A presidential memo asks why the US schedule covers more diseases than peer countries
The 5 December directive tells HHS and the CDC to compare the American childhood schedule with those of other wealthy nations, using a count of diseases as its benchmark.
On 5 December the White House issued a presidential memorandum directing the Secretary of Health and Human Services and the Acting Director of the CDC to review how peer, developed countries structure their core childhood vaccination recommendations and to examine the scientific evidence behind those practices [s1]. If superior practices are identified abroad, the memorandum instructs them to update the US childhood vaccine schedule accordingly, while maintaining access to vaccines currently available to Americans [s1].
It landed the same day the CDC's own advisory committee voted to end the universal hepatitis B birth dose [s2].
The benchmark the memo chose
The accompanying fact sheet argues that the United States is "a high outlier in the number of vaccinations recommended for all children," and supports that with a count of diseases covered by each country's schedule as of January 2025 [s1]:
- United States: 18 diseases, including COVID-19
- Germany: 15 diseases
- Japan: 14 diseases
- Denmark: 10 diseases
It makes two more specific comparisons. The United States recommends yearly influenza vaccination starting at six months of age, while, in the fact sheet's characterisation, many peer countries do not recommend annual influenza vaccination as a core vaccination for all children [s1]. And hepatitis B vaccination at birth is described as standard in the United States but uncommon in most developed countries [s1].
What a disease count does and does not measure
The chosen metric — how many distinct diseases a schedule targets — is worth examining on its own terms, because everything downstream of the memorandum depends on it.
A count treats each disease as one unit regardless of how common it is in that country, how severe it is, how it is transmitted, or what else the health system does about it. Two countries can arrive at different disease counts because their epidemiology differs, because their non-vaccine control measures differ, or because their decision-making bodies weigh evidence differently. The count itself does not distinguish among those explanations.
The fact sheet as published does not present a comparison of childhood disease outcomes between the United States and the countries it names [s1]. It presents a comparison of recommendation counts. Those are different claims, and only the second is actually evidenced in the document.
The hepatitis B example makes the point concretely. The clinical case for a universal birth dose has never rested on the claim that hepatitis B is common in American newborns. It rests on the consequences when it does occur — up to 90% of infants infected in the first year develop chronic infection [s2] — and on the fact that a universal dose does not depend on maternal screening working perfectly in every delivery. A country with different screening infrastructure, different prevalence, and different birth practices can reach a different answer without either country being wrong on the science. A disease count cannot represent that reasoning; it can only record the outcome.
What the memorandum actually requires
Read narrowly, the memorandum is a review order, not a schedule change. It directs two officials to look at peer practices and the evidence behind them, and to act only "if superior practices are identified" [s1]. It also contains an explicit preservation clause: access to vaccines currently available to Americans is to be maintained [s1].
That clause is doing real work. In US practice, whether a vaccine is recommended and whether it is available are linked but distinct. Recommendation status drives the Vaccines for Children programme and insurance coverage requirements; availability is about licensure and supply. A schedule can be narrowed without any product leaving the market — and the practical effect then depends on whether payers and public programmes follow the recommendation or the licensure.
The context it arrives in
The memorandum did not appear in a vacuum. The same week, ACIP voted 8-3 to end the universal hepatitis B birth dose and replace it with individual decision-making for infants born to mothers who test negative [s2]. Professional bodies objected on the grounds that no new safety evidence had prompted the change: the American Association of Immunologists called the science behind the hepatitis B vaccine "robust and well-established" and urged the CDC to reject the recommendation [s3].
Whether the memorandum's review reaches the same conclusions ACIP did, or different ones, is not knowable from the document itself. The memorandum sets a direction of inquiry and names the officials responsible; it does not specify a deadline, a methodology, or who conducts the underlying evidence review [s1].
What to watch
Whether HHS and the CDC publish the assessment itself, rather than only its conclusions — the comparison is only checkable if the country-by-country evidence review is public. Whether the review distinguishes between a country recommending fewer vaccines and a country achieving better child health outcomes. And whether any narrowing of the schedule is accompanied by explicit guarantees on Vaccines for Children eligibility and insurance coverage, since those, not the schedule document, determine what a family actually pays.
Sources
- [s1] The White House, "Fact Sheet: President Donald J. Trump Begins Process to Align U.S. Core Childhood Vaccine Recommendations with Best Practices from Peer, Developed Countries," 5 December 2025. https://www.whitehouse.gov/fact-sheets/2025/12/fact-sheet-president-donald-j-trump-begins-process-to-align-u-s-core-childhood-vaccine-recommendations-with-best-practices-from-peer-developed-countries
- [s2] TIME, "A New CDC Recommendation Could Mean a Big Change for Childhood Vaccines," 5 December
- [s3] American Association of Immunologists, "AAI Statement Following ACIP Vote to End the Recommendation of Hepatitis B Vaccination For All Infants at Birth," 5 December 2025. https://news.aai.org/2025/12/05/acip-recommendation-first-dose-hepb-vaccine/
Sources
- Fact Sheet: President Donald J. Trump Begins Process to Align U.S. Core Childhood Vaccine Recommendations with Best Practices from Peer, Developed Countries — The White House , December 5, 2025
- A New CDC Recommendation Could Mean a Big Change for Childhood Vaccines — TIME , December 5, 2025
- AAI Statement Following ACIP Vote to End the Recommendation of Hepatitis B Vaccination For All Infants at Birth — American Association of Immunologists , December 5, 2025
More on
CDC advisers vote 8-3 to end the universal hepatitis B birth dose
ACIP replaced a recommendation in place since 1991 with individual decision-making for babies born to mothers who test negative. The CDC has not yet adopted it.
Next season's flu vaccines are being rebuilt around the H3N2 variant from August
WHO updated all three components for the 2026-2027 northern hemisphere season after subclade K dominated globally, and recommended a new candidate vaccine virus for an H9N2 avian strain.
WHO calls a planned hepatitis B birth-dose trial unethical; Guinea-Bissau has suspended it
The objection turns on a no-treatment arm. WHO says placebo or no-treatment vaccine trials are acceptable only where no proven intervention exists, and here one does.
A decision memo, not a committee vote, rewrote the childhood vaccine schedule
Eleven vaccines remain recommended for all children. The rest move to risk-based or shared-decision categories, on the strength of a comparison with 20 other countries.