The American Academy of Pediatrics (AAP) has taken an unprecedented step by publishing its own independent childhood immunization schedule for 2025, marking the first time in 30 years that the nation’s leading pediatric organization has diverged from Centers for Disease Control and Prevention (CDC) guidance.

The split stems from Kennedy’s dramatic restructuring of the CDC’s Advisory Committee on Immunization Practices (ACIP), the influential panel that traditionally guides vaccine policy. In June 2025, Kennedy removed all 17 sitting ACIP members and replaced them with handpicked appointees, including several known vaccine skeptics.

Kennedy’s reconstituted ACIP has already begun altering childhood vaccine recommendations. On September 18, 2025, the committee voted 8-3 to no longer recommend the combined MMRV vaccine (measles, mumps, rubella, and varicella) for children under age 4, instead recommending separate MMR and varicella shots. 

The most significant departure between the AAP and CDC involves COVID-19 vaccination recommendations for children. While the CDC now suggests that parents of children aged 6 months to 17 years should discuss vaccination benefits with healthcare providers through “shared clinical decision-making,” the AAP has issued more definitive guidance.

The AAP recommends:

• Universal COVID-19 vaccination for all children ages 6-23 months without contraindications
• Risk-based vaccination for children and adolescents ages 2-18 who are at high risk, live in congregate settings, have never been vaccinated, or have high-risk household members
• Optional vaccination available for any child aged 2-18 whose parents desire protection, regardless of risk status

Beyond COVID-19, the AAP’s 2025 immunization schedule provides updated recommendations for 18 diseases, including significant updates for respiratory syncytial virus (RSV) and influenza vaccines. The schedule incorporates recent changes to pentavalent meningococcal vaccines, HPV vaccine starting ages, and removal of discontinued vaccines.

The document, updated September 17, serves as a comprehensive guide for pediatric healthcare providers navigating the current fragmented landscape of federal vaccine policy.

The schedule provides recommendations for 18 different diseases and includes detailed guidance for multiple vaccines and immunizations.

Complete Vaccine Schedule Overview

The AAP schedule includes vaccines for the following diseases and conditions:

Birth to 2 Years:

• Hepatitis B (HepB) – 3 doses starting at birth
• Respiratory Syncytial Virus monoclonal antibody (RSV-mAb) – 1 dose during RSV season
• Rotavirus (RV) – 2-3 doses depending on vaccine brand
• Diphtheria, Tetanus, and acellular Pertussis (DTaP) – 5 doses through age 6
• Haemophilus influenzae type b (Hib) – 3-4 doses
• Pneumococcal conjugate (PCV) – 4 doses
• Inactivated Poliovirus (IPV) – 4 doses
• COVID-19 vaccines – Age-specific recommendations
• Influenza – Annual vaccination starting at 6 months
• Measles, Mumps, and Rubella (MMR) – First dose at 12-15 months
• Varicella (Chickenpox) – First dose at 12-15 months
• Hepatitis A (HepA) – 2 doses starting at 12 months

Adolescent Years (11-18 years):

• Tetanus, Diphtheria, and acellular Pertussis booster (Tdap) – 1 dose at 11-12 years
• Human Papillomavirus (HPV) – 2-3 dose series starting at 9-12 years
• Meningococcal ACWY (MenACWY) – 2 doses at 11-12 and 16 years
• Meningococcal B (MenB) – Based on shared clinical decision-making
• RSV vaccine (Abrysvo) – For pregnant individuals

Additional Vaccines for Special Circumstances:

• Dengue vaccine – For ages 9-16 in endemic areas
• Mpox vaccine – For ages 18+ at risk

While COVID-19 vaccination represents the most significant departure from CDC guidance, the AAP schedule includes several other important differences:

COVID-19 Vaccination (Major Difference):

• AAP: Universal vaccination for ages 6-23 months; risk-based for ages 2-18
• CDC: Shared clinical decision-making approach for most age groups

MMRV Vaccine:

• AAP: Continues to recommend MMRV for children under 4
• CDC/ACIP: No longer recommends MMRV for children under 4 as of September 2025

RSV Immunization:

• Both schedules include comprehensive RSV prevention strategies
• Detailed guidance on nirsevimab and clesrovimab timing

Respiratory Virus Season Updates:

• Updated recommendations for influenza, RSV, and COVID-19 for the 2025-2026 season

The AAP’s comprehensive schedule has received support from multiple medical organizations beyond just COVID-19 recommendations. The American Academy of Family Physicians (AAFP) has endorsed similar evidence-based approaches to childhood immunizations, and numerous state medical associations have expressed support for maintaining science-based vaccination schedules.

The AAP’s 2025 immunization schedule represents a complete, evidence-based childhood vaccination program covering the full spectrum of vaccine-preventable diseases from birth through 18 years. While COVID-19 vaccination differences have garnered the most attention, the schedule encompasses all routine childhood immunizations and reflects the AAP’s commitment to providing comprehensive, science-based recommendations for pediatric preventive care.

The AAP has called on all insurers to cover vaccines included in its schedule, amid concerns that departures from federal recommendations could affect coverage. Under the Affordable Care Act (ACA), most private health insurance plans are legally required to cover vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) and adopted by the CDC Director at no cost to patients. This requirement creates a direct link between federal vaccine recommendations and insurance coverage obligations.

The federally funded Vaccines for Children program, which serves approximately 50% of all American children, automatically covers all vaccines recommended by ACIP and approved by the CDC. 

Both Medicaid and Medicare coverage requirements are tied to ACIP recommendations. The Inflation Reduction Act of 2022 specifically requires state Medicaid programs to cover all ACIP-recommended vaccines without cost-sharing, while Medicare Part D must cover vaccines recommended by ACIP that aren’t covered under Medicare Part B.

The AAP’s call for insurance coverage reflects concerns that departures from federal recommendations could create significant financial barriers for families. These costs could force parents to choose between financial hardship and protecting their children’s health, potentially leading to decreased vaccination rates and increased disease outbreaks.