Trump Executive Order Overhauls Childhood Vaccine Schedule: 11 Core Shots, MMR Split and Spacing Encouraged

President Trump signed an executive order to break the childhood vaccination schedule recommendation into three categories and reduce the number of vaccines universally recommended down to 11 to align with Denmark. President Trump signed the order Monday afternoon with HHS Secretary Robert F. Kennedy Jr. and NIH Director Jay Bhattacharya alongside. The order also includes provisions directing the Attorney General to advance legal challenges to states that “violate children’s rights to medical or religious exemptions.”

The updated schedule will include 11 vaccinations in the core category that is recommended for all children. This aligns with the administration’s initial change to the vaccine schedule in January that has been on hold due to an ongoing court battle. In addition, the order calls for the MMR (measles, mumps, rubella) to be split into three different shots that will be administered on different days.

The vaccines that are still recommended for all children following the executive order are: measles, mumps, rubella, diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type B, pneumococcal disease, human papillomavirus, and varicella. Immunizations recommended for certain high-risk groups or populations are: respiratory syncytial virus monoclonal antibodies, hepatitis A, hepatitis B, meningococcal B, meningococcal ACWY, and dengue.

Lastly, there are vaccines that fall under the category of shared clinical decision-making to be determined in a conversation between the patient and the doctor. These vaccines are hepatitis A, hepatitis B, rotavirus, meningococcal disease, influenza, and COVID-19.

The administration is also calling for all of the vaccines on the schedule to be spaced out to avoid giving developing babies multiple vaccinations in a short period of time. “For example, at one year you should have five separate visits for vaccines rather than getting them all in the same day,” President Trump said. “We’re doing 20% of that at each visit. And we’ll let time elapse between visits so the body can handle this massive amount of fluid being pumped in.”

Senator Bill Cassidy said, “The President doesn’t have the expertise to make these changes.” Cassidy said he is a doctor and the executive order is wrong. “Breaking up vaccines will mean children will have to get more shots to get the same protection, not fewer shots. It will increase hesitancy and make children less safe.”

Other media reports have noted the stated purpose for providing multiple vaccines at the same time is to make sure children don’t miss any of their vaccines. It is considered difficult, time-consuming, and inconvenient for new parents to make several visits to the doctor as would be recommended under the new schedule.

Dr. Robert Malone celebrated President Trump’s order and said: “It couldn’t have happened soon enough.” Dr. Malone reviewed data on vaccine adverse events and used conservative numbers without accounting for the underreporting of adverse events in the VAERS system. While using conservative numbers, Dr. Malone estimated approximately 2,800 to 3,300 identifiable acute vaccine-attributable reactions per US birth cohort, or roughly one out of 1,100-1,300 children. Dr. Malone noted the conservative numbers and that his calculations leave several categories of vaccine reactions out of the numbers.

“If giving fewer vaccines simultaneously and spreading the schedule out can reduce adverse events without sacrificing protection, why wouldn’t we investigate it?” Dr. Malone asked.

“That should not be a radical proposition. It should be basic risk management.”

A 2013 report and 2019 systematic review identified data gaps regarding concomitant-use studies, which are clinical data studies that evaluate adverse events related to the administration of multiple vaccinations at the same time. When pre-licensure concomitant-use studies are conducted, they are typically designed to assess short-term immunogenicity and common reactogenicity, such as fever and local reactions. They are not large enough or long enough to reliably detect rare adverse events or later-onset outcomes.

The 2013 Institute of Medicine review of the childhood schedule concluded that research examining the safety of the entire schedule, including its order, timing, and cumulative antigen/adjuvant load, was limited. Few studies focused on the schedule as a whole, and there had not been any studies conducted to evaluate the long-term effects of the cumulative number of vaccines.

The primary critique of recommendations to spread out the vaccine schedule is that children will not get all of their vaccines by a certain point in time. That is based on studies that compare children of parents who have decided to spread out the vaccines against the existing recommendations of the CDC, and thus they are parents who are more skeptical of the vaccine schedule in general. The evidence does not adjust for the confounding variables of parental attitudes towards vaccines.

When the administration moved to change the childhood vaccination schedule in January, one concern was that parents who want to continue to get COVID-19, flu, Hepatitis B vaccines, and others according to the previous schedule would not have those covered by insurance. The administration has clarified that all of those vaccines will continue to be covered by insurance even if they are not within the recommended category for all children.

Jefferey Jaxen talked about the executive order on The Download Monday night and referenced the previous reports about the administration stepping away from the contentious topics of vaccines and autism.

“All the adjuvants, vaccinated, unvaccinated studies, hep B timing, everything is on the table,” Jaxen said. “It’s being studied. And it used to just be those two talking about that, those crazy anti-vaxxers, the president and secretary of HHS. But now we have other people like Karoline Leavitt. She is the white House press secretary. She puts this out just really simply on X. This shows the 72 down to 11. Now we’re with member nations, no mandates. That’s how it’s going to work here.”