Who Sets the Vaccine Schedule Now?
Inside the unusual rift between the CDC and the American Academy of Pediatrics
A Rare Split in Vaccine Guidance
For decades, the alphabet soup of U.S. vaccine policy has followed a predictable recipe: experts at the Centers for Disease Control and Prevention (CDC) weighed the evidence, the American Academy of Pediatrics (AAP) signed on, and pediatricians across the country followed a unified childhood immunization schedule. That consensus just cracked, and the split matters more than it might seem.
This week, the AAP released its recommended childhood and adolescent immunization schedule for 2026, breaking from the latest CDC schedule. Such a public divergence is rare. It reflects not a procedural spat, but a deeper disagreement about how best to protect children from vaccine-preventable diseases at a moment when trust in public health guidance is already fragile. For parents, clinicians, and insurers, the question is no longer just “what’s recommended?” but “whose recommendation should I trust?”
Why the AAP Broke With the CDC
The AAP is not a fringe voice. It represents roughly 67,000 pediatricians and pediatric specialists and has been issuing evidence-based vaccine guidance since 1930. Its 2026 schedule is formally endorsed by 12 major medical organizations, including the American Medical Association, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the Infectious Diseases Society of America, and the Pediatric Infectious Diseases Society. Collectively, those groups represent more than a million clinicians.
Historically, the AAP and CDC worked together to produce a single, harmonized schedule. That alignment helped simplify life for parents and pediatricians alike. According to the AAP, the current break stems from recent CDC schedule changes that, in the academy’s view, “depart from long-standing medical evidence and no longer offer the optimal way to prevent illness in children.”
What the AAP Schedule Emphasizes
The AAP’s schedule, by contrast, hews closely to prior guidance and emphasizes disease risk and real-world pediatric care in the United States.
AAP infectious diseases chair Dr. Sean O’Leary said, “There’s no medically justified reason to downgrade the recommendations for these dangerous diseases. There’s no reason children should have to suffer and die from preventable diseases.”
What Clinicians Will Do in Practice
So what happens next in exam rooms across the country?
Many pediatricians — particularly those who are AAP members, work in children’s hospitals, or specialize in pediatric infectious diseases — are likely to continue following the AAP schedule. Others may adhere more closely to CDC guidance, depending on institutional policies, state rules, or personal judgment. The result may be more variability than families are used to, and more conversations at well-child visits.
Questions Parents Should Ask at the Next Visit
Those conversations matter. Parents should feel empowered to ask which schedule their child’s clinician follows and why; what their default recommendations are for vaccines like flu, hepatitis B at birth, COVID, or RSV; and what a catch-up plan would look like if a vaccine is delayed. Just as important is the practical question many families may forget to ask: will insurance cover this vaccine without cost-sharing?
Insurance Coverage: Where the CDC Still Drives Policy
On that front, the CDC still looms large. Insurance coverage is typically anchored to CDC and ACIP recommendations and federal policy, not AAP guidance alone. But even amid the split, pediatric leaders say they are actively trying to prevent coverage confusion. “We’ve also had ongoing conversations with the payers,” AAP president Dr. Andrew Racine said, calling coverage “an extremely important part of what’s going on here” and emphasizing the goal of ensuring “there is no ambiguity with regard to which vaccines are going to be covered.”
Major insurers have also signaled that vaccines recommended by the CDC as of late 2025 will continue to be covered through 2026, even if guidance shifts. Translation: coverage is likely to hold steady for now, but families should still verify plan-specific details.
In the End, This Is a Trust Problem
Vaccine schedules are not just lists. They are trust documents. And in the AAP’s view, trust is now the central currency. “The currency with which we are dealing is a currency of trust, and part of trust is being consistent and making sure that the consistent recommendations that you give rely on the science,” said Dr. Racine.