WASHINGTON — President Trump on Monday signed an executive order recommending that American children receive fewer routine vaccinations and that the combined measles, mumps and rubella shot be broken into three separate doses, remaking federal guidance days before the school year begins in many states.

The order would cut the immunizations recommended for all children to 11 from the 18 in the schedule maintained by the American Academy of Pediatrics, and would move shots against RSV and hepatitis A and B into a tier reserved for children deemed at higher risk, according to a copy obtained by CBS News. It directs the Health and Human Services Department to reassess vaccine sequencing and timing within 90 days, and calls for the development of alternatives to the aluminum salts long used to boost vaccine potency.

Because states — not Washington — set the immunizations required for school attendance, the order functions as guidance, not a mandate. It nonetheless breaks with decades of federal recommendations, and Trump repeatedly tied his announcement to autism in his Oval Office remarks even though the underlying order does not.

What the order does

The shots recommended for every child under the new list cover measles, mumps, rubella, diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type B, pneumococcal disease, human papillomavirus and chickenpox. A separate MMR combination is not currently sold in the United States as three individual shots. Administration officials said the changes would sharply cut a schedule that had reached what Trump called "72 jabs for our beautiful, healthy, lovely, delicate little children," counting annual flu and Covid-19 doses.

Trump described the combined MMR dose as potentially "quite lethal" if given at once, comparing it to pouring a bottle of soda into a child. Asked for evidence, he said, "What I've heard is that there are some people that say it is that way." The Food and Drug Administration lists a single dose of MMR as 0.5 milliliters.

The medical response

Dr. Andrew Racine, president of the American Academy of Pediatrics, called the order "dangerous" and challenged its "gold-standard science" claim, warning: "Delaying or skipping shots is risky, especially as measles continues to spread and children go back to school." The group also described the order as "disheartening" and warned it could "sow confusion so that more people doubt the importance of vaccines."

Republican Sen. Bill Cassidy, a physician who cast the deciding vote to confirm Health and Human Services Secretary Robert F. Kennedy Jr., wrote on X, "I'm a doctor. This executive order is wrong," adding: "The President does not have the expertise to make these changes. Vaccines are overwhelmingly safe. Vaccines are effective. Vaccines DO NOT cause autism."

The evidence

A 2019 Danish study of 657,461 children and a 2015 U.S. study of 95,727 children found no link between MMR and autism. The CDC finds "no published scientific evidence" of any benefit to separating the MMR shot into three doses. Dr. William Schaffner of the Vanderbilt University School of Medicine told the BBC the extra visits would burden parents and providers without scientific benefit. Dr. Céline Gounder, a CBS News medical correspondent, said that when "Japan split its shot in the 1990s," mumps vaccination fell to about a third of children and doctors documented hundreds who lost their hearing.

The counterpoint

No right-leaning outlet appeared in Monday's reporting, leaving the order's most substantive defense to administration figures. Kennedy told CNN last week he had "never questioned the efficacy of the MMR vaccine" and framed the coming shifts as expanding parental choice. Dr. Jay Bhattacharya, the National Institutes of Health director serving as acting CDC director, told CBS's "Face the Nation" on Sunday that "I trust the science" on childhood vaccines and had vaccinated his own children. A federal judge in March blocked an earlier CDC effort to shrink the schedule for skirting rulemaking; CBS chief medical correspondent Dr. Jon LaPook said Monday's order "bypasses that open, transparent process" as well.

HHS has 90 days to return with a revised sequencing plan, arriving as the CDC reports measles cases at their highest level in 35 years and school districts across the country begin the fall term.