28 US States Continue Following the AAP’s Original Vaccine Schedule

Introduction

The United States is experiencing an increasingly fragmented childhood vaccination landscape as states respond differently to changes in federal vaccine recommendations. Twenty-eight states, including Washington, D.C., announced that they would not follow the revised federal childhood vaccine recommendations for at least some vaccines, with most choosing to rely on the broader schedule supported by the American Academy of Pediatrics (AAP).

The development follows a major shift in U.S. vaccine policy in 2026, when federal recommendations were narrowed and the AAP chose to maintain its longstanding approach to routine childhood immunization.

AAP Maintains Broader 2026 Vaccine Recommendations

The AAP's 2026 childhood and adolescent immunization schedule continues to recommend routine protection against 18 infectious diseases. This includes vaccines covering diseases such as measles, influenza, hepatitis A and B, rotavirus, respiratory syncytial virus (RSV), and meningococcal disease.

The AAP's position differs from the revised federal approach, which reduced the number of diseases covered by routine childhood vaccination recommendations. The change created a significant policy divide between federal health authorities and major pediatric and medical organizations.

The AAP has argued that its recommendations are based on vaccine safety evidence, disease epidemiology in the United States, and vaccine effectiveness.

Why States Are Choosing the AAP Schedule

The decision by states to continue using the AAP's broader recommendations is largely connected to concerns about maintaining established childhood immunization practices.

According to KFF, as of January 20, 2026, 28 states including Washington, D.C., had announced that they would not follow the revised federal recommendations for at least some childhood vaccines. Most of these states indicated that they would rely on AAP recommendations, previous federal guidance, or state-level recommendations.

Among the states departing from the revised federal recommendations, 25 had announced plans covering all childhood vaccines, while others were taking a more selective approach.

Several multistate public health alliances have also supported the AAP approach. These include the West Coast Health Alliance, involving California, Hawaii, Oregon, and Washington, and the Northeast Public Health Collaborative, which includes ten states and New York City.

Federal and AAP Recommendations Diverge

The disagreement became particularly significant after federal health authorities revised the childhood vaccine schedule.

Under the revised federal recommendations, several vaccines that had previously been routinely recommended for all children were moved into more limited categories or were no longer routinely recommended for every child.

The AAP, however, retained routine recommendations for these vaccines, arguing that maintaining broad protection is important given the epidemiological conditions and healthcare realities in the United States.

This divergence means that a child living in one state may receive vaccination guidance that differs from that provided to a child in another state.

A New Patchwork of Vaccine Policies

The changing landscape has created what health policy experts describe as a patchwork of vaccination recommendations.

Families may now encounter guidance from multiple sources, including:

• Federal health authorities

• State health departments

• The American Academy of Pediatrics

• Other medical organizations

• Regional public health alliances

• Individual healthcare providers

The situation can create additional challenges for pediatricians and parents trying to determine which recommendations apply to a particular child.

State policy can also affect practical issues such as school-entry requirements, insurance coverage, vaccine availability, and who is authorized to administer certain vaccines.

Medical Organizations Support the AAP

The AAP's 2026 schedule has received support from numerous medical and healthcare organizations.

Organizations endorsing or supporting the AAP schedule include the American Medical Association (AMA), American Academy of Family Physicians (AAFP), American College of Obstetricians and Gynecologists (ACOG), American Pharmacists Association (APhA), Infectious Diseases Society of America (IDSA), and other professional groups.

This broad professional support strengthens the position of the AAP schedule as an alternative reference point for states and healthcare professionals.

Public Health Concerns

The disagreement over vaccine recommendations comes at a particularly important time for U.S. public health.

The country has experienced significant measles activity during 2026. The AAP reported that more than 1,100 confirmed measles cases had been recorded in the United States by late February, with cases reported across multiple states.

Measles is highly contagious, and maintaining high vaccination coverage is considered an important tool for preventing outbreaks.

Public health experts have therefore expressed concern that conflicting recommendations could create confusion among parents and contribute to delayed or missed vaccinations.

What the 28-State Shift Means

The decision by 28 states to depart from revised federal recommendations demonstrates that vaccine policy in the United States is becoming increasingly decentralized.

For healthcare providers, the change means they may need to navigate different recommendations depending on the state in which they practice.

For families, the key issue is understanding which schedule their state's health authorities and healthcare providers recognize, particularly when federal and professional medical guidance differs.

The situation also demonstrates the growing influence of state governments and professional medical organizations in shaping public health policy.

Looking Ahead

The U.S. childhood vaccination landscape is likely to remain dynamic throughout 2026 as federal policy, state decisions, medical guidance, and ongoing legal developments continue to interact.

The divide between the federal recommendations and the AAP's broader schedule has already demonstrated that the United States no longer has a single universally accepted framework for childhood vaccination policy.

For parents and caregivers, pediatricians and state health departments remain important sources for determining which vaccines are recommended for an individual child and when they should be administered.

Conclusion

The decision by 28 states, including Washington, D.C., to move away from revised federal childhood vaccine recommendations and largely rely on the AAP's broader schedule represents a major development in U.S. public health policy.

The AAP continues to recommend routine vaccination against 18 diseases, while states and medical organizations have increasingly asserted their own role in determining childhood immunization policy.

As federal and state approaches continue to diverge, the central challenge will be maintaining clear, evidence-based vaccination guidance while minimizing confusion for healthcare professionals and families.