By Nicolas Hulscher, MPH

CDC SHRINKS ROUTINE CHILDHOOD VACCINE SCHEDULE BY ~55 DOSES

Today, the CDC formally adopted a revised childhood and adolescent immunization schedule, following a Presidential Memorandum directing alignment with international best practices.

This marks the largest rollback of routine childhood vaccination in U.S. history.

After reviewing peer-country schedules and the scientific evidence underlying them, federal health leadership acknowledged that we are hyper-vaccinating our children.

The result is a dramatically smaller routine childhood vaccine schedule, cutting approximately 55 routine doses.

This is a major victory — even as serious safety concerns remain for the vaccines that continue to be recommended.

The Key Change: ~55 Routine Doses Eliminated

Previous U.S. routine schedule (2024)

• 84–88 routine vaccine doses
• Targeting 17 diseases
• (18 if RSV monoclonal antibody is included)

New CDC routine schedule (2026)

• ~30 routine doses
• Targeting 10–11 diseases
• Based on international consensus

Net change: approximately 54–58 routine doses removed, commonly summarized as ~55 routine doses.

Importantly, this reduction applies only to vaccines previously labeled “routine for all children.” No vaccines were banned or removed from availability.

What Was Removed from the Routine Schedule

The following vaccines are no longer recommended for all children by default:

• COVID-19
• Influenza
• Hepatitis A
• Hepatitis B (including removal of the universal birth dose if the mother is HBsAg-negative)
• Rotavirus
• Meningococcal ACWY
• Meningococcal B

These vaccines account for nearly the entire ~55-dose reduction.

What Remains Routine

The CDC now limits routine childhood vaccination to the following vaccines:

• Measles, Mumps, Rubella (MMR)
• Diphtheria
• Tetanus
• Pertussis
• Polio
• Haemophilus influenzae type B (Hib)
• Pneumococcal disease
• Varicella (chickenpox)
• Human Papillomavirus (HPV), reduced from two doses to one

This is still not “safe by default”

These vaccines remain:

• Insufficiently studied for long-term outcomes
• Untested in placebo-controlled trials
• Never evaluated as a cumulative schedule
• Inducers of over 20 chronic diseases

Adverse events such as febrile seizures, severe neurological injury including autism, ADHD, tics, autoimmune disease, asthma, allergies, skin and gut disorders, ear infections, and a long list of other chronic diseases have been documented across multiple vaccines on this list:

BREAKING: Peer-Reviewed Reanalysis of the Henry Ford Birth Cohort Study Finds Vaccinated Children Sicker Across All 22 Chronic Disease Categories Nicolas Hulscher, MPH · December 11, 2025 Read full story

Reducing the schedule does not equal proving safety. It simply reduces exposure. Nonetheless, that reduction alone is quite meaningful.

Where Those Vaccines Went

Non-consensus vaccines were reclassified, not banned:

Shared Clinical Decision-Making

• COVID-19
• Influenza
• Hepatitis A
• Hepatitis B
• Rotavirus
• Meningococcal ACWY
• Meningococcal B

High-Risk Groups Only

• RSV monoclonal antibody
• Hepatitis A (travel, outbreaks, liver disease)
• Hepatitis B (HBsAg-positive or unknown maternal status)
• Dengue
• Meningococcal vaccines for defined risk groups

All remain available and fully covered by insurance. However, given entrenched institutional habits and ideological adherence to maximal vaccination, many clinicians are likely to continue promoting shared clinical decision-making vaccines as de facto routine unless families are informed and assertive.

Why This Is Still a Massive Win

For decades, the childhood vaccine schedule expanded without:

• Schedule-level safety trials
• Long-term outcome data
• Meaningful public debate
• Informed consent

This decision reverses that trajectory. It:

• Shrinks routine exposure dramatically
• Restores parental agency
• Forces future decisions to confront risk-benefit reality

Most importantly, it breaks the false premise that “more vaccines is always better.”

Conclusion

The CDC has eliminated every non-consensus vaccine from the routine childhood schedule, cutting routine exposure by approximately 55 doses—an implicit admission that the safety of the expanded schedule was never adequately established.

This decision does not end the problem. The vaccines that remain routinely recommended are still largely untested in long-term, placebo-controlled trials, are administered during critical periods of neurodevelopment, and continue to pose serious safety concerns. As a result, a substantial number of autism cases and other chronic conditions will continue to occur.

However, by sharply reducing cumulative exposure during early childhood, this change marks the first credible step toward reversing the trajectory. The burden of neurodevelopmental injury should begin to decline—not disappear, but diminish.

Even with its limitations, this action represents the most consequential course correction in U.S. pediatric vaccination policy in modern history. It breaks the assumption that an ever-expanding schedule is inherently safe, restores proportionality, and opens the door to long-overdue accountability, transparency, and real safety science.

Nicolas Hulscher, MPH

Epidemiologist and Foundation Administrator, McCullough Foundation

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From the Brownstone Institute

By Roger Bate  

Every morning, hundreds of millions of people perform a socially approved ritual. They line up for coffee. They joke about not being functional without caffeine. They openly acknowledge dependence and even celebrate it. No one calls this addiction degenerate. It is framed as productivity, taste, wellness—sometimes even virtue.

Now imagine the same professional discreetly using a nicotine pouch before a meeting. The reaction is very different. This is treated as a vice, something vaguely shameful, associated with weakness, poor judgment, or public health risk.

From a scientific perspective, this distinction makes little sense.

Caffeine and nicotine are both mild psychoactive stimulants. Both are plant-derived alkaloids. Both increase alertness and concentration. Both produce dependence. Neither is a carcinogen. Neither causes the diseases historically associated with smoking. Yet one has become the world’s most acceptable addiction, while the other remains morally polluted even in its safest, non-combustible forms.

This divergence has almost nothing to do with biology. It has everything to do with history, class, marketing, and a failure of modern public health to distinguish molecules from mechanisms.

Two Stimulants, One Misunderstanding

Nicotine acts on nicotinic acetylcholine receptors, mimicking a neurotransmitter the brain already uses to regulate attention and learning. At low doses, it improves focus and mood. At higher doses, it causes nausea and dizziness—self-limiting effects that discourage excess. Nicotine is not carcinogenic and does not cause lung disease.

Caffeine works differently, blocking adenosine receptors that signal fatigue. The result is wakefulness and alertness. Like nicotine, caffeine indirectly affects dopamine, which is why people rely on it daily. Like nicotine, it produces tolerance and withdrawal. Headaches, fatigue, and irritability are routine among regular users who skip their morning dose.

Pharmacologically, these substances are peers.

The major difference in health outcomes does not come from the molecules themselves but from how they have been delivered.

Combustion Was the Killer

Smoking kills because burning organic material produces thousands of toxic compounds—tar, carbon monoxide, polycyclic aromatic hydrocarbons, and other carcinogens. Nicotine is present in cigarette smoke, but it is not what causes cancer or emphysema. Combustion is.

When nicotine is delivered without combustion—through patches, gum, snus, pouches, or vaping—the toxic burden drops dramatically. This is one of the most robust findings in modern tobacco research.

And yet nicotine continues to be treated as if it were the source of smoking’s harm.

This confusion has shaped decades of policy.

How Nicotine Lost Its Reputation

For centuries, nicotine was not stigmatized. Indigenous cultures across the Americas used tobacco in religious, medicinal, and diplomatic rituals. In early modern Europe, physicians prescribed it. Pipes, cigars, and snuff were associated with contemplation and leisure.

The collapse came with industrialization.

The cigarette-rolling machine of the late 19th century transformed nicotine into a mass-market product optimized for rapid pulmonary delivery. Addiction intensified, exposure multiplied, and combustion damage accumulated invisibly for decades. When epidemiology finally linked smoking to lung cancer and heart disease in the mid-20th century, the backlash was inevitable.

But the blame was assigned crudely. Nicotine—the named psychoactive component—became the symbol of the harm, even though the damage came from smoke.

Once that association formed, it hardened into dogma.

How Caffeine Escaped

Caffeine followed a very different cultural path. Coffee and tea entered global life through institutions of respectability. Coffeehouses in the Ottoman Empire and Europe became centers of commerce and debate. Tea was woven into domestic ritual, empire, and gentility.

Crucially, caffeine was never bound to a lethal delivery system. No one inhaled burning coffee leaves. There was no delayed epidemic waiting to be discovered.

As industrial capitalism expanded, caffeine became a productivity tool. Coffee breaks were institutionalized. Tea fueled factory schedules and office routines. By the 20th century, caffeine was no longer seen as a drug at all but as a necessity of modern life.

Its downsides—dependence, sleep disruption, anxiety—were normalized or joked about. In recent decades, branding completed the transformation. Coffee became lifestyle. The stimulant disappeared behind aesthetics and identity.

The Class Divide in Addiction

The difference between caffeine and nicotine is not just historical. It is social.

Caffeine use is public, aesthetic, and professionally coded. Carrying a coffee cup signals busyness, productivity, and belonging in the middle class. Nicotine use—even in clean, low-risk forms—is discreet. It is not aestheticized. It is associated with coping rather than ambition.

Addictions favored by elites are rebranded as habits or wellness tools. Addictions associated with stress, manual labor, or marginal populations are framed as moral failings. This is why caffeine is indulgence and nicotine is degeneracy, even when the physiological effects are similar.

Where Public Health Went Wrong

Public health messaging relies on simplification. “Smoking kills” was effective and true. But over time, simplification hardened into distortion.

“Smoking kills” became “Nicotine is addictive,” which slid into “Nicotine is harmful,” and eventually into claims that there is “No safe level.” Dose, delivery, and comparative risk disappeared from the conversation.

Institutions now struggle to reverse course. Admitting that nicotine is not the primary harm agent would require acknowledging decades of misleading communication. It would require distinguishing adult use from youth use. It would require nuance.

Bureaucracies are bad at nuance.

So nicotine remains frozen at its worst historical moment: the age of the cigarette.

Why This Matters

This is not an academic debate. Millions of smokers could dramatically reduce their health risks by switching to non-combustion nicotine products. Countries that have allowed this—most notably Sweden—have seen smoking rates and tobacco-related mortality collapse. Countries that stigmatize or ban these alternatives preserve cigarette dominance.

At the same time, caffeine consumption continues to rise, including among adolescents, with little moral panic. Energy drinks are aggressively marketed. Sleep disruption and anxiety are treated as lifestyle issues, not public health emergencies.

The asymmetry is revealing.

Coffee as the Model Addiction

Caffeine succeeded culturally because it aligned with power. It supported work, not resistance. It fit office life. It could be branded as refinement. It never challenged institutional authority.

Nicotine, especially when used by working-class populations, became associated with stress relief, nonconformity, and failure to comply. That symbolism persisted long after the smoke could be removed.

Addictions are not judged by chemistry. They are judged by who uses them and whether they fit prevailing moral narratives.

Coffee passed the test. Nicotine did not.

The Core Error

The central mistake is confusing a molecule with a method. Nicotine did not cause the smoking epidemic. Combustion did. Once that distinction is restored, much of modern tobacco policy looks incoherent. Low-risk behaviors are treated as moral threats, while higher-risk behaviors are tolerated because they are culturally embedded.

This is not science. It is politics dressed up as health.

A Final Thought

If we applied the standards used against nicotine to caffeine, coffee would be regulated like a controlled substance. If we applied the standards used for caffeine to nicotine, pouches and vaping would be treated as unremarkable adult choices.

The rational approach is obvious: evaluate substances based on dose, delivery, and actual harm. Stop moralizing chemistry. Stop pretending that all addictions are equal. Nicotine is not harmless. Neither is caffeine. But both are far safer than the stories told about them.

This essay only scratches the surface. The strange moral history of nicotine, caffeine, and acceptable addiction exposes a much larger problem: modern institutions have forgotten how to reason about risk.

Author

Roger Bate

Roger Bate is a Brownstone Fellow, Senior Fellow at the International Center for Law and Economics (Jan 2023-present), Board member of Africa Fighting Malaria (September 2000-present), and Fellow at the Institute of Economic Affairs (January 2000-present).