The Trump administration's reform of the U.S. child vaccination system has not been halted due to a court order.
On August 21, the U.S. Department of Health and Human Services (HHS) issued a notice announcing that it is seeking public feedback on the federal vaccine recommendation system. The deadline for submissions is September 20. The main issue being discussed is not whether a particular vaccine is safe or not, but a more fundamental question: how should the U.S. government classify vaccines in the future. HHS even asked whether new categories should be added to the existing three recommended categories.
This seems to be just a technical consultation, but behind it lies another major judicial setback suffered by the Trump administration this year.
In January this year, HHS made significant changes to the child vaccination schedule, removing vaccines for influenza, rotavirus, hepatitis A, and hepatitis B from some of the standard recommendations. At the same time, Health Secretary Robert Kennedy Jr. also removed and reorganized the Advisory Committee on Immunization Practices (ACIP), which is responsible for providing vaccine recommendations to the Centers for Disease Control and Prevention (CDC).
On March 16, Judge Brian Murphy of the Federal District Court for Massachusetts issued a preliminary injunction, suspending not only the January version of the child vaccination schedule, but also the decisions made by Kennedy regarding the 13 members of the ACIP and their related votes. The court ruled that the government's bypassing of the procedures long established by ACIP for reviewing vaccine recommendations likely constitutes a violation of federal laws and administrative procedures.
In other words, the key issue for the court in deciding whether to reduce the number of vaccines is not just "whether the vaccine should be reduced," but also a procedural issue: The White House and HHS cannot simply change the policy at will.
So Trump took a different path.
On August 10th, he signed a new administrative order, proposing the so-called “gold standard children’s vaccine recommendations”. This reduced the recommended vaccinations for all children to just 11 diseases. He also requested a re-evaluation of the timing and sequence of vaccinations for all children. When conditions permit in the future, he hopes to divide the measles, mumps, and rubella combined vaccine (MMR) into three doses, and arrange different vaccines for vaccination at different times during consultations.
However, the administrative order itself cannot override the court injunction, nor can it directly modify the CDC's current vaccine recommendations. Therefore, this latest public consultation becomes particularly crucial.
Currently, the United States generally categorizes vaccine recommendations into three categories: "default recommendations," "recommendations for high-risk groups," and "shared clinical decision-making." The main difference between these three categories lies in the default options they assume.
According to the HHS’ own guidelines, routine recommendations mean that unless there are contraindications, vaccination should be carried out by default. However, when it comes to “joint clinical decision-making,” there is no default choice; doctors and individuals or parents must make decisions based on specific circumstances. The HHS also acknowledges that past research shows that such vaccines not only confuse doctors and patients more, but the actual vaccination rates may also be lower compared to those for vaccines that follow routine recommendations.
Therefore, for the Trump administration, it may not be necessary to directly announce the ‘abolition of a certain vaccine’. By simply changing the category in which it is recommended, the policy could be changed from ‘all children should receive the vaccine’ to ‘you can discuss with your doctor whether or not to receive the vaccine’.
This is also something that some public health experts are really concerned about. Experts interviewed by The Guardian pointed out that soliciting public opinions is perfectly normal. What is unusual is that such fundamental vaccine classification reforms should normally be carried out through the professional procedures of the CDC and ACIP. However, this time it was initiated by the 'Childrens' Vaccine Safety Task Force' led by HHS and Kennedy.
Therefore, the Trump administration is not simply repeating the actions taken in January this time.
For the first time, it directly modified the vaccination schedule, which was stopped by the court due to procedural and legal issues. Now, it is starting to redefine what “recommendation” means from a more upstream perspective, and simultaneously establishing a basis through administrative orders, public consultations, and new policy frameworks.
The court blocked one attempt to change the schedule, but did not halt this reform. The next real battle may have shifted from deciding whether certain vaccines should be administered to a more fundamental question: in the United States, who will define what constitutes "necessary vaccination"?
