an increasingly hostile approach by the Trump administration toward routine vaccines.

The childhood immunization schedule is undergoing sweeping changes under Robert F Kennedy Jr, secretary of the US Department of Health and Human Services (HHS) and a longtime vaccine critic. Some of these changes are being led by its hand-picked vaccine advisers, several of whom have expressed outsized fears about the very rare risks of vaccine side effects compared to the benefits of protection against illness, hospitalization and death, backed by decades of evidence.

Significant additional changes could be made to the childhood vaccination schedule this year, Milhoan, a pediatric cardiologist, told The New York Times last week. ACIP will “not necessarily” change recommendations to make all vaccines optional, but the committee is “reevaluating all vaccine products, including risks and benefits,” Milhoan said.

In a separate interview on the Why Should I Trust You? podcast, released last Thursday, Milhoan said he supports individuals over the collective public and framed vaccine debates as “autonomy versus public health.”

“There will always be a tension between what is supposed to be good for everyone and what is good for the individual,” Milhoan said.

It’s a false dichotomy, said Jason Schwartz, associate professor of health policy and management at the Yale School of Public Health, because vaccines provide protection to both individuals and those who come into contact with them.

“It’s often presented as an idea of ​​the common good, but it’s an individual benefit that also brings a lot of good to our communities,” he said.

Polio and measles vaccines figured particularly prominently in Milhoan’s discussions.

“When you look at polio, we shouldn’t be afraid to consider that we’re in a different time than then,” Milhoan said on the podcast, pointing to improvements in sanitation — a common Kennedy talking point that doesn’t explain lasting improvements in Americans’ health. “Our risk of disease is different, and so all of these factors come into play in determining whether it’s worth it,” Milhoan said.

Polio outbreaks were suppressed in the United States thanks to highly successful vaccination campaigns.

“Vaccine-preventable diseases are much less common because we vaccinated in the first place,” Schwartz said. Still, experts say more polio cases could be on the horizon as vaccination rates decline.

The measles outbreak in the United States is reaching new heights, with 416 confirmed cases this year, compared to 2,255 confirmed cases last year, according to the U.S. Centers for Disease Control and Prevention (CDC). The United States already has about a fifth of 2025’s cases just three weeks into 2026 — and last year was the worst outbreak in three decades.

Milhoan appears to view this rapid growth as an opportunity to understand how dangerous measles is to unvaccinated people.

“What we’re going to have is real-world experience of when unvaccinated people get measles. What is the new incidence of hospitalization? What is the incidence of death?” he said on the podcast.

Elizabeth Jacobs, professor emeritus at the University of Arizona and founding member of Defend Public Health, said Milhoan “wants to experiment on the U.S. population by observing what happens when vaccination coverage collapses and infectious diseases spread.”

“It’s so dangerous that it borders on criminality,” she added.

Milhoan framed the vaccination recommendations as giving families “no choice” and likened them to a “medical battery” in the Times article. All vaccinations are already optional in the United States. The U.S. government has never required children to be vaccinated. ACIP’s independent advisors are responsible for making evidence-based recommendations, which the CDC may or may not consider.

But Milhoan seemed to mischaracterize that role in the podcast: “We’re making a recommendation, the CDC should basically canonize it.” »

The vaccine committee recently changed its recommendations “because we were concerned about the mandates, and the mandates really hurt and increased hesitancy,” Milhoan said on the podcast. The “harsh” and “authoritarian” recommendations of previous commissions “led to mandates,” he added.

Milhoan did not respond to questions from the Guardian about the committee’s vaccine review and the role the recommendations play in school mandates.

Current ACIP members “clearly view even recommending a vaccine, which has been the committee’s responsibility for 60 years, as an attack on parental freedom,” Schwartz said. This amounts to suggesting that the dietary guidelines released last week infringe on the freedom to choose what foods to eat, he said.

States and localities, not the ACIP or CDC, set vaccination requirements, with “comprehensive processes” that typically involve local health departments and often require legislation to make changes, Schwartz said.

“The idea that there is some kind of sign-off approach by states to just transfer the CDC schedule to the mandate schedule just doesn’t fit with what states are actually doing,” he added. There are also several vaccines, such as flu, rotavirus, and HPV, that have been recommended by the CDC but are rarely required in school.

While some jurisdictions have looked to the evidence behind ACIP or CDC recommendations to inform their decisions, “it’s clear that link has been broken,” Schwartz said. The majority of states are now delinking their recommendations from federal guidelines, according to a new report from the health policy nonprofit KFF.

All states offer medical exemptions for school vaccination requirements, and some states also allow philosophical exceptions — a growing trend that risks outbreaks, new research shows.

“What I wish I could do is give people medical freedom,” Milhoan said on the podcast.

But experts say this approach will result in less personal freedom, not more.

“What about the rights of vaccinated children to be in playgrounds, camps and schools where their risks of vaccine-preventable diseases may be increased by the presence of unvaccinated children? » asked Schwartz. “What about the rights of children who cannot be vaccinated due to weakened immune systems or other health conditions? This rights issue works both ways.”

Medical freedom includes the ability “to not contract a life-threatening infectious disease against your will,” Jacobs said — and since the overwhelming majority of families want vaccines, this group is significantly larger than the minority who oppose them.

Milhoan expressed concerns that vaccines “stimulate the immune system over and over again” and expressed concerns, unsupported by decades of data, that vaccines may be linked to rates of allergies, asthma and eczema.

He also said he doesn’t like the term “settled science” when talking about vaccines. “Science is what I observe,” meaning safety can only be observed – not proven, he said. But observations are only the starting point for research, followed by meticulous work of data collection and analysis.

“Established science is why we have lived in a golden age where we have been able to hold off vaccine-preventable diseases that for centuries routinely disabled and killed children,” Jacobs said.

The next ACIP meeting is scheduled for February.

“We should fully expect that this committee will continue to sow doubt about the value of vaccines, highlight the alleged harms of vaccines and downplay their benefits, and advocate for a narrower set of recommendations from the federal government,” Schwartz said.

Recommendations from medical organizations, state and local health officials and new regional health alliances will carry more weight than ever, he said: “The rest of the public health community must recognize where they can step in to fill the void that ACIP has traditionally filled.” »