By James Lyons-Weiler, Contributor, The MAHA Report
As my colleague Adam Garrie wrote on Monday, the Centers for Disease Control and Prevention (CDC) quietly made one of the most significant changes to U.S. vaccine policy in recent memory — backing away from its previous blanket endorsement of COVID-19 shots for all children and adults. In a shift with far-reaching implications, the agency says decisions about whether to vaccinate against COVID-19 should now be made on a case-by-case basis, between patients and their healthcare providers.
At the same time, CDC recommended that young children receive separate chickenpox and MMR vaccines, rather than the combined four-in-one shot, to avoid an increased risk of febrile seizures in toddlers.
The new guidance follows a vote last month by the CDC’s Advisory Committee on Immunization Practices (ACIP), which unanimously supported the COVID change.
But despite this high-level decision, the agency made no fanfare about it — no press conference, no public Q&A. Instead, it posted a brief announcement online and moved forward.
A policy earthquake — delivered with a whisper
According to the CDC, the decision was driven by updated risk-benefit assessments. The revised guidance formally classifies COVID-19 vaccination as a “shared clinical decision” — meaning it’s no longer a standing recommendation for all ages, but rather something patients and providers should discuss together based on individual risk.
That classification still qualifies the vaccine for coverage under Medicare, Medicaid, and most insurance plans. But it marks a clear shift from prior language, which treated COVID vaccination as routine across the board.
“This is a fundamental change in posture,” said a senior health policy expert not involved in the decision, who spoke on condition of anonymity. “It signals the end of one-size-fits-all COVID vaccine mandates.”
CDC Acting Director Jim O’Neill confirmed the move in a post on X (formerly Twitter), where he also called on vaccine makers to develop separate, single-antigen versions of the MMR vaccine — measles, mumps, and rubella — saying families deserve “safe monovalent options.”
As of now, the FDA has approved only the combined MMR vaccines from Merck (M-M-R II) and GSK (Priorix). No standalone measles, mumps, or rubella vaccines are currently available in the United States.
Febrile Seizure Risk Drives Chickenpox Decision
The second major change affects routine childhood vaccinations. For years, doctors have given toddlers a four-in-one combination shot for measles, mumps, rubella, and varicella (chickenpox) — known as MMRV. ACIP’s recommendation, and the CDC’s agreement to split the MMRV into separate doses is based on at least three studies that show that when given between 12 and 23 months of age, the first dose of MMRV doubles the short-term risk of febrile seizures compared to giving the MMR and chickenpox shots separately.
The absolute risk remains small — about one extra seizure for every 2,300 kids vaccinated with MMRV. But after years of accumulating evidence, the ACIP voted 8–3 to make the split official policy for young children.
The recommendation does not affect the second MMRV dose given at ages 4 to 6, which does not appear to carry the same seizure risk.
Texas Attorney General Fires Back
The federal guidance changes had barely registered around the U.S. before Texas Attorney General Ken Paxton blasted the state’s largest physician group, the Texas Medical Association (TMA), accusing it of undermining the CDC’s revised COVID-19 policy.
In a fiery press release Monday, Paxton accused the TMA of clinging to “anti-scientific” mandates and pushing the vaccine on children “at all costs.” He called the new CDC stance a “win for personal liberty” and urged Texas doctors to “speak out” against what he characterized as a betrayal of medical freedom.
“TMA has chosen to ignore overwhelming evidence,” Paxton said, “and is acting as if the mandate is still in place.”
TMA has not issued a formal response to Paxton’s comments, and it is unclear whether the group plans to update its COVID-19 guidance. On its website, TMA still refers physicians to CDC recommendations, which now include the shared-decision model.
What the CDC’s Changes Mean for You
For patients, little changes in terms of access: COVID-19 vaccines are still available at pharmacies and clinics, and insurance coverage remains intact. But the new guidance gives doctors more leeway to say “not necessary,” depending on a patient’s risk profile.
For parents, especially those of toddlers, pediatricians are now expected to offer separate chickenpox and MMR vaccines instead of the combined version — at least for the first dose. Whether pharmacies and pediatric practices have enough separate stock to accommodate the shift remains to be seen.
And for policymakers and school districts, what comes next is uncertain. With the federal stance softened, state and local vaccine mandates — especially for school entry — may now face renewed challenges, both legal and political.
In Washington, Acting Director O’Neill’s push for monovalent MMR options could open a new front in the vaccine-access debate, especially if manufacturers are willing to step up. But for now, the available shots remain unchanged, even as the rules around them are updated to reflect a new national agenda.
Three Takeaways
1. COVID-19 Vaccination Is Now a Personal Medical Decision
For the first time since the pandemic began, the CDC no longer recommends COVID-19 vaccination for all individuals. Instead, it has shifted to a shared clinical decision-making (SCDM) model — meaning the choice to vaccinate is up to each patient and their healthcare provider, based on personal risk factors. This marks the end of blanket endorsements and a major retreat from previous mandates.
The move to SCDM impacts physicians’ net profit in two ways; physicians could gain profit on a per-patient basis if insurers reimburse for longer consultations, but if volume reduces due to personal choice, physicians and, obviously, vaccine manufacturer’s bottom line could suffer based on uptake due to decisions based on risk awareness.
2. Chickenpox Shot Separated from MMRV to Reduce Seizure Risk
The CDC also recommends giving chickenpox (varicella) as a separate shot rather than as part of the 4-in-1 MMRV combination for toddlers. The reason: MMRV given between 12 and 23 months doubles the short-term risk of febrile seizures compared to giving the MMR and varicella vaccines separately. This signals a move toward making vaccines safer, not ending vaccination.
3. Texas AG Accuses Medical Group of Undermining Parental Choice
In response to the federal update, Texas Attorney General Ken Paxton issued a press release in which he accused the Texas Medical Association of ignoring the CDC’s new guidance and continuing to pressure physicians to vaccinate children against COVID-19 regardless of individual risk. Paxton called it “anti-scientific” and a threat to medical freedom, urging physicians to push back. This foreshadows a future in which state authority on vaccine mandates and public health will trigger litigation and new federal legislation to protect constitutionally guaranteed individual rights.
 | A guest post by
|