Robert Hopkins, MD, on CDC vaccine schedule changes raising concerns

Recent changes to US childhood and adolescent immunization recommendations have prompted concern among clinicians about how the revisions were developed and how they may affect vaccine delivery and patient communication, according to Robert Hopkins, MD, professor of internal medicine and pediatrics at the University of Arkansas for Medical Sciences and medical director of the National Foundation for Infectious Diseases.

Hopkins said the revised guidance diverged from the usual evidence-based process overseen by the Advisory Committee on Immunization Practices, which traditionally incorporates epidemiologic review and input from multiple professional societies. He described the absence of that standard review as a key concern for clinicians interpreting the changes.

Recommendations reorganized, not eliminated

Although the updated schedule reduces the number of vaccines labeled as “routine,” Hopkins emphasized that most vaccines previously recommended for children and adolescents remain clinically indicated. Rather than being withdrawn, many were reassigned to categories such as individualized decision-making or risk-based use. In day-to-day practice, he noted, clinicians should still view these vaccines as recommended and covered by public and private insurance.

Hopkins identified only one meaningful change in coverage to date: the revision to routine universal hepatitis B vaccination at birth, which he said raises concerns based on long-standing evidence supporting neonatal immunization.

Effects on clinician–family communication

Hopkins said the reframing of recommendations has already led to increased confusion among families, particularly regarding influenza and COVID-19 vaccination. He noted that parents are questioning whether these vaccines are still necessary after hearing about changes to the schedule.

Despite the shift in framing, Hopkins emphasized that the underlying evidence has not changed. He cited longstanding data showing reductions in influenza-related hospitalizations and deaths associated with vaccination, as well as more recent studies demonstrating continued reductions in COVID-19 hospitalizations and mortality through recent seasons. Safety monitoring, he said, continues to support the use of both vaccines, with serious adverse events remaining rare.

“The evidence is that influenza vaccine and COVID-19 vaccine reduce the risk for your child ending up hospitalized with those diseases or having severe adverse outcomes,” Hopkins said.

Access and equity concerns

Hopkins also expressed concern that a greater emphasis on shared decision-making could unintentionally widen disparities in rural and underserved areas, where access to clinicians and pharmacies may be limited. In such settings, he said, families may have fewer opportunities to discuss vaccination or receive timely immunization, increasing the risk of transmission within households that include older adults or immunocompromised individuals.

Reinforcing trust in clinical care

In response to the changes, Hopkins encouraged clinicians to focus on reinforcing trust and continuity in the clinician–family relationship. He suggested framing vaccine recommendations around the clinician’s commitment to a child’s health, rather than relying solely on standardized scripts.

“We not only preach this, but we also practice it in our own homes,” Hopkins said.

Disclosure:

Hopkins is the medical director of the National Foundation for Infectious Diseases.