Immunization teams have spent the past year working from a moving target. Since mid-2025, federal officials have shifted several childhood vaccines from universal recommendations into high-risk or shared clinical decision-making (SCDM) categories. A federal court paused most of those changes in March 2026. The federal government has appealed that ruling, and the Centers for Disease Control and Prevention (CDC) is telling providers that the July 2025 recommendations still apply for this season's flu and COVID-19 vaccines.
Each shift leaves vaccination teams sorting out which guidance to follow, what to tell families, and what might change next. Families feel that uncertainty too, and many of them call their local health department in search of a straight answer.
To see how vaccine schedule changes are playing out day to day, Patagonia Health surveyed public health professionals across the U.S., from community health workers running mobile mass vaccination clinics to lhd clinical staff, immunization coordinators, and front-desk teams. Between June 2 and September 10, 2026, we received 68 anonymous responses to three questions:
But before we dive into the results, let's examine what has actually changed since 2025.
According to the Congressional Research Service (CRS), the process held steady for more than 60 years. The Advisory Committee on Immunization Practices (ACIP) weighed the evidence and voted, and the CDC director decided whether to adopt the recommendation. ACIP also refreshed the childhood and adult schedules each fall.
That pattern broke in 2025. In June, the Secretary of Health and Human Services (HHS) removed all 17 ACIP members and appointed replacements. The new committee voted on several changes, and HHS and CDC made others on their own, including a full rewrite of the childhood schedule in January 2026.
In March 2026, a federal district court stayed most of those actions. CRS reports that the stay put the schedules largely back to their January 2025 versions while the case moves forward.
| What Changed | Date | Source |
| ACIP allowed the MenABCWY vaccine when MenACWY and MenB are both indicated at the same visit, and recommended one RSV vaccine dose for adults 50 to 59 at increased risk. | April 15-16, 2025 | CRS |
| COVID-19 vaccination for healthy children moved from a universal recommendation to SCDM. For pregnant women, the recommendation changed to no guidance. | May 27, 2025 | CRS, CAP |
| The HHS Secretary removed all 17 sitting ACIP members and later appointed new ones. | June 9, 2025 | CRS |
| The reconstituted ACIP recommended clesrovimab, a new respiratory syncytial virus (RSV) immunization for infants. It also reaffirmed annual flu vaccination for everyone 6 months and older and recommended discontinuing thimerosal-containing flu vaccines. | June 25-26, 2025 | CRS |
| Many health plans committed to covering vaccines ACIP recommended as of September 2025, at least through the end of 2026. (Later extended; see May 2026.) | Sept 2025 | JHU IVAC |
| ACIP moved COVID-19 vaccines for adults and children from universal to SCDM. It also recommended separate MMR and varicella shots over the combined measles, mumps, rubella, and varicella (MMRV) vaccine. | Sept 18-19, 2025 | CRS |
| ACIP moved the hepatitis B birth dose from universal to SCDM for infants whose mothers test negative or have an unknown status. Infants of mothers who test positive still receive the birth dose. | Dec 4-5, 2025 | CRS |
| A presidential memorandum directed HHS and CDC to compare the U.S. schedule with those of peer nations and update it if they found better approaches. | Dec 5, 2025 | CDC |
| CDC adopted a revised childhood schedule sorted into three categories: recommended for all children, recommended for certain high-risk groups, and SCDM. It combined six changes drafted by federal officials with two earlier ACIP changes. | Jan 5, 2026 | CDC, CRS |
| ACIP postponed its February meeting, the first on its calendar after the childhood schedule overhaul. |
Feb 2026 |
JHU IVAC |
| In American Academy of Pediatrics v. Kennedy, a federal district court stayed the 2026 childhood schedule, 13 ACIP appointments, and every ACIP vote taken after June 11, 2025. ACIP's March meeting was postponed. | Mar 16, 2026 | CRS, NACCHO |
| AHIP, the national trade group for health insurers, extended its members' no-cost-sharing coverage of ACIP-recommended immunizations through the end of 2027. | May 2026 | AHIP |
| CDC renewed ACIP's charter with revisions. Members can now come from a wider range of fields, safety and evidence gaps get more weight, and the committee must factor in other preventive options. | May 19, 2026 | CRS |
| Executive Order 14407 directed CDC and ACIP to review the January 2026 schedule and take steps to update the child and adolescent schedules. | May 29, 2026 | CRS |
| HHS asked the appeals court to fast-track its challenge to the March stay. ACIP's June 24–26 meeting was canceled. | June 2026 | CIDRAP |
| CDC said the July 2025 schedule's recommendations remain in effect for the 2026–27 season, citing legal uncertainty. This applies to flu (Sept. 1) and COVID-19 (Sept. 23). |
Sept 2026 | CDC flu, CDC COVID-19 |
The January 2026 schedule changed recommendations for 10 vaccines and left nine alone: dengue, DTaP, Hib, polio, MMR, MenB, pneumococcal, Tdap, and varicella. Because of the court's decision to stay (pause) the changes, none of the changes below are currently in effect. That could change depending on how the appeal is decided.
Some states are widening their sources of guidance. Before 2025, Colorado based its school immunization requirements on ACIP alone. The state now also draws on recommendations from the American Academy of Family Physicians (AAFP), the American College of Obstetricians and Gynecologists (ACOG), and the American College of Physicians (ACP).
What's been announced and what's enforced aren't always the same. Under the court's stay, the federal schedules largely match their January 2025 versions, with two exceptions: the April 2025 recommendations and the May 2025 COVID-19 change remain in effect. Here's where things stand on the questions immunization teams are fielding this fall:
State law sets school requirements, and many of those laws point back to ACIP. That's how federal vaccine schedule changes can still reach local requirements, insurance coverage, and who's allowed to give a vaccine. Before updating standing orders or talking points, confirm the current federal and state guidance with your state immunization program.
Counseling is the public-facing side of shifting guidance, and it's where teams feel it most. In all, 43% of respondents named counseling patients and answering their questions as their biggest source of extra work. When recommendations change, families call, and frontline staff at local health departments (LHDs) pick up the phone. One respondent described "a fairly steady flow of calls" about what's required versus recommended.
Updating clinical protocols or standing orders came second at 28%. That's the behind-the-scenes work. Every change can mean revising standing orders, retraining staff, and double-checking that everyone's working from the same version.
Smaller shares pointed to vaccine ordering and inventory, including VFC (6%), coordinating with outside providers or schools (6%), and updating records in the immunization information system, or IIS (1%).
Not every team feels the strain. 1 in 10 respondents reported minimal impact on their work. Another said getting students immunized before school starts is a challenge every year, federal changes or not.
Most teams say they're managing. Among respondents, 41% feel somewhat prepared to answer questions about schedule changes, and 29% feel very prepared with clear, current talking points. That's 71% combined.
Others are on shakier footing. Close to one in five (18%) said readiness varies day to day, and 10% said they could use better resources. One respondent put it bluntly: "We have no idea what we are doing because they keep changing the rules."
The respondents who felt most prepared tied that confidence to clear, current talking points. That lines up with what NACCHO has heard from its members, who say the federal changes have added to public confusion and made communication harder for LHDs.
Our read: readiness depends heavily on how well guidance is organized and shared inside a department, and a health department can control that part even while federal policy keeps moving.
School requirements came up more than any other topic.
Variations of this question appeared repeatedly: "What is actually required and recommended?" and "Why do we need all of these vaccines for school?" When federal recommendations shift, families naturally wonder whether school requirements shifted too. Because those requirements come from state law, the answer depends on where the family lives.
One respondent said most of the immunization questions they field involve what a child needs for school or a request for a copy of the child's records for camp enrollment. Fast, accurate access to records matters most during those seasonal peaks.
Some questions focus on the vaccines themselves: "Is it safe?" and "Is this an mRNA vaccine?" These call for consistent, clinician-approved answers that staff can give with confidence.
One respondent observed that health departments mostly see families who already plan to vaccinate, and many of them haven't heard much about the changing guidance. Among families who have, some are limiting vaccinations or asking how to request an exemption. As this respondent summed it up, families say "they don't know whom to trust anymore."
The first four steps come from what respondents told us. The fifth comes from NACCHO's guidance for local health departments.
Shifting guidance has added real work for immunization teams, from rewriting standing orders to fielding the same school question from family after family. Most teams are keeping up, and those with clear, up-to-date talking points feel the most prepared. With the appeal still pending, more vaccine schedule changes are possible. Health departments that have a routine for absorbing them will feel the next round less.
Patagonia Health collected 68 anonymous responses through an online form between June 2 and September 10, 2026. Respondents included community health workers, clinical staff, immunization coordinators, and front-desk staff. Quotes appear only from respondents who gave permission to share them. Percentages are rounded, so totals may not equal 100%. Because this is a voluntary sample, results reflect the teams that responded and may not represent all U.S. health departments.
Thank you to every immunization specialist, nurse, community health worker, and coordinator who took the time to share their experience with us.
For more insights from public health teams, subscribe to our content updates.
Patagonia Health is public health's most trusted EHR, Practice Management, and Billing solution. We empower you with the tools you need to simplify admin work and transform care in your community.