The American Academy of Pediatrics released its annual immunisation schedule on Tuesday, recommending that all children aged six to 23 months receive a COVID-19 vaccine and that older children be vaccinated if they have chronic conditions that raise the risk of severe disease. The advice departs sharply from guidance issued in May by the Centers for Disease Control and Prevention, which ended routine COVID-19 vaccination recommendations for healthy children and shifted to a “shared clinical decision-making” model. It is the first time in three decades that the leading paediatric society has issued substantially different vaccine guidance from the federal government. AAP President Susan J. Kressly said infants and toddlers face the highest hospitalisation rates among paediatric age groups, with risk levels comparable to adults aged 50 to 64, and argued that clear direction is needed amid widespread misinformation. Health and Human Services Secretary Robert F. Kennedy Jr., who dismissed the CDC’s 17-member Advisory Committee on Immunization Practices in June and appointed a smaller panel that includes vaccine sceptics, criticised the AAP for “undermining national immunisation policymaking.” Kennedy warned that recommendations not aligned with the CDC list may fall outside the liability protections of the 1986 Vaccine Injury Act. HHS called on the academy to strengthen its conflict-of-interest safeguards. The policy clash coincides with new research published in JAMA showing that financial conflicts of interest among federal vaccine advisers have dropped to historically low levels—averaging 6.2 percent for ACIP members and 1.9 percent for the FDA’s vaccine committee since 2016—countering Kennedy’s claims that widespread conflicts had justified his sweeping overhaul of the advisory panel.