Revised Childhood Immunization Schedule Lacks Transparency: Former ACIP Member Noel T. Brewer, PhD

Early last month, the CDC announced major revisions to the US childhood immunization schedule, reducing the number of diseases covered by routine vaccines from 17 to 11. This followed a December 2025 presidential memorandum directing HHS Secretary Robert F. Kennedy Jr and acting CDC director Jim O’Neill to update the schedule if “superior approaches” were identified abroad.

These changes come months after Kennedy ended the terms of all 17 Advisory Committee on Immunization Practices (ACIP) members in June 2025 and quickly replaced them with new appointees, some of whom had previously expressed antivaccine views. He claimed the move was intended to restore public trust in vaccines.

One of the ACIP members whose term ended is Noel T. Brewer, PhD, a distinguished professor at the UNC Gillings School of Global Public Health. Brewer recently spoke with The American Journal of Managed Care^® (AJMC^®) and shared his opinions on the childhood immunization schedule changes.

Read more expert insights on this topic here.

This transcript has been lightly edited for clarity.

AJMC: What was your initial reaction to the recent childhood immunization schedule changes?

Brewer: It's not good. It's unhelpful to have arbitrary, sudden, and ill-informed policy decisions that affect hundreds of millions of people. I don't like that it was a secretive process that we have no insight into. I don't like that there's no apparent use of evidence, although there may have been; it’s just unknown.

I don't like that they moved outside of the usual ways that we develop policy. There are problems with the current ACIP, but they're still the group that would be in charge of this, and they moved outside of that group. So, we now have this impossible situation where ACIP has lost most credibility with provider organizations.

These provider organizations have developed their own schedules. States have developed their own schedules. ACIP has its old schedule that they're slowly changing, and now we have yet another group of schedules. All of these competing schedules mean that providers have to make difficult decisions about how to take care of the families and children they're in charge of. This is not a good setup for making people healthy.

AJMC: Based on your experience on ACIP, how did the process behind the recent changes compare with past deliberations?

Brewer: When ACIP was indeed making decisions, it had very specific approaches. In brief, they would stand up a committee; establish policy questions they wanted to address; gather evidence that would bear on those policy questions, including through systematic reviews; grade the evidence for certainty and also for what the actual indication was in the evidence; evaluate this evidence and other factors using an evidence-to-research, evidence-to-recommendations framework; vote as a work group on what they thought was the best approach; and then bring all of this work in a transparent fashion to the main ACIP voting members.

Those voting members would then digest this evidence, leave the room typically, and have a 3- to 6-month period during which they could consider what they heard. Then, at the next regular meeting, vote on whether to adopt the policy change. This work was done in a deliberative, evidence-informed, transparent way that is no longer present on ACIP and is especially no longer present with CDC.

So, that leaves health care providers and families not knowing what they should do with vaccines. I believe this is perhaps deliberate as a way to make it harder for people to get vaccines and to scramble people's motivations and ability to pursue vaccination.

AJMC: Something that stood out to me from the CDC’s announcement was that it discussed how some peer nations recommend fewer routine vaccinations while achieving strong health outcomes and high coverage. How do you think the revised US schedule may influence vaccination rates and child health outcomes?

Brewer: The vaccination schedule is for a large, heterogeneous country. We are a lot of countries all pushed together. We're not a little kingdom in the north of Europe that has high income and a bunch of White people who like to sit and have hot chocolate together.

We're a lot of different cultures, a lot of different people, all under 1 roof, but some of us have health insurance, and some of us don't. Some of us live in areas with an OB-GYN, or there is a primary care provider, while others don't. Many of us live in areas where those basic services are not easily accessible, or getting a Pap smear or certain vaccines is going to take an hour. We have to think about public health in those terms.

We also have, for example, a much higher risk for hepatitis B infections than there is in Northern Europe. So, we have to have a policy that is relevant to our context as it exists today, not an idealized summer in Denmark.

One of the people presenting at a recent ACIP meeting was valorizing Denmark, talking about it as if it were just the best thing ever. I don't want my vaccine policy to be run by someone who went and had a fun time on vacation or a year abroad; it’s not smart.

Just because someone has a feeling doesn't mean that we should be changing vaccine policy. It should be based on evidence, on what will keep Americans safe, not what will keep a bunch of rich Europeans safe. We're not rich Europeans. We are diverse, we are poor, we are wealthy, and we are everything in between.