Why RFK’s CDC Is Endorsing ‘Shared Decisionmaking’ for Vaccines

In the year After U.S. Health and Human Services Secretary Robert F. Kennedy Jr. took office, his agency made unprecedented changes to the childhood immunization schedule, removing universal recommendations for a half-dozen vaccines in favor of “shared clinical decision-making.”

The term became something of a mantra for Kennedy’s Make America Healthy Against (MAHA) movement. National Institutes of Health Director Jay Bhattacharya, who also temporarily leads the Centers for Disease Control and Prevention, said he believes “very fundamentally in shared decision-making.” And during her confirmation hearing before the Senate Health Committee in February, Casey Means, nominee for U.S. surgeon general, invoked shared clinical decision-making when senators pressed her for her views on vaccines.

At first glance, the term seems reasonable. It is 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 person to receive it. But public health experts say the term was co-opted by the MAHA movement as a way to undermine vaccines.

“The evidence on vaccines, both on their safety and the protection they provide, is very clear, and that 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 you label them as something that requires shared clinical decision-making, it implies that it’s not a standard of routine care practice, but that there is some uncertainty about safety or benefit, and that’s just wrong.”

In response to a request for comment, HHS spokesperson Andrew Nixon first asked for the names of people WIRED spoke with for this article before following up with a statement in which he wrote: “The CDC has an established tradition of applying shared clinical decision-making when individuals may benefit from vaccination, but broad vaccination of people in this group is unlikely to have population-level impacts.”

The CDC first applied the term to Covid-19 vaccines last May, when the agency said healthy children ages 6 months to 17 years could get vaccinated, but only after a shared clinical decision between the child’s parents and their health care provider. In the fall, Kennedy’s hand-picked vaccine advisory committee went further, reversing previous government guidance that everyone over 6 months should receive an annual Covid vaccine, in favor of shared clinical decision-making.

The most recent and sweeping change occurred in January, when Kennedy bypassed his own vaccine advisory committee and abandoned universal recommendations for hepatitis A, hepatitis B, influenza, meningococcal ACWY, and rotavirus vaccines and instead placed them in the “shared clinical decision-making” category. This change, which is not supported by any new evidence or data, means that these vaccines will no longer be considered routine.

The idea of ​​shared clinical decision-making emerged in the 1980s in response to a long legacy of paternalistic medicine. It was common for doctors to make decisions on behalf of patients, for example for cancer treatment, often without informing them of the risks. Shared clinical decision making is typically used for complex medical decisions for which there is no single “best” option or for which treatment benefits are less certain, and not for routine vaccines that are known to be safe and effective.

“Public health is based on recognizing that individual decisions combine with population outcomes,” says Jake Scott, an infectious disease physician and clinical associate professor at Stanford University. “What seems like a personal choice whether or not to vaccinate your child is also a decision that affects the infant next door who is too young to be vaccinated, or the immunocompromised child in the same classroom, or the pregnant woman at the grocery store.