State Recommendations for Routine Childhood Vaccines: Increasing Departure from Federal Guidelines

In anticipation of federal changes to vaccine policy by the Trump administration, last year, some states began to de-couple their own vaccine recommendations from the federal government. This marked a departure from prior practice where, historically, states typically relied on Centers for Disease Control and Prevention (CDC) and its Advisory Committee on Immunization Practices (ACIP) for such recommendations. Starting in May of last year, HHS Secretary Kennedy and the CDC/ACIP began to make changes to the federal vaccine schedule for children, culminating in an announcement on January 5 of this year with the most wide-ranging changes to date (see Table 1). Collectively, these changes have resulted in reducing the number of diseases targeted from 17 to 11 and the number of routine vaccines from 13 to 7. As part of these changes, six vaccines are no longer recommended for routine use by all children in the United States.

This policy brief tracks the number of states that have announced they are no longer following federal government recommendations for childhood vaccines as of January 20, 2026, updating an analysis from September of last year (while the current analysis focuses on state sources for childhood vaccine recommendations, our earlier analysis also looked at state actions regarding insurance coverage requirements and pharmacist administration). Overall, the number of states that have taken such an action has increased significantly since last September, with a majority of states (28) now departing from federal guidelines for some or all childhood vaccines compared to 22 states in September of last year (see Table 2). Moreover, the number of states decoupling their vaccine recommendations for all childhood vaccines has risen from just nine in September to 25. The red-blue divide across the country continues to grow, with all blue states¹ (those with Democratic governors) having announced that they will no longer follow federal guidelines, though four states with Republican governors have also done so.

Findings

As of January 20, 2026, the majority of states (28 states, including DC) have announced that they will not follow the new CDC childhood vaccine recommendations for at least some childhood vaccines, instead relying on prior recommendations, state recommendations, and/or those of external entities. Most of these states have indicated that they will follow the recommendations of the independent medical association, the American Academy of Pediatrics (AAP). Among these are two inter-state public health alliances which previously formed to develop shared recommendations and have reaffirmed their intent to follow AAP guidelines: the West Coast Health Alliance, which includes California, Hawaii, Oregon, and Washington, and the Northeast Public Health Collaborative, which includes ten states and New York City.

Almost all of these states (25 of 28) have announced that they will do so for all childhood vaccines. Most of these states are choosing to follow non-federal guidelines for all childhood vaccines. The three states that are more limited are Alaska and Mississippi, which announced that they would continue to recommend the Hepatitis B vaccine at birth for all infants, even those whose mothers test negative (no longer recommended as routine by the CDC), and Arizona, which has announced that it will continue to recommend Hepatitis B at birth and COVID-19 vaccines consistent with guidelines from external entities.

This marks a significant increase since September when only nine states had announced that they would not follow CDC/ACIP vaccine recommendations for all childhood vaccines (some also did so for adults). In September, most states that had announced changes did so for COVID-19 only (13), which at that time, was the only vaccine for which changes had been made by the federal government (removing the routine vaccination recommendation generally, including for children). With the changing recommendation regarding Hepatitis B vaccine in December of 2025 and additional vaccines in early January 2026, many more states have expanded this scope to include all childhood vaccines.

The red-blue divide in vaccine policy continues with all blue states (those with Democratic governors) departing from federal guidelines. As in September, there is a significant political divide in vaccine policies across the country, which is even sharper today. While all blue states have departed from federal recommendations (one exception is Virginia which just swore in a new Democratic Governor this week and may choose to change their position regarding vaccine recommendations soon), four states with Republican governors have also done so for at least some childhood vaccines (Alaska, Mississippi, New Hampshire, and Vermont). This divide in state policy mirrors a growing divide in public opinion).

Looking ahead, it is possible other states will join this group and de-couple their own childhood vaccine recommendations from the federal government. Regardless of future state decisions, the current landscape – with diverging recommendations from the federal government, many states, and physician organizations — represents a challenging one for parents and providers to navigate, which could dampen already falling vaccination rates. Moreover, much of this divide is likely to play out in the next school season, when states have to decide whether and how to translate their vaccine recommendations into school attendance requirements or revise existing exemption allowances.

Table 2: State Childhood Vaccine Recommendations: Reliance on Non-Federal Sources
State	Party of Governor	Relies on non-Federal Source for Routine Childhood Vaccine Recommendations
		As of September 22, 2025 All Vaccines: 9 States COVID-19 only: 13 States	As of January 20, 2026 All Vaccines: 25 States COVID-19/Hepatitis B: 1 State Hepatitis B only: 2 States
Alabama	R
Alaska	R		Hepatitis B
Arizona	D	COVID-19 Only	COVID-19/Hepatitis B
Arkansas	R
California	D	All Vaccines	All Vaccines
Colorado	D		All Vaccines
Connecticut	D	COVID-19 Only	All Vaccines
Delaware	D	COVID-19 Only	All Vaccines
District of Columbia	D	All Vaccines	All Vaccines
Florida	R
Georgia	R
Hawaii	D	All Vaccines	All Vaccines
Idaho	R
Illinois	D	All Vaccines	All Vaccines
Indiana	R
Iowa	R
Kansas	D		All Vaccines
Kentucky	D		All Vaccines
Louisiana	R
Maine	D	COVID-19 Only	All Vaccines
Maryland	D	All Vaccines	All Vaccines
Massachusetts	D	All Vaccines	All Vaccines
Michigan	D	COVID-19 Only	All Vaccines
Minnesota	D	COVID-19 Only	All Vaccines
Mississippi	R		Hepatitis B
Missouri*	R
Montana	R
Nebraska	R
Nevada*	R
New Hampshire	R		All Vaccines
New Jersey	D	COVID-19 Only	All Vaccines
New Mexico	D	COVID-19 Only	All Vaccines
New York	D	COVID-19 Only	All Vaccines
North Carolina	D	COVID-19 Only	All Vaccines
North Dakota	R
Ohio	R
Oklahoma	R
Oregon	D	All Vaccines	All Vaccines
Pennsylvania	D	All Vaccines	All Vaccines
Rhode Island	D	COVID-19 Only	All Vaccines
South Carolina	R
South Dakota	R
Tennessee	R
Texas	R
Utah	R
Vermont	R	COVID-19 Only	All Vaccines
Virginia**	D
Washington	D	All Vaccines	All Vaccines
West Virginia	R
Wisconsin	D	COVID-19 Only	All Vaccines
Wyoming	R
Notes: While news reports for Missouri and Nevada indicate that these states do not anticipate making changes to their vaccine recommendations, despite CDC changes, these were not attributed to specific officials or other documentation and were therefore not included here. *As of January 17, 2026, Virginia’s governor is now a Democrat, and the state may choose to change their position regarding its vaccine recommendations soon.