Doctors say changes to US vaccine recommendations are confusing parents and could harm kids

Dr. Molly O’Shea has noticed growing vaccine skepticism at her two Michigan pediatric practices and says this week’s unprecedented and confusing changes to federal vaccine guidelines will only make things worse.

One of her offices is in a Democratic area, where more and more of the parents she sees are opting for alternative schedules that stagger shots. The other is located in a Republican area, where some parents have completely stopped vaccinating their children.

She and other doctors worry that the new recommendations and the terminology surrounding them will fuel even more vaccine hesitancy, pose challenges for pediatricians and parents, making it harder for children to get vaccinated and ultimately leading to more illness and death.

The biggest change was ending blanket recommendations for protection against six diseases and recommending these vaccines only to at-risk children or through what’s called “shared clinical decision-making” with a health care provider.

Experts say the phrase is confusing and dangerous: “It sends the message to parents that in reality, only a select group of people really need the vaccine,” O’Shea said. “This creates an environment that creates a sense of uncertainty about the value, necessity or importance of vaccines in this category.”

Health Secretary Robert F. Kennedy Jr., who helped lead the anti-vaccine movement for years, said in announcing the changes that they better align the United States with peer countries “while strengthening transparency and informed consent.”

But doctors say they are sowing doubt — vaccines have been studied extensively and shown to be safe and effective in protecting children against nasty diseases — at a time when childhood vaccination rates are already declining and some of these infectious diseases are spreading.

On Friday, the American Academy of Pediatrics and more than 200 medical, public health and patient advocacy groups sent a letter to Congress about the new childhood vaccination schedule.

“We urge you to investigate why the schedule was changed, why credible scientific evidence was ignored, and why the committee charged with advising the HHS Secretary on vaccinations did not discuss schedule changes as part of its public meeting process,” they wrote.

O’Shea said she and other pediatricians discuss vaccines with parents at every visit where they are administered. But it is not necessarily “shared clinical decision making,” which has a specific definition.

On its website, the Advisory Committee on Immunization Practices states: “Unlike routine, catch-up, and risk-based recommendations, vaccinations made through shared clinical decision-making are not recommended for all persons in a particular age group or all persons in an identifiable risk group. Instead, shared clinical decision-making recommendations are individually based and informed by a decision-making process between the health care provider and the patient or patient. parent/guardian.”

In this context, health care providers include primary care physicians, specialists, physician assistants, nurse practitioners, registered nurses, and pharmacists.

Two surveys conducted last year by the Annenberg Public Policy Center at the University of Pennsylvania suggest that many people don’t fully understand the concept, which was brought up last year when the federal government changed its recommendations for COVID-19 vaccinations.

Only about 2 in 10 American adults knew that one of the meanings of shared decision-making is that “getting vaccinated may not be a good idea for everyone, but would benefit some.” And only about a third of pharmacists realize they are one of the health care providers to talk to during the process, even if they frequently administer vaccines.

As of this week, vaccines that protect against hepatitis A, hepatitis B, rotavirus, RSV, influenza and meningococcal disease are no longer universally recommended for children. Vaccines against RSV, hepatitis A, hepatitis B, and meningococcus are recommended for certain high-risk populations; Influenza, rotavirus, hepatitis A, hepatitis B and meningococcal vaccines are recommended under shared decision-making – as is the COVID-19 vaccine, although this change was made last year.

Shortly after the federal announcement Monday, Dr. Steven Abelowitz heard from a half-dozen parents. “This concerns us, but more importantly, it worries parents of children, especially young children, and creates confusion,” said Abelowitz, founder of Ocean Pediatrics in Orange County, California.

Although the federal recommendations are not mandates — states have the authority to require schoolchildren to be vaccinated — they can affect how easily children get vaccinated if doctors choose to follow them.

Under the new guidelines, O’Shea said, parents seeking shots in the shared decision-making category might no longer bring their children for a quick, vaccine-only appointment with staff. They would sit down with a health care provider and discuss the vaccine. And it might be harder to have a flu clinic, where parents drive up and kids get vaccinated without seeing a doctor.

Still, doctors say they won’t let the changes stop them from helping children get the vaccines they need. Major medical groups are sticking to previous vaccine recommendations. Many parents are too.

Megan Landry, whose 4-year-old son Zackary is one of O’Shea’s patients, is one of them.

“It is my responsibility as a parent to protect the health and well-being of my child,” she said. “Vaccines are a really effective and well-studied way to do this. »

She plans to continue having the same conversations she always had with O’Shea before getting the vaccine for Zackary.

“Relying on reliable medical evidence and advice really helps me make these decisions,” she said. “And for me, it’s not just a personal choice for my own son but a way to contribute to the health of all.”

But for other families, trust in vaccines is waning as trust in science erodes. O’Shea lamented that parents are getting the message that they can’t trust medical experts.

“If I take my car to the mechanic, I don’t do my own research ahead of time,” she said. “I go to someone I trust and trust them to tell me what’s going on.”

Abelowitz, the California doctor, likened the latest federal measure to adding fuel to the fire of distrust that was already burning.

“We are concerned that the fire is out of control,” he said. “We’ve already seen that with measles and whooping cough, there’s an increase in hospitalizations and even an increase in deaths. So, as I see it – and my colleagues see it – we’ve been essentially going backwards for decades.”

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.