On August 10th, President Trump issued Executive Order (EO) 14420 Delivering Gold Standard Childhood Vaccine Recommendations for Americans. The President’s Order endorses a truncated childhood vaccine framework that includes vaccination against a reduced number of diseases, reworked risk categories, and increased access to religious exemptions and other parental choice protections. While the Trump Administration celebrates the EO for better aligning U.S. policy with that of other peer nations, many major medical organizations worry the Order makes a sharp departure from evidence-based policy and could reduce vaccination rates—particularly for children. 

What does the EO do?  

The EO establishes “gold standard” recommendations that the White House will encourage, including a routine childhood immunization against 11 diseases (a decrease from the currently recommended 18). It also moves several vaccines out of universal recommendation categories, including influenza, hepatitis A and B, and COVID-19. The President encourages, but does not require, that states review their school immunization requirements, being mindful to protect parental choice and religious exemptions. 

The Order doesn’t change the childhood immunization schedule managed by the Centers for Disease Control and Prevention (CDC). However, it does recommend future changes, like the splitting of the Measles-Mumps-Rubella (MMR) compound vaccine into individual medicines—a format that doesn’t currently exist. It also doesn’t change insurance coverage, require that clinicians alter their practice patterns or eliminate access to currently available vaccines. 

How is the medical community responding? 

Most major physician and public health organizations have been publicly critical of the Order, including outgoing Senator Bill Cassidy, (R-LA). 

• American College of Physicians: “This executive order is part of a troubling pattern by the administration to attempt to unilaterally change vaccine guidance, particularly for children, rather than relying on the transparent, scientific review that has guided the U.S. childhood vaccine schedule for decades.” 

• Senator Bill Cassidy, M.D. (R-LA): “I’m a doctor. This executive order is wrong. The President does not have the expertise to make these changes. Vaccines are overwhelmingly safe. Vaccines are effective. Vaccines DO NOT cause autism.” 

• Johns Hopkins School of Public Health: “There was some very misleading information on different issues at the press conference for the executive order. One of them was that the United States is this huge outlier that does so many more shots than other countries. That’s not true.” 

What happens next?
State and Federal agencies will have to decide on the details of aligning with these new recommendations, with some analysts expecting future legal challenges. AHPA will be watching closely to see whether the President’s recommendations will translate into durable policy change, or whether implementation will be slowed by litigation, state-level decisions and continued opposition from major medical organizations.