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For the past 31 years, pediatricians have administered vaccines to children across the U.S. based on a recommended immunization schedule maintained on the website of the Centers for Disease Control and Prevention.

Those recommendations were made through a carefully established and transparent process. They rested on assessments of lab studies and real-world evidence by experts who knew what they were looking at. These experts made their decisions by balancing how risky specific infectious diseases are to children in the U.S. and how well and how safely available vaccines protect against those diseases, given the specifics of our health system.

But on Monday, federal health officials took the unprecedented step of bypassing that process to cross six vaccines from the list – without any new evidence. In today’s lead article, infectious disease physician Jake Scott describes the long history of how the U.S. came to have the vaccine schedule it did – until recently.

“The vaccine schedule wasn’t designed in a single stroke,” Scott writes. “It was built gradually over decades, shaped by disease outbreaks, technological breakthroughs and hard-won lessons about reducing childhood illness and death.”

Scott, who treats vaccine-preventable diseases and reviews the clinical trial evidence behind immunization recommendations, also explains how the government’s decision came about and what its effects will likely be.

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