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An executive order signed Monday by President Donald Trump has ramped up the national debate over childhood vaccines. The order calls for sweeping changes to U.S. vaccine policy, including reducing the number of diseases for which kids receive routine childhood vaccines and upholding parental and religious rights.
Mary Holland, CEO of Children’s Health Defense (CHD), said the order is a “significant” move that “announces a commitment to freedom.”
Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons, said the executive order “is a positive step and will stimulate a lot of debate that is now being squelched.”
But aside from symbolizing the administration’s support for health and medical freedom, and rekindling public debate over potential risks associated with routine childhood vaccines, questions remain as to the extent to which the executive order is enforceable and its ability to lead to tangible changes to U.S. vaccine policy.
The Defender spoke to legal and public health experts, who discussed what the executive order might accomplish — and where legal, judicial and constitutional limitations may remain.
Order doesn’t immediately change childhood vaccination schedule
Trump’s executive order calls on states to harmonize their policies with a U.S. Department of Health and Human Services (HHS) study showing that the current 18-disease childhood vaccination schedule requires more vaccinations than other high-income countries in Europe and Asia.
The executive order also asks states to consider updating their school vaccination laws to reflect the new recommendations and advises federal agencies to incorporate the new guidance in their policies.
Brian Hooker, Ph.D., CHD’s chief scientific officer, said the order “is filled with so many positive steps toward ending the chronic disease epidemic in the United States” — an issue that previous administrations “kicked down the road for over 25 years.”
Writing on his blog, attorney Rick Jaffe said the executive order is a “big deal” when looking at the “big picture,” but its impact may be limited in the short term.
Jaffe told The Defender that executive orders “do not have the force of law.” Instead, it is “state governments that decide mandatory school vaccination.” This means that the executive order has “little to no immediate operative effect.”
The executive order does not formally change the Centers for Disease Control and Prevention’s (CDC) recommended childhood vaccination schedule, nor does it change state-level and school-level vaccination requirements, Jaffe wrote. “Not today, not in ninety days, and not until something else big happens.”
Jaffe wrote that school vaccine mandates fall under the purview of “state police power” and cannot be preempted by an executive order.
He noted that states “have been walking away from the federal recommendations on their own initiative” ever since Trump and U.S. Health Secretary Robert F. Kennedy Jr. took office last year.
Over the past year, some states have established their own vaccine schedules, aligned with the CDC’s previous recommendations, not the newer changes made under the Trump administration.
“The only thing the federal government can do is to make recommendations about childhood vaccination, and control federal payment programs like the Vaccines for Children Program, supplying free vaccines to Medicaid providers,” Jaffe said.
‘Anything done by executive order can be undone by executive order’
Jaffe wrote that most states did not fully align their childhood vaccination schedules or school vaccination requirements to the CDC’s recommended schedule even before the current administration’s changes — nor have most states fully aligned their schedules with the recommendations of the American Academy of Pediatrics (AAP), which developed its own alternative schedule last year.
“The gap between recommendation and requirement was always wider than people assume,” Jaffe wrote. “The federal schedule covered (more or less) eighteen diseases. California mandates ten for school. Massachusetts is at nine for kindergarten through twelfth grade.”
Internal medicine physician Dr. Meryl Nass, founder of Door to Freedom, wrote on Substack that Trump’s executive order moved to “essentially change the CDC recommendations without going through CDC.”
However, she said, “It is the states that will need to make changes if changes are to happen. Essentially all the blue states have indicated in the past, they do not want to change according to Trump‘s recommendations or those of his CDC.”
“The executive order’s policy recommendations are significant, but 28 states have already indicated they will not follow them in favor of Pharma-backed recommendations through the AAP,” Holland said.
Executive orders can also be easily overturned. “Anything done by executive order can be undone by executive order,” said Karl Jablonowski, Ph.D., CHD’s senior research scientist. “If immunization policy remains politically divisive, the executive order is up for reelection” during the next presidential election, he said.
“The remaining 819 days of the Trump administration is not a lot of time to do the science (that we’ve failed to do for decades), implement new policies guided by that science … measure the outcomes of the new policies, and communicate the changes to the citizens,” Jablonowski said.
Changes to CDC vaccine schedule still blocked by federal court order
Changes to the CDC’s recommended childhood vaccination schedule or to state-level policies have also been hampered by judicial challenges.
Last year, the AAP and other medical organizations sued Kennedy and HHS over several vaccine policy changes the Trump administration enacted. The AAP alleges the changes — including changes to the recommended childhood vaccination schedule — were made unlawfully.
In March, a federal judge blocked the schedule changes and stayed the appointments of the new members of the Advisory Committee on Immunization Practices (ACIP) appointed between June 2025 and January 2026. ACIP advises the CDC on vaccine policy and makes non-binding recommendations.
HHS appealed the ruling, but the stay remains in effect. ACIP has not held a meeting since December 2025.
Jaffe wrote that Trump’s executive order does not change anything in relation to the AAP’s lawsuit or the March ruling.
“A president cannot dissolve a federal court injunction by signing a different document,” Jaffe wrote. “He cannot direct his subordinates to do what a court has forbidden them to do.”
According to Jaffe, what this means is that the rulings in the AAP case will remain “the law of that case until a higher court changes it.”
Does executive order compel states to recognize religious exemptions?
For Jablonowski, “The champion of the executive order is ‘parental authority.’”
Trump’s executive order directs the U.S. Department of Justice (DOJ) to investigate states that may be violating parental rights and religious freedom, including disability accommodations, and religious and medical exemptions for childhood vaccinations.
Jaffe told The Defender:
“The federal executive branch does not have … power to create a federal constitutional right to a religious exemption to vaccination. Only the courts can create or recognize such a right and so far they haven’t done it.”
But Nass suggested the executive order’s power to compel change based on parental and religious rights may come through the federal purse strings. She said the order may act as “a veiled threat to states to comply” with the Trump administration’s wishes regarding vaccine policy.
“CDC provides considerable funds for public health in the states, and if that was withheld, it would have a huge effect,” Nass said. “Other federal agencies could also potentially withhold funds for various projects, including aid to schools.”
Nass also suggested the federal government “could sue states that failed to offer religious exemptions or limit medical exemptions.” However, she questioned whether newly confirmed Attorney General Todd Blanche would be “ready to put resources on this.”
Nass also questioned whether the federal government would be willing to use other enforcement powers it may have at its disposal.
“HHS has a civil rights team, but I do not know if they have the right to legally challenge the states over issues like refusal of religious exemptions, or whether they must go through the DOJ,” Nass said. “Perhaps the HHS civil rights team could make recommendations for how HHS distributes money to the states and thereby provide a lever for change,” she said.
On his blog, Jaffe said that the federal government’s power to withhold funds from states that continue to maintain vaccine policies that are at odds with those of the federal government is “less than people think,” citing the example of California and a recent U.S. Supreme Court ruling, National Federation of Independent Business (NFIB) v. Sebelius.
“Roughly $174 billion a year flows through California’s state budget from Washington, about 35 percent of the total, and around $119 billion of that is Medi-Cal. In NFIB v. Sebelius the Supreme Court held … that the federal government cannot hold the entire Medicaid grant hostage to force a state into something that is not Medicaid.”
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Executive order’s impact may be felt ‘in the exam room’
Jaffe told The Defender that the federal government also lacks clear legal authority to require states to recognize religious rights, including religious exemptions to vaccination requirements.
“The Supreme Court has never held that the First Amendment requires a religious exemption to a vaccine mandate, and no federal appeals court has either,” Jaffe said. “Congress wrote a religious accommodation requirement into Title VII for employees and never wrote one for schoolchildren, which is why New York and Connecticut were able to repeal theirs and survive the challenges,” Jaffe said.
New York and Connecticut are among the four states that have banned religious exemptions for schoolchildren. California and Maine also eliminated religious exemptions. In West Virginia, the issue is the subject of ongoing litigation and political debate.
Jaffe said the federal government has much more leeway to launch investigations. “Investigation authority is the better question, and those tools sit at DOJ and the HHS civil rights office. Both can open compliance reviews without waiting for anyone to file anything,” Jaffe wrote.
For Jaffe, the executive order’s greatest impact may be felt “in the exam room.” He wrote:
“It puts a signed federal document behind what families have been saying for years, that influenza and COVID are shared clinical decisions and that spacing shots across separate visits is a legitimate choice rather than a character defect.
“That matters in a conversation with a pediatrician, and it matters more if a refusal ever escalates into a medical neglect referral or a custody dispute.”
‘Medical freedom is now a mainstream Republican issue’
For Michael Kane, CHD’s director of advocacy, the executive order is significant as it was signed during the lead-up to this year’s congressional midterm elections.
“The biggest thing about this executive order is that it was signed on a Monday at the height of election season,” Kane said. “That means the vaccine issue has been greenlit by the GOP as one that is going to help them in the midterm elections. What we are seeing is that medical freedom is now a mainstream Republican issue.”
The executive order gives Kennedy and HHS 90 days to deliver plans to Trump on vaccine timing and sequencing, risk-benefit analysis and improved safety monitoring.
“Ninety days from Monday is early November” — just before the midterms, Jaffe wrote.
Related articles in The Defender
- Trump Signs Executive Order Aimed at Reducing Number of Childhood Vaccines
- Trump Reportedly Weighing Executive Order on Vaccines, Autism
- RFK Jr. Lets Loose on CNN, Sportscaster Apologizes for Vilifying Unvaccinated — Is a COVID Reckoning on the Horizon?
- Exclusive: ‘Unqualified’ Judge to Blame for ‘Highly Politicized’ Ruling Against RFK Jr.’s Vaccine Advisers
- Breaking: Federal Court Blocks ACIP Meeting, Changes to Childhood Vaccine Schedule
- Trump Signs Executive Order Backing HHS on Childhood Vaccine Reform — Will It Matter?
