US President Donald Trump on 11 August 2025 signed an executive order reducing the number of diseases for which vaccines are routinely recommended for all American children — cutting the list from 18 diseases to 11 — and urging states to reconsider school immunisation requirements. The directive, framed as the 'Gold Standard Childhood Vaccine Recommendations', represents the most sweeping federal intervention in childhood immunisation policy in decades.

What the New Schedule Covers

The revised universal immunisation list covers 11 diseases: measles, mumps, rubella, diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type B, pneumococcal disease, human papillomavirus, and chickenpox (varicella). This compares with the 18 diseases covered under the US Centers for Disease Control and Prevention (CDC) schedule in 2024, according to a White House fact sheet.

Immunisations moved out of the universal category include respiratory syncytial virus monoclonal antibodies and vaccines against hepatitis A, hepatitis B, meningococcal B, meningococcal ACWY, and dengue — these are now designated for high-risk groups only. Rotavirus, influenza, and COVID-19 vaccines, along with hepatitis A and hepatitis B, are placed under a 'shared clinical decision-making' category, to be decided jointly by parents and clinicians.

Key Directives in the Order

The executive order instructs the Health and Human Services (HHS) Secretary to submit plans within 90 days for offering individual vaccines, beginning with the combined measles-mumps-rubella (MMR) shot. The administration recommends replacing the combined MMR vaccine with three separate single-disease shots, once such products become domestically available. It also calls for childhood vaccines to be administered during separate medical visits 'to the maximum extent feasible.'

Notably, the order does not itself alter state laws — individual states retain authority to set vaccination requirements for school attendance. However, the directive instructs the Attorney General to support 'meritorious legal actions' challenging state laws that conflict with federal or constitutional obligations involving parental authority, religious freedom, disability accommodations, and equal protection. The departments of Justice, Education, and HHS were also directed to ensure contractors and grant recipients comply with requirements to provide medical and religious exemptions where federal law mandates them.

The Administration's Rationale

The White House cited an HHS assessment completed in January which found that the United States recommended more childhood vaccines than peer developed nations. According to the administration, American children following the CDC schedule received 23 doses in 7 shots against 7 diseases in 1980. By 2024, that figure had risen to at least 84 doses in at least 57 shots covering 17 diseases, plus RSV monoclonal antibody immunisation — a more than threefold expansion over four decades.

Broader Policy Context

The order is the latest in a series of actions under Trump's Make America Healthy Again (MAHA) initiative. Trump established the MAHA Commission in February 2025, and had previously ended the blanket COVID-19 vaccine recommendation for children and directed HHS to benchmark the American immunisation schedule against those of other developed countries. Critics and public health experts have raised concerns that scaling back universal recommendations could reduce vaccination rates and leave children vulnerable to preventable diseases. The administration maintains that combination vaccines and vaccines under shared decision-making will remain accessible to all families.

How individual states respond to the federal directive — and whether legal challenges to state school immunisation mandates gain traction — will determine the real-world impact on childhood vaccination coverage across the country.