Host: Dr. Liz Mumper | Guests: Dr. Kirk Milhoan
Recent updates to the U.S. childhood immunization schedule have raised questions for many parents. Understanding what’s new, why changes were made, and how they may affect your child can help families feel more confident and informed. This conversation builds on recent discussions while focusing on the newest updates parents are hearing about now.
Pediatrician and host Dr. Elizabeth Mumper is joined by Dr. Kirk Milhoan, IMA Senior Fellow and Chairman of the Advisory Committee on Immunization Practices (ACIP), for a timely and approachable discussion on the latest updates to the childhood vaccine schedule. Together, they’ll break things down in a clear, practical way and share what parents should know when talking with their child’s doctor.
For the first time in a generation, the U.S. childhood vaccine schedule is getting smaller, not larger. The one-size-fits-all approach that turned recommendations into mandates is giving way to something IMA has advocated for years: individualized, risk-based decision-making that puts parents and doctors back in charge. If you’ve been waiting for this shift, it’s here.
This conversation builds on IMA’s December discussion about the Hepatitis B birth dose decision—but goes further. The full scope of the HHS directive is now clearer, and parents heading into well-child visits deserve practical guidance on what to expect, what questions to ask, and how to work with their pediatrician. In this episode, pediatrician Dr. Elizabeth Mumper is joined by Dr. Kirk Milhoan, IMA Senior Fellow and Chairman of the Advisory Committee on Immunization Practices (ACIP), for a timely discussion that cuts through confusion and puts families back in the driver’s seat.
Meet the Experts
IMA Senior Fellow and pediatrician. Author of the Parent’s Guide to Childhood Immunizations and host of the IMA series Kids’ Corner with Dr. Liz. Dr. Mumper has spent decades helping families navigate complex vaccine decisions with clarity, evidence, and respect for informed consent.
IMA Senior Fellow and Chair of the Advisory Committee on Immunization Practices. A pediatric cardiologist and medical missionary, Dr. Milhoan brings both clinical and ethical experience to vaccine policy discussions. His work with IMA on pediatric care and medical ethics is collected here.
What’s Actually Changed: The Full Picture
At the direction of the President, HHS was asked to develop a vaccine schedule that more closely reflects what peer countries around the world are doing. The result is outlined in a white paper by Tracy Beth Hoag and Martin Kulldorff titled Assessment of the U.S. Childhood and Adolescent Immunization Schedule Compared to Other Countries.
The approach was straightforward: identify which vaccines all peer countries agree on. That analysis landed on roughly 10 vaccines—comparable to Denmark’s schedule, with minor differences around varicella and HPV. The previous U.S. schedule covered approximately 18 disease states. The new one reduces both the total number of vaccines and the total number of injections considerably.
But here’s the critical point many headlines miss: nothing has been taken away.
“All of the vaccines are still available. All the vaccines are still fully covered by insurance. None of that has changed. If a doctor wants to go back and do the schedule exactly how they did it two years ago, they can do that.” — Dr. Kirk Milhoan
What changed is the framing. The schedule has shifted from a community-based, one-size-fits-all model to a risk-based, patient-centered approach. Dr. Milhoan explains that in previous decades, pediatricians routinely made individualized decisions—certain vaccines were reserved for specific risk groups, like yellow fever for travelers to West Africa or rabies for zoo workers. Over time, that reasoning gave way to the idea that if something was good for one, it was good for everyone.
This update reverses that drift.
“What HHS did was go much more risk-based, individual-based, freedom-based—and less authoritarian. But for people who want that, nothing’s been taken away.” — Dr. Kirk Milhoan
👉 Read more: Assessment of the U.S. Childhood and Adolescent Immunization Schedule Compared to Other Countries
Recommendation vs. Mandate: Why Words Matter
One of the most important distinctions in the conversation is what a “recommendation” actually means, and how it has historically functioned in practice.
ACIP is an advisory committee. It cannot mandate anything. But because federal funding, Medicaid coverage, and the Vaccines for Children program are tied to ACIP recommendations, those recommendations have carried enormous downstream weight. Schools, employers, and hospitals have used them as the basis for requirements. The word “recommended” has often operated as a de facto mandate.
Dr. Milhoan explains that ACIP is working to change that dynamic. The new language uses terms like “suggested” and emphasizes shared decision-making rather than blanket policy. The goal is to return authority to where it belongs: the conversation between doctor and patient.
“We’re trying to take away the stigma of ‘well, you didn’t do it the right way.’ You weren’t with me with this patient—I did right for the patient.” — Dr. Kirk Milhoan
There’s also a legal dimension worth understanding. Attorney Aaron Siri has raised questions about whether the liability protections granted to vaccine manufacturers under the 1986 National Childhood Vaccine Injury Act apply only to vaccines that are “recommended.” If a vaccine moves to shared decision-making status, does that change the liability landscape? This hasn’t been tested in court, but it’s part of the broader conversation about what words like “recommended” actually mean in practice.
For parents, the takeaway is simpler: recommendations are not requirements. The new framework makes that explicit.
Why Recommendations Change: The Science Behind the Shift
Dr. Mumper asks a question many parents wonder about: why would recommendations change at all? Isn’t the science settled?
The answer is that science is never settled… it evolves. And vaccine policy should evolve with it.
Dr. Milhoan identifies several reasons why revisiting the schedule makes sense now. First, peer country data shows that children in Denmark, Japan, Germany, France, and Norway are not experiencing dramatically different health outcomes despite receiving fewer vaccines. If outcomes are comparable, why assume more is always better?
Second, treatment options have improved. Medicine in 2025 is not medicine in 1965. A disease that was untreatable decades ago may now be manageable. And of course, that fact changes the risk-benefit calculus.
“It’s never wrong to say, ‘Okay, do we still need this?’ We needed it in 1960. It was beneficial in 1960. How beneficial, I don’t know—because a lot of things changed. It’s just being willing to look at everything and ask the question.” — Dr. Kirk Milhoan
Third, longer-term risks are becoming visible. Dr. Mumper raises the explosion of autoimmune disease in the United States and the plausible mechanisms that could contribute, namely molecular mimicry, adjuvant-driven immune activation, repeated antigen exposure. Many vaccines were studied for shockingly short periods. The Hepatitis B vaccine, for example, was monitored for side effects for only four to five days. Autoimmune conditions can take a decade or more to manifest. Without long-term surveillance, those signals are easy to miss.
“When we are giving something to a healthy child, the risk must be infinitely low. All injected products have risks. We need to look to see if the risk is lower than the benefit.” — Dr. Kirk Milhoan
The committee’s approach is to ask better questions, look at real-world outcomes across countries, and be willing to update policy when the evidence warrants it.
Practical Guidance: What to Expect at Your Next Well-Child Visit
So where does all this change leave parents?
The reality is that responses from pediatricians will vary. Some will continue with the previous schedule unchanged. Others will welcome parental input and use the new framework as an opportunity for discussion. Dr. Milhoan shares an encouraging example: one family reported receiving a sheet with QR codes linking to risk-benefit information for each vaccine their child was scheduled to receive. That kind of proactive transparency is exactly what ACIP is trying to encourage.
At minimum, parents should receive a Vaccine Information Statement (VIS) for each vaccine. ACIP has been working with the CDC to update these documents with the latest data. But beyond paperwork, what matters most is the conversation.
Dr. Milhoan offers a practical communication tip: ask “what” questions rather than “why” questions. A “what” question invites explanation. A “why” question can feel accusatory. For example, “What is the benefit of this vaccine for my child?” opens dialogue. “Why are you giving my child this?” can put a doctor on the defensive.
“I would encourage parents to ask ‘what’ questions. Go in looking to understand what they are saying—and wanting them to understand your concerns.” — Dr. Kirk Milhoan
Dr. Mumper adds important context: pediatricians are often under enormous time pressure. Many are expected to see four or five patients per hour. A short or hurried answer may reflect scheduling constraints, not indifference. If a conversation feels rushed or dismissive, it may simply be a sign that the fit isn’t right—and that’s okay.
“Have confidence in your instincts as a parent. Maternal instincts are honed over millennia to take care of your baby. If you start to feel uncomfortable or coerced, it’s perfectly within your right to politely leave.” — Dr. Liz Mumper
The goal isn’t to walk in looking for a fight. It’s to find a provider who will sit with you, answer your questions, and respect your role in the decision.
The IMA Parents Guide: Ahead of the Curve
Dr. Mumper notes that IMA developed its Parent’s Guide to Childhood Immunizations several years ago, based on her own experience using a modified vaccine schedule in clinical practice. That guide emphasized individualized risk assessment, parental choice, and a scaled-back approach for low-risk children.
Ironically, the schedule IMA recommended then now closely mirrors what the CDC has just endorsed. Followers of IMA got a preview of where vaccine policy was heading—years before it arrived.
“One could argue that those of you who are followers of IMA got a little preview of what’s happened this year—a couple years ago.” — Dr. Liz Mumper
IMA plans to update the guide to reflect the new alignment, but the core principles remain unchanged: assess individual risk, respect informed consent, and support the doctor-patient relationship.
👉 Learn more: Parent’s Guide to Childhood Immunizations
Moving Forward with Confidence
The conversation closes with reassurance for parents who may feel anxious about upcoming decisions or about vaccines their children have already received.
Dr. Milhoan is direct: if your child has completed the full schedule and is healthy, there’s no reason to spiral into worry.
“Enjoy your child. If your child doesn’t have any effects, be thankful. Be a good mom and take care of your child. Don’t start worrying about something until your kid shows you something.” — Dr. Kirk Milhoan
Dr. Mumper addresses the deeper emotional layer: maternal guilt. Mothers, she observes, are relentlessly hard on themselves. They feel guilty for what they did, what they didn’t do, and everything in between. But the truth is that parents made the best decisions they could with the information available at the time. And much of what happens in life isn’t fully within anyone’s control.
“You made the best decision you could with the information you had at the time. Let yourself off the hook.” — Dr. Liz Mumper
The path forward is not about regret. It’s about being informed, asking good questions, and finding providers who treat you as a partner in your child’s care.
📢 IMA News & Announcements
- Journal of Independent Medicine: We’re excited to announce the release of the latest issue, marking the start of its second year of conflict-free, evidence-based science. This issue covers vaccination, COVID-19, euthanasia and assisted suicide, socio-political conformity, and more.
- Congratulations to Dr. Kimberly Biss on her appointment to the Advisory Committee on Immunization Practices. She joins fellow IMA leaders Dr. Kirk Milhoan and Dr. Robert Malone on the panel—marking another important step toward patient-centered, transparent reform in U.S. healthcare.
- Stand for Health Freedom Coalition: IMA is part of a growing coalition working to advance state legislation that protects medical freedom and pushes back against mandates and enforced medical interventions. Idaho just passed a key bill. Indiana is next. If you’re an Indiana resident, visit standforhealthfreedom.com for more information on SB 174 and take action:
