In a year that United States Secretary of Health and Human Services Robert F. Kennedy Jr. took office, his agency made unprecedented changes to the childhood vaccination schedule, removing universal recommendations for six vaccines in favor of “shared clinical decision-making.”
The term became something of a mantra for Kennedy’s Make America Well Again (MAHA) movement. National Institutes of Health Director Jay Bhattacharya, who also temporarily heads the Centers for Disease Control and Prevention, he said believes “very deeply in collaborative decision-making.” During his confirmation hearing before the Senate Health Committee in February, Casey Means was nominated as U.S. Surgeon General induced she made clinical decisions together when senators pressed her on her views on vaccines.
On the surface, this deadline seems reasonable. It refers to a conversation between a health care provider and a patient or caregiver about the benefits and risks of a medical intervention and whether it makes sense for the person to pursue it. But public health experts say the term has been hijacked by the MAHA movement in an effort to weaken vaccines.
“The evidence base about vaccines, both their safety and the protection they provide, is quite clear, which is why they are recommended as a routine standard of care,” says Jennifer Nuzzo, professor of epidemiology and director of the Pandemic Center at Brown University. “When it is characterized as something that requires shared clinical decision-making, it means that it is not the routine standard of care practice, but there is some uncertainty about its safety or benefit, which is simply not true.”
In response to a request for comment, HHS spokesman Andrew Nixon initially requested the names of people WIRED interviewed for this article, then released a statement saying: “CDC has a strong tradition of using shared clinical decision-making when individuals may benefit from vaccination, but widespread vaccination of individuals in this group is unlikely to have a population impact.”
This is the first time the CDC has applied the term to Covid-19 vaccines last Maywhen the agency said hearty children ages 6 months to 17 years could be vaccinated, but only after a joint clinical decision was made by the child’s parents and his or her health care provider. In the fall, Kennedy’s chosen vaccine advisory committee went a step further: overturning previous government guidance that every person over 6 months of age receives an annual Covid-19 vaccine for shared clinical decision-making.
The latest and most dramatic change came in January, when Kennedy bypassed his own vaccine advisory committee gave up on universal recommendations for hepatitis A, hepatitis B, influenza, meningococcal ACWY and rotavirus vaccines and instead placed them in the “shared clinical decision-making” category. The change, which has not been supported by any up-to-date evidence or data, means these vaccines will no longer be considered routine.
The idea of shared clinical decision-making emerged in the 1980s in response to the long legacy of paternalistic medicine. Doctors often made decisions on behalf of patients, such as cancer treatment, often without informing them of the risks. Shared clinical decision making is typically used for sophisticated medical decisions where there is no single “best” option or the benefits of treatment are less certain, this is not the case for routine vaccines that are known to be safe and sound and effective.
“Public health is based on the recognition that individual decisions translate into population outcomes,” says Jake Scott, an infectious disease physician and clinical associate professor at Stanford University. “What looks like a personal choice to vaccinate your child is also a decision affecting the baby next door who is too young to be vaccinated, the immunocompromised child in the same classroom, or the pregnant woman at the grocery store.”