Disclaimer: This paper represents the views of the authors and not of their institutions.

Competing Interests: Dr. Zimmerman is primarily funded by federal research grants but also receives vaccine industry grants, consulting, teaching and patient care revenues. Dr. Moehling Geffel is primarily funded by federal research grants but also received vaccine industry grants and teaching revenues. For both, none are these are directly related to this topic.

In 2026, and in contrast to previous precedent, the federal childhood immunization schedule was revised by the U.S. Department of Health and Human Services (HHS) without open discussion at the Advisory Committee on Immunization Practices (ACIP), which is charted by Congress to do this, and without harmonization with professional medical societies, as has been done for decades.¹ Herein, we respond through a bioethical analysis in the context of Christian theology.

Theological Foundation

The concept of prevention flows from the sanctity of life and common grace. The idea of reducing a disease that causes suffering flows directly from the promotion of human flourishing (Genesis 1:26-28). Prevention has a biblical basis: “When you build a new house, be sure to put a railing around the edge of the roof…” (Deuteronomy 22:8, GNT). Humans are made in God’s image (Genesis 1:27), and we are to protect life. Furthermore, theologian Herman Bavinck wrote: “Science, art, moral, domestic, and societal life…were derived from that common grace….”² Indeed, CMDA’s Ethics Statement on Vaccines and Immunizations notes: “Vaccines have significantly reduced the incidence of life-threatening infections and have saved lives. Vaccines are an important part of maintaining health, especially in children.”³

Altruism and love of neighbor. The “love one another” passages in the New Testament support caring for another, “…our love should not be just words…shows itself in action” (1 John 3:18, GNT). Being vaccinated dramatically reduces the risk that one will contract a disease and, thus, the risk of transmission to others.

The value of process. Orderly process is a divine biblical mandate, instituted as a check on mans’ darkened sinful hearts (Jeremiah 17:9). Scripture is replete with calls for process: first “inquire, probe and investigate…thoroughly” a matter (Deuteronomy 13:14, NIV). A thorough process provides metric checks of restraint, accountability and verification prior to rendering a decision. Furthermore, biblical judicial process mandates multiple witnesses (Deuteronomy 19:15), impartial examination (Deuteronomy 1:17) and public judgement (Deuteronomy 21:19-21; Ruth 4:1-2) prior to the final verdict.

Key Parts of New Recommendations

“CDC will continue to recommend that all children are immunized against 10 diseases for which there is international consensus, as well as varicella (chickenpox).”⁴ This reduces recommended vaccines from 17 to 11. For other diseases, the removal of broad recommendations “allows for more flexibility and choice, with less coercion, by reassigning non-consensus vaccines to certain high-risk groups or populations and shared clinical decision-making.”⁴ Vaccines “will still be available to anyone who wants them through Affordable Care Act insurance plans and federal insurance programs….”⁴

Concern about Process

Given the biblical importance of community, process and awareness of the noetic effects of sin, we are concerned about the closed-door process leading to the reduced childhood immunization schedule that did not involve: (1) open presentation of the rationale including benefits and risks; (2) opportunity for opposing viewpoints; (3) following the congressional charter for recommendations via ACIP; and (4) collaborating with professional medical societies. That is not to minimize the excellent training or intelligence of the two federal authors who wrote the background rationale;⁵ it is to point out that two authors wrote the rationale for the policy for the nation. The major outcome is that the professional societies are developing their own recommendations, and there is now mistrust and disharmony between the U.S. Centers for Disease Control and Prevention’s (CDC) and professional societies’ recommendations.

The previous CDC processes involved the explicit and detailed Evidence-to-Recommendations framework, which involved assessment if it was a public health problem, impact on equity, consideration of benefits and harms, values of the target population (e.g., parent’s feelings), acceptability to key stakeholders (e.g., clinicians), resource use (e.g., cost-effectiveness) and feasibility (e.g., storage).⁶ The benefits and harms assessment used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework and was evidence-based as to the infectious disease outcomes, study design quality, risk of bias and safety evaluation.^7,8

The Purported Criticisms and Replies of the Previous Childhood Schedule

1. Criticism: The U.S. recommends more vaccines than other developed nations.⁵ Reply: The number of vaccines recommended in the U.S. is fairly similar to many high-income countries (17 versus 14 in France, Germany and Israel).⁹ Furthermore, if we can afford these vaccines and if they better protect our children, then having a larger number is a virtue to promote the health flourishing of children.
2. Criticism: Loss of trust in public health has occurred. “With COVID-19 vaccine mandates and false CDC claims…the loss of trust…contributed to less adherence to the full CDC childhood immunization schedule…A new U.S. childhood schedule that removes the routine recommendation for non-consensus vaccines could lessen coercion and increase public trust.”⁵ Reply: We agree that trust in public health is diminished, but this as a solution is untested and theoretical. Indeed, the confusion between competing federal and professional society schedules might actually worsen the situation. Furthermore, Denmark, which is the country the new recommendations emulated, is a relatively homogenous country and international diversity among developed nations about vaccines does occur; for instance, Britain recommends childhood influenza vaccination.¹⁰
3. Criticism: Lack of double-blind placebo-controlled randomized trials. Reply: All vaccines of which we are aware have had randomized controlled trials of at least one type. As to placebos, three scenarios are common: (1) true placebo; (2) a dissimilar vaccine was given to the control group so they received something and were not disadvantaged by receiving nothing; and (3) a previous version of the vaccine with fewer serotypes to the control because it was unethical to deprive a child of the current standard of care (e.g., compare a 13-valent pneumococcal vaccine with the previously licensed and recommended 7-valent vaccine).
4. Criticism: “Number needed to vaccinate (NNV) and number needed to harm (NNH) calculations should be performed for low- and high-risk children for each vaccination on an ongoing basis as harms are identified and as new information is obtained about efficacy against severe disease.”⁵ Reply: Agreed that NNV and NNH are key parameters and such information was possible from public health and cost-effectiveness modeling that is a part of the previously used Evidence-to-Recommendations process.⁶ We agree this could have been done more frequently, but that in itself does not necessarily call for a change in recommended vaccines, just in a prioritization of calculation and recalculation of NNV and NNH.
5. Criticism: Vaccine safety surveillance systems “have serious shortcomings in that they have been underutilized, including for evaluating long-term effects of vaccines and the effect of various combined aspects of the vaccine schedule.”⁵ Reply: Although any system has shortcomings, the fact that there are five safety systems should be reassuring. The Vaccine Safety Datalink (VSD) includes 11 sites, which provide electronic health record data on more than 10 million annually and has yielded more than 350 published articles. Because VSD is large and controlled, it provides the strongest evidence on safety.

Reducing the Recommended Number of Vaccines toward Shared Decision-making

The following vaccines were moved from “recommended” to “shared clinical decision-making (SCDM):” hepatitis A, hepatitis B, rotavirus, meningococcal, influenza and COVID-19.¹ First, while hepatitis A and B are both infections that many will not contract, they have been through a process looking at the evidence and leading to a harmonized recommendation. Consider the analogy of other preventive services: we recommend colon and breast cancer screening, although most persons will never develop these cancers. In another post, we have discussed hepatitis B vaccine and our disagreement with the change to SCDM and will not repeat it here.¹¹ Second, meningococcal disease is rare but devastating; it is not cost-effective^12,13 and a case can be made that it should be SCDM. Third, nearly everyone will contract influenza, COVID and rotavirus at some point. Children are a main driver of the spread of influenza outbreaks, and vaccination of children not only reduces their risk but also that of older and high-risk adults. Thus, Britain uses a school-based influenza vaccination program to protect the children¹⁰ and the larger population. According to CMDA’s Ethics Statement on Healthcare Right of Conscience, “Patients with decision-making capacity have the right to refuse treatment, even when such refusal would bring them harm. When a patient’s refusal of treatment threatens the lives of others, the patient’s right to refuse treatment should be subordinate to the protection of others….”¹⁴ Fourth, the 2025 recommendations for COVID vaccine were already for those at higher-risk for severe outcomes (children less than 2 years of age and children with high-risk conditions). Fifth, rotavirus disease causes gastroenteritis and dehydration; although these are not typically fatal in the U.S., the vomiting and diarrhea causes substantial burden on children and to their parents, and the vaccine prevents numerous emergency department visits and hospitalizations for dehydration.

Summary

We have major concerns about the comparisons and processes used in reducing the federal number of recommended childhood immunizations and fear the disharmony with professional societies will lead to further confusion and distrust of public health. We disagree with most points of criticism of the previous recommended childhood schedule and believe an open process is needed to limit the noetic effects of sin and promote the flourishing of our precious children.

Krissy Moehling Geffel, PhD, MPH, is an Assistant Professor in the Department of Family Medicine at the University of Pittsburgh School of Medicine. Her research interests are: influenza and RSV epidemiology and vaccine effectiveness, social determinants of health and associations with health disparities, vaccine messaging and message framing for increasing vaccine confidence, and increasing vaccination uptake across the lifespan. Her mission is to help vulnerable people thrive.

References

1. O’Neil J BJ, Mehmet O, Makary M. Decision Memo: Adopting Revised Childhood and Adolescent Immunization Schedule. Centers for Disease Control and Prevention,. (https://www.hhs.gov/sites/default/files/decision-memo-adopting-revised-childhood-adolescent-immunization-schedule.pdf).
2. Bavinck H, Bolt J, Vriend J. Reformed dogmatics. Grand Rapids, Mich.: Baker Academic, 2003.
3. Christian Medical & Dental Associations. Vaccines and Immunizations. (https://cmda.org/policy-issues-home/position-statements/).
4. US Department of Health and Human Services. Fact Sheet: CDC Childhood Immunization Recommendations. US Department of Health and Human Services,. (https://www.hhs.gov/press-room/fact-sheet-cdc-childhood-immunization-recommendations.html).
5. Hoeg TB KM. Assessment of the U.S. Childhood and Adolescent Immunization Schedule Compared to Other Countries. Department of Health and Human Services,. (https://www.hhs.gov/sites/default/files/assessment-of-the-us-childhood-and-adolescent-immunization-schedule-compared-to-other-countries.pdf).
6. Centers for Disease Control and Prevention. ACIP Evidence to Recommendation User’s Guide. In: Centers for Disease Control and Prevention, ed.2020.
7. Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices Policies and Procedures. (https://www.cdc.gov/acip/downloads/Policies-Procedures-508_1.pdf).
8. Centers for Disease Control and Prevention. ACIP GRADE Handbook for Developing Evidence-based Recommendations. In: Centers for Disease Control and Prevention, ed.: Centers for Disease Control and Prevention; 2024.
9. Vaccine Integrity Project Staff and Avisors. Viewpoint: The myth of an over-vaccinated America: The US DOES follow global consensus. Center for Infectious Disease Research & Policy, University. of Minnesota. December 22, 2025 (https://www.cidrap.umn.edu/vaccine-integrity-project/viewpoint-myth-over-vaccinated-america-us-does-follow-global-consensus).
10. UK Health Security Agency. Flu vaccination programme 2025 to 2026: information for healthcare practitioners. UK Health Security Agency,. (https://www.gov.uk/government/publications/flu-vaccination-programme-information-for-healthcare-practitioners/flu-vaccination-programme-2023-to-2024-information-for-healthcare-practitioners#:~:text=Summary%20of%20eligible%20groups,%2C%20Chapter%2019%20(Influenza))).
11. Zimmerman R. Hepatitis B Vaccine and the Christian Clinician: A Bioethical Analysis of the Votes in December 2025 of the Advisory Committee on Immunization Practices (ACIP). Christian Medical Dental Associations. (www.cmda.org/point/).
12. Nwogu IB, Jones M, Langley T. Economic evaluation of meningococcal serogroup B (MenB) vaccines: A systematic review. Vaccine 2021;39(16):2201-2213. DOI: 10.1016/j.vaccine.2021.02.049.
13. Shepard CW, Ortega-Sanchez IR, Scott RD, 2nd, Rosenstein NE, Team AB. Cost-effectiveness of conjugate meningococcal vaccination strategies in the United States. Pediatrics 2005;115(5):1220-32. DOI: 10.1542/peds.2004-2514.
14. Christian Medical & Dental Associations. Healthcare Right of Conscience Statement. (https://cmda.org/policy-issues-home/position-statements/).