Newly announced guidance from the federal government that removes a half-dozen long-standing and common vaccines from the list of recommended immunizations for children could sow further mistrust in the shots among families and lead to unnecessary confusion and challenges for schools, according to experts on vaccine law and school health.
Vaccines against measles, mumps, rubella, polio, and whooping cough remain recommended for all children, while immunizations against other diseases including RSV will be recommended for high-risk groups. Other common shots, including the influenza vaccine, COVID-19 immunizations, and those that protect against meningitis and hepatitis A and B are now recommended to children after consultation with a health care provider—a process the CDC terms “shared clinical decision-making.” (See the full recommendations from the U.S. Centers for Disease Control, which is a part of HHS, here.)
The changes put schools in a complicated position, some experts say, as they navigate newfound confusion and questions about what is required for children to attend school. Some experts also worry that they will lead to more preventable disease outbreaks that result in lost class time for children and wider spread of disease to vulnerable communities—even outside of schools.
“School requirements are not policies that are just intended to protect people in congregate settings. Because we compel people to go to school, it’s a mechanism that we have to protect the entire population from all of these diseases,” said Richard Hughes, a vaccine-law expert. “I realize from an educator standpoint, they may say, ‘We don’t exist to advance public health initiatives,’ but at the same time, it’s a mechanism we have to reach children with safe and effective vaccines.”
In announcing the changes, HHS said its comparison to 20 peer nations found that the United States was an “outlier” in both the number of vaccinations and the number of doses it recommended to all children and the changes were meant to align the U.S. guidance with others’. Other vaccine experts have pointed out that the United States’ previous vaccine recommendations were largely in line with those of peer nations including Australia, Britain, Canada, and Germany.
“This decision protects children, respects families, and rebuilds trust in public health,” HHS Secretary Robert F. Kennedy Jr. said in a statement Monday.
But it is up to states to determine whether they will follow the federal guidelines, and state law determines which vaccines are required to enroll in public schools, Hughes said.
Many states have traditionally aligned their school vaccination requirements with the CDC’s recommended vaccine schedule. But already, some states and professional organizations have rejected the new HHS vaccine schedule.
“The truth is that while vaccine guidance is largely similar across developed countries, it may differ by country due to different disease threats, population demographics, health systems, costs, government structures, vaccine availability, and programs for vaccine delivery,” the American Academy of Pediatrics said in a statement on its website.
Some professional groups, like the Center for Infectious Disease Research and Policy at the University of Minnesota and state health departments, including Maryland’s, for example, have rejected the changes and said their states’ childhood-vaccination schedules will instead continue to follow the American Academy of Pediatrics’ guidance.
The conflicting messaging will likely lead to confusion among parents and caregivers about which immunizations are required for their children to attend school or day care, said Lynn Nelson, the president of the National Association of School Nurses.
“It’s just going to sow more mistrust and the idea that vaccines are optional, but the truth is that every state has their own requirements [for school vaccines], and this doesn’t change that,” Nelson said.
There’s also confusion around the meaning of shared clinical decisionmaking—when vaccinations are to be decided following consultation with a health care provider.
Public surveys have found that many think it means talking to family and that others are unclear on which health care providers they can consult. Nurses and pharmacists are among the health professionals who can administer vaccines.
Schools should be prepared to answer parents’ questions about what is required and explain the differences between state law and federal guidance. That is likely most easily done with a fact sheet about the vaccines, the science that guides the decisions, and whether state mandates have changed in any way, Nelson said.
Parents tend to trust school nurses, so ensuring school and district leaders collaborate to include nurses in their messaging can go a long way, Nelson said.
“The people who are open to these discussions around vaccines—there are some who have never been and never will be—and who are newly doubtful because they’re getting mixed messages, they still trust us,” Nelson said.
Schools often partner with local health departments to host community vaccination clinics, particularly during flu season and prior to the start of a new school year. Districts should continue hosting those clinics, said Hughes, though he said he’s concerned about new challenges that could arise.
“In terms of promoting vaccination, schools shouldn’t be shy,” Hughes said. “We should continue to follow the science and continue having those clinics to make vaccines available.”
