On August 10, President Trump signed an executive order titled “Delivering Gold Standard Childhood Vaccine Recommendations for Americans” that classifies childhood immunizations into three tiers and directs the attorney general to sue states lacking religious exemptions from school requirements. The order and accompanying White House fact sheet describe a reduction from 18 to 11 recommended items by excluding an RSV monoclonal antibody that is not classified as a vaccine. The universal tier retains vaccines against measles, mumps, rubella, diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b, pneumococcal disease, HPV, and varicella, while the high-risk tier covers the RSV antibody, meningococcal B, meningococcal ACWY, and dengue.