New executive order sets federal childhood vaccine recommendations

Clinical takeaway: The executive order establishes three categories for federal childhood immunization recommendations and directs federal agencies to take steps to advance them. For several vaccines, the federal framework uses risk-based or shared clinical decision-making recommendations where the AAP recommends routine vaccination.

On August 10, President Donald Trump issued an executive order establishing “Gold Standard Childhood Vaccine Recommendations,” following earlier changes to federal childhood vaccine recommendations whose implementation, according to the order, has been delayed by litigation.

The order organizes childhood immunization recommendations into three categories:

1. Recommended for all children: measles, mumps, rubella, diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type B, pneumococcal disease, HPV, and varicella.
2. Recommended for certain high-risk groups or populations: RSV monoclonal antibodies and vaccines against hepatitis A, hepatitis B, meningococcal B, meningococcal ACWY, and dengue.
3. Recommended based on shared clinical decision-making: hepatitis A, hepatitis B, rotavirus, meningococcal disease, influenza, and COVID-19.

Hepatitis A and hepatitis B appear in both the high-risk and shared clinical decision-making categories in the executive order.

The executive order also states that MMR should be administered as three separate single-disease vaccines once such products become domestically available. It further calls for childhood immunizations to be administered at separate medical visits “to the maximum extent feasible.” The order separately directs the Department of Health and Human Services (HHS) to develop options for administering core childhood vaccines, beginning with MMR, as single vaccines while maintaining availability of combination vaccines.

The framework differs from the American Academy of Pediatrics (AAP) 2026 childhood immunization schedule for several vaccines. The AAP continues to recommend protection against 18 diseases, including hepatitis A, hepatitis B, rotavirus, influenza, RSV, and meningococcal disease. The AAP schedule also advises using combination vaccines instead of separate injections when appropriate.

In an August 11 statement, the Society for Maternal-Fetal Medicine (SMFM) said it continues to support the AAP-recommended childhood vaccine schedule. “SMFM is concerned that the new executive order creates further unnecessary confusion and distrust of vaccines and undermines public health efforts against preventable diseases and deaths,” the society said. SMFM also stated that vaccine recommendations should be based on current evidence and account for disease burden in the United States.

Federal agencies are directed to review the recommendations in the executive order and take appropriate steps to advance them. States and territories are advised to consider updating immunization requirements for settings including school enrollment and attendance. The recommendations will also be reassessed based on findings from the HHS Task Force on Safer Childhood Vaccines, which is due to present its initial plans within 90 days.

Source: The White House. (2026 Aug 10) Executive Order. Delivering Gold Standard Childhood Vaccine Recommendations for Americans