Yesterday, in introducing drastic cuts to the nation’s childhood immunization schedule, the Centers for Disease Control and Prevention (CDC) said “shared clinical decision-making” would be used for pediatric vaccines against rotavirus, COVID-19, influenza, hepatitis A and B, and meningococcal disease.
But most Americans are confused by the idea of shared clinical decision-making, according to datafrom the Annenberg Public Policy Center (APPC), which asked adults about the term in two separate surveys in August and December of last year. The polls were conducted in light of the CDC’s decision to move COVID-19 vaccines to a shared clinical decision-making model, which resulted in low uptake and confusion at pharmacies and clinics across the country.
According to the CDC’s Advisory Committee on Immunization Practices (ACIP), shared clinical decision-making consists of a discussion between the health care provider and the patient or parent/guardian. “Unlike routine, catch-up, and risk-based recommendations, shared clinical decision-making vaccinations are not recommended for everyone in a particular age group or everyone in an identifiable risk group,” ACIP states.
25% think shared decision-making means talking to family
The Annenberg polls found that 68% of adults understood shared decision-making means they should review their or their child’s medical history with their health care provider for any vaccine, including COVID-19 vaccines.
One in five people (22%) believe shared decision-making means that “taking the vaccine may not be a good idea for everyone but would benefit some.” Furthermore, more than one in 10 are not sure what shared decision-making means, either for a new vaccine (13%) or for vaccinating children against COVID-19 (12%).
Twenty-five percent said shared decision-making means that vaccination need to be discussed with family members, which is not in ACIP’s definition.
Americans are also confused about which health care providers can engage in shared clinical decision-making. Most (86%) chose a physician when polled, and 66% chose a physician assistant or nurse practitioner. But only half (50%) chose a registered nurse, and just 33% chose a pharmacist, both of whom can administer vaccines.
“Expecting parents to engage in shared decision-making with health care providers about routine, thoroughly studied childhood vaccinations suggests that the public health community has doubts about the safety and efficacy of these vaccines when it does not,” said Patrick E. Jamieson, PhD, director of APPC’s Health and Risk Communication Institute. “These vaccines have been part of the recommended childhood schedule because the benefits of taking them substantially outweigh the risks.”
Both polls had a margin of error of 3.5 percentage points at the 95% confidence level.
States, counties assure vaccine access is unchanged
Following the CDC’s announcement yesterday, several states and counties issued statements concerning vaccine access and recommendations. States make the final decisions about school vaccine requirements.
Health officials in Marylandposted on X, saying Maryland’s vaccine schedule will still follow the American Academy of Pediatrics’ (AAP’s) recommended schedule.The AAP recommends continuing to routinely vaccinate against 17 diseases in childhood, including vaccinations now designated to require shared clinical decision-making.
AAP continues to recommend that children be immunized against these diseases, and for good reason
“AAP continues to recommend that children be immunized against these diseases, and for good reason; thanks to widespread childhood immunizations, the United States has fewer pediatric hospitalizations and fewer children facing serious health challenges than we would without this community protection,” said AAP President Andrew Racine, MD, PhD, in apress statement yesterday.
Los Angeles County also said it would continue to follow the existing California Department of Public Health (CDPH) vaccination guidelines for children. “There is no new scientific evidence indicating that the existing childhood vaccination schedule is ineffective or unsafe,” county officials said in a news release.
And today, the Association of Immunization Managers (AIM) said it was deeply concerned by the CDC’s announcement yesterday.
“Changing the recommendations, without scientific review, analysis, public comment, and evidence-based decision-making, increases the risk of preventable diseases, hospitalizations, and death. These are outcomes we have been working for decades to prevent,” said Claire Hannan, MPH, executive director of AIM,in a statement.
