The executive order signed Monday directs that the MMR shot be given as three separate single-disease vaccines, and no such vaccine is currently licensed or manufactured in the United States. The most-quoted instruction in the order is, for now, an instruction addressed to a factory that does not exist. What the order changes, and what it only recommendsThe order, titled Delivering Gold Standard Childhood Vaccine Recommendations for Americans, sorts childhood immunization into three tiers. Eleven diseases stay under a universal recommendation: measles, mumps and rubella, diphtheria, tetanus, pertussis, polio, Hib, pneumococcal disease, HPV and varicella. Sixteen years later there is no FDA-licensed monovalent measles, mumps or rubella vaccine in the United States.