Recommendations for Routine Childhood Vaccines: Shifting from Federal Guidelines

in anticipation of federal changes to vaccine policy by the Trump administration, last year, some states began to de-couple their ⁣own vaccine recommendations from the federal ⁢government. This marked a departure from prior practice where, historically, states typically relied on Centers for Disease Control and prevention (CDC) and ​its ‍Advisory Committee ​on Immunization Practices (ACIP) for such recommendations.  Starting in May of last year, HHS Secretary ⁤Kennedy​ and the‌ CDC/ACIP began to ‌make changes to the federal ​vaccine ⁢schedule for children, culminating ‌in an announcement on January 5 of this year with the most​ wide-ranging changes to date (see Table ‍1). Collectively, these changes have resulted in reducing the number of diseases⁤ targeted from 17 to 11 and ‍the number of routine vaccines from 13 to 7. As part of these⁣ changes, six vaccines are no longer recommended ‍for routine use by all⁣ children in⁣ the United States.

This policy brief tracks the number of states that have announced they are no longer following federal government​ recommendations for childhood vaccines as of January 20,2026,updating an analysis ​ from ‌September of last year (while the current analysis focuses on state sources for childhood vaccine recommendations, our earlier analysis also looked⁣ at ‍state actions regarding‌ insurance coverage ⁢requirements and pharmacist administration).  the number of states that have taken ⁢such an action has increased considerably as ⁢last September,with a majority of states (28) now ​departing from federal guidelines for some‌ or all ⁢childhood ​vaccines compared to ​22 states ‍in September of last year (see Table 2). Moreover,the‍ number of⁤ states decoupling ⁣their vaccine ‍recommendations ​for ⁤ all childhood​ vaccines has risen from just nine in September to 25. The⁤ red-blue divide across the contry continues to grow, with all blue states¹ (those with Democratic governors) having ‌announced⁢ that they will no longer ​follow federal guidelines, though four states with Republican governors have also done so.

Findings

As of January 20,2026,the ‌majority of states (28 states,including DC) have announced that they will not ‍follow the new ‍CDC childhood ‌vaccine​ recommendations for at least​ some childhood vaccines,instead relying on prior recommendations,state recommendations,and/or ​those of external entities.Most of these states have indicated‌ that they will follow the recommendations of the independent medical association, the American Academy of Pediatrics (AAP). Among ⁣these are two inter-state public health alliances which‌ previously formed to develop ‍shared recommendations and have reaffirmed their intent to follow AAP guidelines: ‍the West Coast​ Health Alliance, which includes california, Hawaii,⁢ Oregon, and Washington, and the Northeast public Health Collaborative, which includes ten states and New York City.Almost all⁢ of these states (25 of 28) have announced that they will do so for all childhood vaccines. most of these states are choosing to follow non-federal guidelines for all childhood vaccines. The‌ three sta“`html