The New U.S. Childhood Vaccine Schedule: A Key Change for HPV Immunization
Impact for SGO Members: HPV immunization remains recommended for all children but it is now recommended as a single dose, instead of the 2 or 3 dose series that was previously recommended.
On January 5, the Centers for Disease Control and Prevention (CDC) announced a major revision to the U.S. childhood and adolescent immunization schedule. The revision is based on an internal assessment of U.S. immunization practices conducted in response to a directive from President Donald Trump to review international approaches used by peer, developed countries and was not recommended by the Advisory Committee on Immunization Practices (ACIP).
The revised CDC recommendations categorize immunizations as recommended for all children, recommended for high-risk children, or based on shared clinical decision-making. This updated schedule effectively reduces the number of diseases targeted from 17 to 11 and the number of recommended immunizations for all children from 13 to 7.
Among the recent updates, the change of greatest interest to the SGO community is that while HPV vaccination remains recommended for all children it is now recommended as a single dose instead of the previous two- or three-dose series.
Historically, the U.S. has recommended two doses of HPV vaccine if started before age 15, and three doses if started at age 15 or older, and for immunocompromised people. As justification for this one-dose approach, the Department of Health and Human Services (HHS) cited alignment with “peer nations” and recent scientific studies that have shown that one dose of the HPV vaccine is as effective as two doses. The United States does not currently have a licensed single-dose HPV vaccine.
HPV Vaccine Coverage: What’s Changing?
Because the first dose of the HPV vaccine is in the “recommended for all children” category, coverage will remain in place. As the CDC now recommends one dose of HPV vaccine, payers will no longer be required to cover additional doses. America’s Health Insurance Plans (AHIP) stated last fall that health insurers plan to continue covering all vaccines recommended as of September 1, 2025 through the end of 2026. , but it is not clear what coverage for additional HPV vaccine doses could look like beyond 2026.
In response to changes in federal guidelines that have narrowed some vaccine recommendations, some states have taken steps to align their policies independently of federal guidance. It will be ultimately up to the state and local jurisdictions to determine key childhood vaccine policies, such as recommended vaccines for routine use and requirements for school attendance. According to the Kaiser Family Foundation, 24 states no longer use federal guidance for vaccine recommendations, instead relying on state or external expert groups like the AAP, with a smaller number also mandating no-cost coverage by state-regulated insurers. This means vaccine coverage and access could increasingly depend on where one lives, which could have significant impact on public health, including adolescent cancer prevention.
The full schedule can be viewed here, and the HHS evidence document can be found here.