HHS Secretary Robert F Kennedy Jr and his anti-vaccine sycophants at the CDC recently moved several recommended vaccines to “shared clinical decision-making.” Although it may sound good, it creates more confusion about vaccine safety and effectiveness, which could lead to lower access and uptake.

Shared clinical decision-making (SCDM) sounds like a good idea — the patient (or the parents if the patient is a child) has a conversation with a health care provider to decide whether a treatment is appropriate. It is usually reserved for complicated medical decisions where the medical options are unclear, not for routine vaccines that have been clearly shown to be safe and effective.

But there are consequences to employing shared clinical decision-making with vaccines, and most of them are not good for the health of the USA. This post will outline the largest of these.

The pitfalls of shared clinical decision-making and vaccines

The vaccines that were moved from recommended to shared clinical decision-making were:

• hepatitis A
• hepatitis B
• influenza
• meningococcal
• respiratory syncytial virus (RSV)
• rotavirus

Despite the new categorizations of these vaccines by RFK Jr and his CDC, their safety and effectiveness are not in doubt. Moreover, the dangers of contracting these diseases are also not in doubt.

Putting these vaccines into the SCDM category makes it appear that there is a false equivalence between safe and unsafe, and between effective and ineffective. Shared clinical decision-making is usually reserved for procedures or medications where the risk and benefit are unclear. For example, SCDM makes sense for a cancer therapy where there is a decision to be made between outcomes and the adverse events associated with that therapy.

SCDM makes it appear that the differences in outcomes of vaccinating or not vaccinating a child are relatively equivalent. However, not vaccinating a child puts that child at risk, puts the family at risk, and puts the community at risk for the vaccine-preventable disease. The outcomes are not equivalent — one removes risk, not vaccinating increases risk.

I am not suggesting that a parent should not discuss the risks and benefits of a particular vaccine. But the default option should be that the vaccine is recommended, and should only not be used if there’s some issue for a particular child where they should remain unvaccinated, such as a severe allergy to a component of the vaccine.

By placing these critical vaccines lower in the hierarchy of vaccines (from recommended to shared clinical decision-making), it sows fear, uncertainty, and doubt about these vaccines. For those of us engaged in scientifically researching vaccines, we will unquestionably give our children (and ourselves) these vaccines. I did discuss vaccines for my children with their pediatrician, because I was fully on board with the full vaccine schedule. Of course, I’m a real scientist who knows how to really research vaccines, and I’m not frightened by the tropes and lies of the anti-vaccine crowd.

On the other hand, parents who are not engaged with the whole vaccine “debate” may see that these six vaccines now require shared clinical decision-making and wonder if something is going on with them. They may refuse them because they are no longer “recommended,” putting everyone at risk of these diseases.

Other problems could arise from this shared clinical decision-making:

• Pediatricians may increase the amount of time they spend with parents discussing safe and effective vaccines. This could lead to fewer appointments per day available for patients. Again, I realize physicians should discuss vaccines with parents, but once a vaccine is no longer “recommended” by the CDC, it could increase worry with longer discussions with pediatricians.
• One major concern is that health insurers may stop reimbursing for vaccines or increase co-pays for them. At this time, all vaccines recommended by the CDC are covered by health insurers. Would they stop doing this? I’m a bit skeptical since health insurers are the ultimate experts in managing medical costs. Treating RSV in an ICU is significantly more expensive than the RSV vaccine.
• Another concern is that the vaccines removed from the “recommended” list will also be removed from the covered vaccines in the National Vaccine Injury Compensation Program, the Federal program that provides compensation for vaccine injury claims approved by a Special Master. The compensation is funded by a Federal tax on vaccines. If those vaccines are removed from the program, manufacturers of the non-recommended vaccines may have to endure frequent lawsuits. As a result, the companies could withdraw from the US market, effectively putting our children at risk of these diseases. The program was set up in 1986 specifically because of numerous vaccine lawsuits that threatened the US supply of vaccines. Anti-vaccine lawyers are drooling at this prospect because they appear to have a limited interest in the health of our children.
• Even if the National Vaccine Injury Compensation Program continues to include the vaccines on the shared clinical decision-making list, it could nevertheless put pediatricians and other healthcare workers who prescribe and administer vaccinations at risk of lawsuits. This could seriously limit how willing physicians will be to recommend or give vaccines on the SCDM list.

Summary

I see nothing good coming out of the move of these six vaccines from “recommended” to “shared clinical decision-making.” These vaccines are very safe, and they prevent dangerous and ultimately deadly diseases.

This change was absolutely unnecessary, but it does a wonderful job in potentially reducing vaccine uptake by making it more complicated to get these vaccines. And over the long-term, it could lead to vaccine hesitancy for parents, and, possibly, physicians.

As I wrote before, RFK Jr wants to damage or eliminate the vaccine system in the USA. This is just the start.

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