Wisconsin rejects CDC vaccine changes, recommends guidance from pediatrics group
A nurse gives a vaccine to a child. (Getty Images)
State health officials won’t change their recommendations for childhood vaccines, endorsing the guidance of the American Academy of Pediatrics, the Wisconsin Department of Health Services announced Thursday.
The announcement comes three days after the federal Centers for Disease Control and Prevention on Monday scaled back its list of recommended childhood vaccines — reducing the number of diseases for which vaccines are recommended for all children from 17 to 11.
The scaled-down recommendation has alarmed public health organizations and providers across the country.
“No new clinical data on either safety or effectiveness were presented that would justify these changes,” wrote Dr. Ryan Westergaard, the DHS chief medical officer and state epidemiologist for communicable disease, in a memo sent Thursday to providers and organizations that offer vaccination services in Wisconsin.

In place of the revised CDC recommendation, DHS is recommending that health providers refer to the immunization schedule published by the American Academy of Pediatrics “as the standard of care when they provide care to children and adolescents,” Westergaard said Thursday afternoon.
“We update recommendations when new, high-quality evidence shows that a change would improve safety or effectiveness,” he told reporters at a media briefing. “We’ve not seen any new evidence that would justify changing long-standing recommendations that have successfully protected children in the United States for decades.”
In the CDC’s new list, some vaccines formerly recommended for all children were reclassified as primarily for “certain high risk groups,” Westergaard said. Other vaccines were assigned a category to be considered “only after an individualized risk assessment.”
After reviewing those changes, however, DHS concluded there was no reason to change Wisconsin’s childhood vaccination recommendations.
“In the past 48 hours, multiple state health departments and leading health and medical organizations have independently reached the same conclusion and issued similar public statements,” Westergaard said.
The immunization schedules by themselves don’t create legal requirements or mandates. But they have historically been based on “rigorous, transparent processes to evaluate vaccine safety, effectiveness,” he said. “Parents and health care professionals deserve information that’s accurate, credible and consistent.”
Public health professionals have been concerned about declining vaccination rates in Wisconsin, including among children, in recent years. “They’re not as high as we wish they were,” Westergaard said. While most parents do get their children fully vaccinated, “we want that to be as close to 100% as we can.”
But he said he hopes the federal changes will not deter families from getting their children vaccinated. Since the CDC announcement, state and local health departments along with health professionals’ organizations “are speaking with one voice” on the importance of vaccine schedules and the evidence to support them “as the best ways to keep our children healthy,” he said.
Although the CDC has stopped requiring states to report vaccination rates, he said DHS will continue to track that information.
Comparing other countries
The CDC’s revisions followed a directive in December from President Donald Trump to look to other developed countries, including Denmark, in revising the U.S. vaccine schedule. Federal officials said the change was based on that review and called the U.S. a “global outlier” for the number of diseases and vaccine doses in its recommendations.
“Copying another country’s schedule without its health and social infrastructure will not produce the same health outcomes,” DHS Secretary Kirsten Johnson said in a statement Thursday. “It creates chaos and confusion and risks the health of Wisconsin’s youngest and most vulnerable citizens.”
While some other countries have fewer routinely recommended vaccines on their schedules, Westergaard said those comparisons ignored other important factors.
Denmark, for instance, has a smaller and less diverse population, with disease risks that are different from the U.S., and with “a health system that has universal access and very strong primary care continuity,” he said.
“Vaccine schedules are designed around local disease epidemiology and health system capacity,” Westergaard said. “So what works well in Denmark does not automatically translate to a large, diverse country like the United States, which faces different risks, different barriers to other types of preventive care. That’s why US vaccine recommendations should be based on U.S. data and U.S. public health realities.”
Until now, the CDC’s vaccine advisors “have focused on those on-the-ground public health realities, equity concerns, economic concerns in the United States,” he added. “That lens was not used by the federal government” when making its latest changes.
Overcoming confusion
He suggested that parents who may be confused by the new differences between CDC recommendations and those being made by Wisconsin health officials should talk to their personal physicians.
“We want to communicate to Wisconsin families and communities that the science hasn’t changed and our recommendations haven’t changed,” Westergaard said. The department is also sending the message to the medical community that the state and local health departments along with other health care leaders all agree on maintaining the past recommendations.
He suggested that the CDC decision to reclassify some diseases that were previously targeted for universal vaccination as better left to “shared decision-making” on the part of providers and patients is problematic.
“I am very pro-shared clinical decision-making,” said Westergaard, calling informed consent an “ironclad ethical principle” in medical care.
A universal vaccine schedule doesn’t take that away, he said. But in the past, the CDC and its vaccine advisory panel has distilled a deep reservoir of scientific literature to identify vaccines for which the evidence is especially strong, making them appropriate for virtually the entire population with only limited exceptions.
In those evaluations, “shared clinical decision-making has been a flag to say, ‘Well, the evidence might not be quite as strong,’” Westergaard said — warranting individual doctor-patient discussions.
For a vaccine that has already passed muster as widely beneficial, the universal recommendation “can save us a lot of time rather than for individual clinicians to look at data, to look up articles, look up reviews for individual vaccines,” he said.
The science behind the schedule before the CDC made its changes this week “hasn’t changed at all,” Westergaard said, and the AAP’s schedule reflects the longstanding consensus process.
“That’s the type of thoroughness that is absent from the memo that the federal government released this week that we wanted to draw attention to, and why we shouldn’t change practice based on that — because it hasn’t used that same consensus-building process,” Westergaard said.
DHS administers Wisconsin’s Medicaid programs and said the health insurance program for people with low incomes will cover all the recommended vaccines, including for newborns. They will also remain covered under the Vaccines for Children program.
The Office of the Commissioner of Insurance issued a reminder Thursday that state law requires individual, small group and self-funded health plans to cover immunizations for patients and their dependents from birth without a copayment.
- To check on a child’s vaccine status and recommended vaccines see the Wisconsin Immunization Registry.
- For clinicians, refer to the DHS Recommended Vaccination Schedule for Wisconsinites.
This report was updated following a DHS media briefing on its announcement Thursday.
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