When Science Splinters: Vaccine Federalism and the Erosion of National Standards

For more than half a century, Americans could rely on a unified, science-based system for vaccine recommendations. The Centers for Disease Control and Prevention, working through its Advisory Committee on Immunization Practices (ACIP), issued guidance that was nearly uniformly relied upon across the country and was operationalized in the CDC’s national immunization schedules. ACIP’s mandate, methods, and proceedings—set out in its public charter and evidence frameworks—created a transparent pathway from emerging scientific data to clinical recommendations.

That coherence did more than simplify workflow for pediatricians and internists; it facilitated broad access to ACIP-recommended vaccines via school vaccination policies, the Vaccines for Children Program and mandatory full cost insurance coverage under the Affordable Care Act. That structure, built on science, has kept the United States far safer and healthier: diseases that once defined childhood receded, like measles, mumps, chickenpox, and polio. The achievement was scientific, certainly, but it was also civic: a pluralist federation acting together