Why RFK’s CDC supports “shared decision making” on vaccines

In general The US Secretary of Health and Human Services Robert F. kennedy jr Since taking office, his agency has made unprecedented changes to the childhood immunization schedule, eliminating global recommendations for six vaccines in favor of “shared clinical decision-making.”

The term has become a slogan for Kennedy’s Make America Healthy Against (MAHA) movement. NIH Director Jay Bhattacharyya, who interim leads the Centers for Disease Control and Prevention, He said He believes “very fundamentally in the importance of joint decision-making.” At her confirmation hearing before the Senate Health Committee in February, US Surgeon General nominee Casey Means It was invoked She was involved in clinical decision-making when senators pressed her on her views on vaccines.

On the face of it, this term seems reasonable. It refers to a conversation between a health care provider and a patient or patient’s guardian about the benefits and risks of a medical intervention and whether it makes sense for that individual to receive it. But public health experts say the term has been co-opted by the MAHA movement as a way to undermine vaccines.

“The evidence base for vaccines, both in terms of 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 Center for Epidemiology at Brown University. “When you classify it as something that requires shared clinical decision-making, it implies that it is not a routine standard of care practice, but that there is some uncertainty about safety or benefits, and that is simply wrong.”

In response to a request for comment, Department of Health and Human Services spokesman Andrew Nixon initially asked for the names of the people WIRED spoke to for this article before following up with a statement in which he wrote: “CDC has a long-established tradition of applying shared clinical decision-making when individuals may benefit from vaccination, but widespread vaccination of people in this group is unlikely to have population-level impacts.”

The Centers for Disease Control and Prevention first applied the term to COVID-19 vaccines Last Maywhen the agency said healthy children ages 6 months to 17 years may get the shot, but only after joint clinical decision-making between the child’s parents and their health care provider. In the fall, Kennedy’s chosen vaccine advisory committee went one step further, Violating previous government directives That everyone over 6 months of age should receive an annual coronavirus vaccine in the interest of shared clinical decision-making.

The latest and most sweeping change came in January, when Kennedy bypassed his own vaccine advisory committee Global recommendations were dropped For hepatitis A, hepatitis B, influenza, meningococcal ACWY, and rotavirus vaccines, I placed them instead in the “shared clinical decision making” category. This change, which was 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 arose in the 1980s in response to a long legacy of paternalistic medicine. It was common for doctors to make decisions on behalf of patients, such as cancer treatment, often without informing them of the risks. Shared clinical decision making is typically used for complex medical decision making where there may not be a single “best” option or where the benefits of treatment are less certain, not for routine vaccines known to be safe and effective.

“Public health is built on the recognition that individual decisions add up to population outcomes,” says Jake Scott, MD, an infectious disease physician and clinical assistant professor at Stanford University. “What seems like a personal choice about vaccinating your child is also a decision that affects the baby next door who cannot be vaccinated, the immunocompromised child in the same classroom, or the pregnant woman in the grocery store.”