It is up to individual states to determine if they want to adopt the newly announced Centers for Disease Control and Prevention recommendations that now advise universal vaccination against 11 diseases — down from 17.  

The new guidelines will lead to “more splintering of vaccine policies” and a patchwork system, warned vaccine law expert Richard Hughes, who also predicted legal challenges to the way the change was implemented.

Northe Saunders, president of the pro-vaccine advocacy organization American Families for Vaccines, said “there’s going to be a red-state, blue-state divide where blue states look to the science, and red states look to the ill-conceived recommendations of the federal government.”

“With differing vaccine schedules state by state,” he continued, “parents aren’t going to know what the right thing to do for their family is.”

The new guidelines continue to universally recommend vaccines against 11 diseases including measles, mumps, rubella, polio and tetanus. But, shots protecting against a number of other diseases will no longer be recommended and will only be available for certain high-risk groups or after a consultation with a medical professional, also known as shared clinical decision-making. 

These include meningococcal disease — which causes meningitis — hepatitis A, hepatitis B, rotavirus and respiratory syncytial virus, more commonly known as RSV, the

CDC officials said their decision will more closely align the United States with other peer nations, mirroring a policy objective voiced by President Donald Trump in December, but one that critics claim is a false equivalency meant to further the administration’s anti-vaccine agenda.

“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,” Health Secretary Robert Kennedy Jr., a longtime vaccine skeptic, said Monday. “This decision protects children, respects families, and rebuilds trust in public health.”

Sean O’Leary, chair of the American Academy of Pediatrics Committee on Infectious Disease, said Monday “what was announced today is part of a decades-long effort on the part of the health secretary to spread fear and falsehoods about vaccines. This is another step in the secretary’s effort to dismantle the U.S. vaccination system.”

While shared clinical decision-making for these vaccines “may sound good on its surface, it’s actually really problematic,” said O’Leary. Pediatricians are already having these conversations with parents before vaccinating their kids. Shifting the recommendation won’t strengthen those exchanges, “it just makes things more confusing for parents and clinicians,” he said.

The American Academy of Pediatrics will continue to recommend kids get vaccinated against all 17 diseases, and multiple states have already banded together to form regional health alliances and establish their own vaccine recommendations. In September, the governors of California, Oregon and Washington created the to “ensure residents remain protected by science, not politics.”

Later that month, several others announced the . While neither alliance is solely focused on immunization policy, both have stated goals of science-based vaccine recommendations and equitable access to shots.

At the same time, Florida Gov. Ron DeSantis veered towards a vastly different approach, announcing the state’s intention to become the first to drop all vaccine mandates, including for schoolchildren. State officials have since taken steps towards making that goal a reality.

‘Children’s lives are at stake’

William Moss, director of the Johns Hopkins’ International Vaccine Access Center, told The 74 this week’s dramatic shift in the CDC’s recommendation “will lead to more disease and potentially some deaths in children in this country that could have been prevented.”

The process that led to the changes represents a sharp departure from past practices, which would have required extensive research, a forum for public comment, an opportunity for relevant stakeholders — such as vaccine manufacturers and pediatricians — to weigh in and a formal meeting of the CDC’s Advisory Committee on Immunization Practices, also known as ACIP. 

Significant changes such as the one announced Monday were historically “very deliberate by design,” said O’Leary because “literally children’s health and children’s lives are at stake.”

None of those steps were followed here, said Hughes, a George Washington University law professor.

“These are not rigorous analyses,” Hughes said. “These are not people who are qualified to be making these decisions. They’re not grounded in evidence. And for that reason they are unlawful.”

Kennedy last year fired all 17 ACIP members, replacing them with hastily hand-picked advisors who largely share his views on vaccines. It has since voted to overturn a recommendation that all newborns receive the hepatitis B vaccine; change policies surrounding the measles, mumps, rubella and varicella (chickenpox) combination vaccine; and roll back recommendations around 2025’s COVID 19 booster. 

The decision to change the childhood vaccine schedule in a much more far-reaching way did not go through ACIP, and the premise it was based on — to more closely match U.S. policy with those of other wealthy nations such as Denmark — is not a sound one, according to medical experts.

“You can’t just copy and paste public health,” said O’Leary, who argued there are fundamental differences between the counties that lead to very different needs.

Moss echoed this point: “Denmark has a universal health care system where we have this very fragmented, insurance-based health care system. Denmark’s the size of Wisconsin, so [the U.S. is] just a much bigger country, a more complex country.”

And, when it comes to diseases such as hepatitis B, Denmark has much stronger screening rates.

While HHS claimed all vaccines previously recommended will remain fully covered by insurance and available to parents who want to vaccinate their kids, others are less sure. According to O’Leary, HHS leaders appear to have misunderstood how insurance companies determine coverage: Historically vaccines recommended for high-risk groups are only covered for children included in that group.

At the very least, doctors and advocates argue, the shift will put up additional barriers in an environment that is already filled with vaccine hesitancy and confusion, inevitably leading to diminished uptake and, ultimately, more sick kids. Health care providers may also start stocking fewer vaccines, making it harder for families to access them. 

There also remains uncertainty around who can actually participate in the shared clinical decision-making; in some states, this may mean that pharmacists can no longer administer vaccines, such as RSV, independently. 

And even if the shots remain available, this week’s action by the CDC will likely further undermine confidence in vaccines, as immunization rates are already falling and diseases are on the uptick. 

In 2025, there were 2,065 confirmed measles cases — the most recorded since the U.S. deemed the virus eliminated a quarter-century ago. The vast majority of cases were in unvaccinated kids, died. 

Flu cases this season are also rising at a faster rate than in previous years, There have been 7.5 million cases so far, leading to 81,000 hospitalizations, and 3,100 deaths — including eight children. Despite this week’s updated guidance, the still recommends everyone 6 months and older receive a flu shot. 

This is the context in which I’ve been thinking about the , a measure placed on the November ballot that would high schools to offer, and students to take, a semester-long personal finance course. 

Of course, I’m in favor of increased financial literacy. Many Americans lack such skills, and it leaves them at a serious disadvantage. It’s important to understand things like how to save for retirement (many people ), how to pay taxes (many people ) and how to avoid predatory lenders (many people fall victim to and credit card companies). High school may even be a good place to teach such skills — there is some decent that financial literacy can improve personal finance , like saving.

But I’ll be voting against the ballot initiative. There are several reasons why I oppose it, related to the idea of mandating curriculum via ballot measure in general and to this specific initiative in particular. 

The primary general reason I oppose this initiative is that it sets a terrible precedent. While we might all like financial literacy, it’s not hard to imagine future ballot initiatives that try to change curriculum in ways we might not like. Referendums could try to strip race- and LGBT-related content from the curriculum, mandate abstinence-focused sex education or ban environmental content in science classes. Education policy is already too much like a pendulum, giving educators whiplash with constantly shifting demands. The last thing we need is to pile on new mandates via popular vote — and ballot measures in particular are notoriously difficult to undo.

Another general reason I oppose this initiative is that California already has paths for education policymaking that are subject to electoral accountability, and those elected folks should be allowed to do their jobs. There’s the governor and the state legislature, plus the state board of education and more than 1,000 local school boards on top of that. If voters want their government officials to do something about a curriculum issue, they can lobby for change or vote them out of office. The legislature has indeed already been in this area, with new curriculum requirements in ethnic studies and computer science and a financial literacy proposal very much like one on the ballot.

Beyond that, legislators, boards and executives in state government are much better positioned to pass rules that make sense in the context of existing education policies. In this case, for instance, California high schoolers , and that course covers many of the same topics as the new proposed mandate. Why not simply sharpen the list of subjects that need to be included in the economics course, rather than layering another partially duplicative requirement on top? The California Department of Education can also work to ensure that appropriate supports are provided to teachers — especially high-quality curricular materials that align with the new expectations — so financial literacy classes don’t become just another complicated-to-understand, unfunded burden on educators.

As for the specifics, I’m not opposed to teaching students about financial literacy, but it’s important to consider the tradeoffs in terms of what will be replaced. With in math and English Language Arts and widespread disengagement from school, I am worried about new course requirements that would distract from the educational core. 

And while financial literacy is great, it is no substitute for more direct actions the government can take to help people make better and easier decisions. We can teach children about doing their taxes, but we can also increase that saves taxpayers from needless fees from for-profit tax-preparation companies. We can coach children in how to manage checking and savings accounts, but we can also ban or sharply cap overdraft or ATM fees. We can teach young people the importance of early retirement, but we can also create safer and more generous retirement options that . 

If I’m feeling bored, the next time I get in my Lyft, I’ll bring up education policy, as usual. But I’ll tell the driver to oppose the financial literacy ballot initiative and leave the education policymaking to the policymakers. Or maybe I’ll do what my husband does when he doesn’t want to talk to his drivers and just tell them I do HVAC repair while I put in my headphones.