RFK Jr. Signals a Shift in How Vaccine Recommendations Are Categorized

Health Secretary Robert F. Kennedy Jr. is exploring changes to how the Centers for Disease Control and Prevention categorizes vaccine recommendations — a move that could reframe vaccines currently described as universally recommended as more conditional advice.

In a 10-page Request for Information published Friday and posted in the Federal Register Monday, Kennedy posed a series of questions about the three existing recommendation categories used by the CDC's Advisory Committee on Immunization Practices (ACIP), asking the public to weigh in on potential alternatives by a September 20 deadline.

The current categories

ACIP currently classifies vaccines into three tiers:

• Routine — vaccines recommended for all people in a specific age group, with no known contraindications.
• Risk-based — vaccines recommended only for people at higher risk due to age, occupation, or medical conditions.
• Shared Clinical Decision-Making (SCDM) — vaccines where the benefit is less certain, and providers discuss the trade-offs with each patient.

The proposed changes

Kennedy's RFI suggests replacing or supplementing the current framework with new designations such as "recommended with qualification" or "recommended based on shared clinical decision-making." The document does not propose specific rules but signals a preference for language that is "more transparent about the limitations of the evidence base."

The request asks commenters to address: whether the current categories are "clear and useful" to providers and the public; whether new categories would better reflect individualized risk; and how vaccine confidence might be affected by changes in how recommendations are described.

What hasn't changed

No new rules or recommendation changes have been issued. The RFI is explicitly exploratory — Kennedy has made no proposals for specific category changes, and the existing ACIP framework remains in effect. The CDC and ACIP have not signaled support for revising the categorization system, and outside public health experts say there is no evidence-based reason to alter categories that have guided clinical practice for years.

Background context

Kennedy, who was confirmed as health secretary in May 2026, has long been a vocal critic of vaccine mandates and has advocated for greater scrutiny of vaccine safety. He previously founded the nonprofit Children's Health Defense, which has promoted debunked claims about vaccine-autism links — claims that the broader medical community continues to reject.

The ACIP's current evidence-based decision-making framework evaluates each vaccine on the strength of clinical trial data, post-market surveillance, and epidemiological studies. Its recommendations are updated on a schedule and apply uniformly across the country unless superseded by state-level policy.