The U.S. Department of Health and Human Services, under Secretary Robert F. Kennedy Jr., has removed universal recommendations for several routine childhood vaccines, placing them in a "shared clinical decisionmaking" category instead. Public health experts argue this term, while legitimate for complex medical choices, is being co-opted to undermine vaccines by falsely suggesting uncertainty about their safety and efficacy, despite clear evidence supporting them as standard care.
The changes, which include vaccines for hepatitis A, hepatitis B, influenza, meningococcal disease, and rotavirus, were not based on new data. Experts warn that framing routine vaccinations as individual choices ignores their critical role in population-level public health and herd immunity.
Main Topics: Changes to U.S. childhood immunization policy; the use and critique of "shared clinical decisionmaking"; public health concerns regarding vaccine hesitancy and herd immunity.
In the year that US Health and Human Services Secretary Robert F. Kennedy Jr. has been in office, his agency has made unprecedented changes to the childhood immunization schedule, removing universal recommendations for a half-dozen vaccines in favor of “shared clinical decisionmaking.”
The term has become something of a mantra for Kennedy’s Make America Healthy Against (MAHA) movement. National Institutes of Health Director Jay Bhattacharya, who is also temporarily leading the Centers for Disease Control and Prevention, has said he believes “very fundamentally in shared decisionmaking.” And in her confirmation hearing in front of the Senate health committee in February, US surgeon general nominee Casey Means invoked shared clinical decisionmaking when senators pressed her about her views on vaccines.
On its face, the term seems reasonable. It refers to a conversation between a health care provider and a patient or their guardian about the benefits and risks of a medical intervention and whether it makes sense for that individual to receive it. But public health experts say that the term has been co-opted by the MAHA movement as a way to undermine vaccines.
“The evidence base for vaccines, both their safety and the protection that they offer, is quite clear, and that's why they're recommended as routine standard of care,” says Jennifer Nuzzo, a professor of epidemiology and director of the Pandemic Center at Brown University. “When you label them as something that requires shared clinical decisionmaking, that implies that it is not a routine standard of care practice, but that there is some uncertainty about either the safety or the benefits, and that's just simply false.”
In response to a request for comment, HHS spokesperson Andrew Nixon initially demanded the names of people WIRED spoke to for this article before following with a statement in which he wrote, “The CDC has an established tradition of applying shared clinical decisionmaking when individuals may benefit from vaccination, but broad vaccination of people in that group is unlikely to have population-level impacts.”
The CDC first applied the term to Covid-19 vaccines last May, when the agency said that healthy children aged 6 months to 17 years may get the shot, but only after shared clinical decisionmaking between a child's parents and their health care provider. In the fall, Kennedy’s hand-picked vaccine advisory committee went a step further, overruling previous government guidance that everyone over 6 months old should receive an annual Covid vaccine in favor of shared clinical decisionmaking.
The latest and most sweeping change came in January, when Kennedy bypassed his own vaccine advisory committee and dropped universal recommendations for the hepatitis A, hepatitis B, influenza, meningococcal ACWY, and rotavirus vaccines and instead placed them in the “shared clinical decisionmaking” category. The change, which was not backed by any new evidence or data, means those vaccines will no longer be considered routine.
The idea of shared clinical decisionmaking arose in the 1980s in response to a long legacy of paternalistic medicine. It was common for doctors to make decisions on behalf of patients, such as for cancer treatment, often without informing them of risks. Shared clinical decisionmaking is typically used for complex medical decisions where there may is no single “best” option or treatment benefits are less certain, not for routine vaccines that are known to be safe and effective.
“Public health is built on the recognition that individual decisions aggregate into population outcomes,” says Jake Scott, an infectious disease physician and a clinical associate professor at Stanford University. “What looks like a personal choice about whether to vaccinate your child is also a decision that affects the infant next door who's too young to be vaccinated, or the immunocompromised kid in the same classroom, or the pregnant woman at the grocery store.”
The only prior instance when shared clinical decisionmaking was applied to a vaccine was in 2015, when the CDC’s Advisory Committee on Immunization Practices, or ACIP, recommended the meningococcal B vaccine in adolescents after shared clinical decisionmaking. Scott says this was a very specific case because the vaccine does not reduce the amount of bacteria a person carries, meaning that it only provides protection for a vaccinated individual. Unlike other vaccines, it does not stop transmission at a population level.
Katherine Hall Jamieson, a professor who studies misinformation and campaign communication and serves as the director of the Annenberg Public Policy Center at the University of Pennsylvania, says the reframing of shared clinical decisionmaking creates confusion around the necessity of some vaccines. “Suddenly it became language to suggest freedom of choice,” she says.
A survey of 1,700 adults conducted by the Annenberg Public Policy Center in August found that one in five people thought that shared decisionmaking means “taking the vaccine may not be a good idea for everyone but would benefit some.”
She says it also suggests that the CDC was somehow forcing people to get vaccinated. In reality, the CDC only issues guidance on the optimal time to receive vaccines in order to best protect against disease. States and local jurisdictions set vaccine requirements for school entry. Parents have always been able to opt out of vaccines for their children, and in fact, the number of parents seeking vaccine exemptions for their school-aged children is rising nationally, reaching a record 3.6 percent for the 2024-25 school year, up from 2.5 percent in 2019-20.
Scott says that shared clinical decisionmaking is being used as a political instrument to downgrade vaccines without explicitly banning them or taking them off the market. “It’s being used as a template, and the changes in January were not the end of the process,” Scott says. “I think it’s worth watching where the template gets applied next.”
Meridiano
