RFK Jr and Donald Trump. Credit: X @RobertKennedyJr
In January 2026, the US government introduced two significant public-health changes within days of each other: the 2025–2030 Dietary Guidelines for Americans and a revised childhood immunisation schedule.
Health Secretary Robert F. Kennedy Jr described both as overdue course corrections, telling CBS: “My message is clear. Eat real food.”
What the new US dietary guidelines say
The updated dietary guidelines, released by the US Department of Health and Human Services (HHS) and the Department of Agriculture, place greater emphasis on whole foods, higher protein intake, and so-called “healthy fats,” while urging Americans to limit ultra-processed foods and added sugar.
Announcing the update, HHS said the aim was to tackle chronic disease, noting that “nearly 90 per cent of the nation’s $4.5 trillion in annual health care expenditures are for people with chronic and mental health conditions.”
Media coverage has focused on a redesigned food pyramid that visually elevates protein-rich foods such as meat, eggs, and dairy.
The case for the new food pyramid
Ultra-processed foods and health
Supporters argue the stronger stance on ultra-processed foods reflects growing scientific evidence. A 2024 BMJ umbrella review found higher consumption was associated with increased risks across multiple cardiometabolic outcomes and mortality. The authors stressed that the evidence is largely observational, showing correlation rather than direct causation.
Protein and ageing
The guidelines have also been linked to research suggesting higher protein intake may help preserve lean mass. A systematic review in Nutrients reported associations between intakes of 1.2–1.6 g per kilogram of body weight per day and improved or maintained muscle mass in adults, depending on age and context.
Saturated fat debate
Critics argue that visually emphasising meat and dairy risks clashing with long-standing cardiovascular guidance. The American Heart Association states there is “strong and consistent evidence” that replacing saturated fat with unsaturated fat reduces cardiovascular disease risk.
Kennedy disputes this, telling CBS, “There is no good evidence that saturated fats drive cardiac disease.”
Sugar guidance
Reporting suggests the new guidelines discourage added sugar more strongly, with descriptions equivalent to around 10 grams per meal and zero added sugar for young children. Critics note that while the message is simple, translating per-meal guidance into daily habits may be difficult given current food labelling and portion sizes.
The CDC childhood vaccine update
The Centers for Disease Control and Prevention has revised how childhood vaccines are categorised. National reporting indicates the number recommended for all children has been reduced from 17 to 11, with others moved into shared clinical decision-making (SCDM) or higher-risk categories.
Kennedy said, “We’re not taking vaccines away from anybody. You need to do a shared decision-making with your physician.” His long-standing scepticism stems from concerns about ingredients such as thimerosal, which he believes are linked to childhood disorders like autism.
Examples of re-categorised US vaccines:
- Influenza → COVID-19
Now offered based on individual risk and discussion with a doctor, rather than automatically to all children. - Rotavirus → Hepatitis A
No longer universally recommended; given depending on age, exposure risk, or clinical judgement. - Meningococcal → Hepatitis B
Shifted from routine use for all children to targeted or risk-based recommendation. - RSV → specific age or risk groups
Recommended only for certain ages or children with higher medical risk.
Why medical groups are alarmed
Public-health researchers at CIDRAP reported “confusion” following the announcement, quoting officials who said there was “no new scientific evidence indicating that the existing childhood vaccination schedule is unsafe.”
The American Academy of Pediatrics and several state medical organisations have expressed stronger opposition. The California Medical Association warned the change “weakens the childhood immunisation schedule” and could undermine disease prevention.
The US vaccine injury compensation system
In the US, vaccine injury claims are primarily handled through the National Vaccine Injury Compensation Program (VICP), a no-fault federal scheme established in 1986. Claims are assessed against defined legal and medical criteria, including the Vaccine Injury Table, rather than requiring proof of negligence.
Compensation may include medical costs, loss of earnings, and capped payments for pain and suffering. There is no fixed disability percentage threshold, though successful claims typically involve injuries meeting established criteria, which may – but do not always – involve long-term impairment.
Vaccines authorised under emergency public-health declarations fall outside the VICP and are instead covered by the Countermeasures Injury Compensation Program, which has stricter eligibility and more limited benefits.
How other wealthy countries vaccinate: Japan and UK
Japan
Japan operates one of the least intensive infant vaccination schedules among wealthy nations, spreading vaccines over a longer period with fewer combination shots. It administers BCG in infancy and uses a measles–rubella vaccine rather than MMR, meaning mumps is not routinely included.
Japan reports one of the world’s lowest infant mortality rates, at around 2 deaths per 1,000 live births, despite a high population of roughly 123–124 million. Researchers emphasise this reflects broader factors such as prenatal care, universal maternal services, and low prematurity rates, not vaccination policy alone.
Japan also operates a government-run vaccine injury compensation system using administrative review by expert committees, without requiring proof of negligence.
United Kingdom
The UK runs a denser, front-loaded infant immunisation programme delivered through the NHS, with multiple combination vaccines in the first year of life. Its infant mortality rate is much higher than Japan’s, at around 3.9–4.0 deaths per 1,000 live births, and the population is much lower at 68–69 million. Authorities attribute the deaths to prematurity, congenital conditions, and socioeconomic inequality rather than immunisation policy.
Vaccine injury compensation is handled through the Vaccine Damage Payment Scheme, which provides a one-off £120,000 payment only where disability is assessed at 60 per cent or higher. Less severe but permanent disabilities such as autism are not eligible, though private legal settlements may occur and often include confidentiality clauses.
US health policy shifts often influence global debate, online wellness culture, and English-language health information far beyond American borders.
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