On March 16, a federal judge in Massachusetts granted preliminary relief in a lawsuit filed by the American Academy of Pediatrics, the American Public Health Association, and other medical and public health groups against the U.S. Department of Health and Human Services (HHS). The order temporarily blocks changes to federal immunization recommendations and calls into question the validity of the current composition of CDC’s Advisory Committee on Immunization Practices (ACIP). This preliminary relief will remain in place as the lawsuit proceeds until the judge can make a final ruling on the merits of the case. 

Specifically, the judge placed a stay on three specific vaccine-related actions. First, the January 5 memo from HHS announcing changes to the pediatric immunization schedule is stayed. Second, the court determined that the reconstitution of ACIP membership likely violates the Federal Advisory Committee Act (FACA), and the 13 appointments are stayed. Finally, all votes made by this reconstituted ACIP are also stayed. The ACIP was scheduled to convene March 18 and 19 to discuss COVID-19 vaccine injuries, long COVID, and ACIP’s recommendation methodologies; however, this meeting has been postponed as the ruling stipulates that given the stays on the appointments of most of the ACIP members, it cannot meet. Follow this link to read the court’s full order.

Implications of the Court’s Decision on Immunization Guidance

• The court ruled that the 13 stayed members cannot serve, which means ACIP, in its current form, cannot function. The court was explicit that it cannot hold meetings without nearly its entire membership.
• The recommended federal vaccine schedules for children and adults have reverted to the schedules that were in place before the January 2026 memo. The 17 routine childhood vaccinations that were in effect before the memo are, once again, the federal operating guidance. More details are available in NACCHO’s Analysis..)
• Changes that downgraded COVID, influenza, hepatitis B, rotavirus, and others to shared clinical decision-making (SCDM) designations are paused. 
• All votes made by the newly assembled ACIP members, including those in June, September, and December 2025, have been stayed. Those votes included:
  • recommendations to remove thimerosal from influenza vaccines,
  • downgrading COVID-19 vaccine recommendations to SCDM,
  • recommendation against the combined MMRV vaccine for certain age groups 
  • moving hepatitis B birth-dose decisions to individual decision-making.

Impacts on Local Health Departments 

Communication and Education

Over the past year, NACCHO has heard from its members that the significant changes to federal vaccination guidance have contributed to increased public confusion and created challenges for local health departments who are communicating about these changes to the public. The judge’s orders may also lead to confusion or increased questions about an individual’s current immunization needs. The U.S. vaccine schedule historically has been built upon extensive scientific evidence and continuous safety monitoring to best protect children as they grow. Community members should be reassured that immunizations are the most effective defense we have against a host of deadly and painful illnesses.  In the case that state guidance aligning with the January 2026 HHS schedule was implemented at the local level, health care providers should review records to make sure community members did not miss or delay doses during the period of uncertainty. 

Access and Cost 

NACCHO does not anticipate impact on vaccine cost, billing and reimbursement as a result of this ruling. Insurance coverage for all vaccines on the routine childhood schedule remain available at no out-of-pocket cost since coverage is tied to ACIP recommendations. Prior to the March 16 ruling, insurers had committed to covering pre-September 2025 recommendations without cost-sharing through 2026. The stay of the schedule change gives even more reassurance that coverage will remain unchanged. Additionally, Medicaid coverage and the Vaccines for Children program remain unchanged.  

This is a preliminary ruling and further legal action is expected, including possible appeals on the stays described above, as this case continues to move through the courts. NACCHO will continue to monitor the situation closely to understand, anticipate, and communicate impacts on local health departments. Please contact [email protected] with feedback or questions about this resource guide or information related to the local public health impacts of these changes.