Why shifting childhood vaccines to “shared clinical decision-making” puts kids at risk

not used title

Federal health officials recently decided that some childhood vaccines will no longer be routinely recommended and instead be recommended using “shared clinical decision-making (SCDM).” As an emergency physician, I know how important it is for patients to discuss health care decisions with their doctors and health care professionals.

Vaccination has always included these types of conversations between providers and their patients or parents.

Applying a SCDM recommendation to vaccines that have clear, long-standing benefits, and in the absence of valid scientific evidence, risks creating confusion for patients and potentially introducing unnecessary barriers to care. As a physician, I strongly support SCDM when the evidence is evolving, or the benefit is uncertain. That is not the case for the recent changes to the childhood vaccine schedule.

Public health recommendations should reduce confusion. Applying SCDM to well-established vaccines does the opposite. And missed vaccinations can have serious consequences, like we are already seeing with measles outbreaks.

Here’s what else you need to know:

SCDM is already routinely used in medical practice. Take for example a patient who is facing a complex medical decision, like how to treat chronic back pain, where there is not one clear solution. They might have a discussion with their doctor about a range of treatment options including seeing a surgeon or alternatively trying a more conservative route like going to physical therapy. After weighing their options and determining what makes the most sense for their personal health goals, they can come up with a solution and re-evaluate over time.
In the vaccine context, SCDM does not just refer to a conversation but has a different significance. For vaccines, SCDM is a specific type of recommendation that has been reserved for instances when public health and data show that there is individual-level benefit to vaccination but less certainty about the benefit to the entire population. The vaccines recently updated to SCDM which had for many years been previously recommended at a population level, including those that protect against rotavirus, influenza and meningococcal disease, have decades of evidence supporting their use and the broad benefit to public health.

The abrupt shift to SCDM recommendations for these vaccines was not driven by scientific evidence or what’s best for American children, but rather positioned to better align the U.S. childhood vaccine schedule with other countries, Denmark specifically, which was an outlier among developed nations.
Applying SCDM recommendations to well-established, broadly recommended vaccines—and in the absence of scientific evidence—limits choice and creates confusion. Some of the impacts include:
- Barriers for patients. SCDM assumes that patients have reliable access to a clinician, sufficient time for in-depth discussions, and continuity of care to revisit decisions as needed. In practice, many patients, particularly those in rural or underserved communities, face structural barriers to meeting these assumptions, including limited access to primary care, fragmented delivery and challenges with health literacy. When applied to childhood vaccines, SCDM recommendations risk converting logistical barriers into clinical ones.
- Barriers for providers. SCDM recommendations may impact procedures in some states that allow providers like nurses and pharmacists to vaccinate people outside of a doctor’s office.
- Vaccine administration challenges. The recommendation may also complicate vaccination infrastructure which has been built for clearer, population-based vaccine recommendations. Electronic health record systems for instance may not always integrate under SCDM and alert providers that patients are due for a vaccine. This lack of clarity could extend to more layers of paperwork causing confusion. All told, these changes could create additional barriers and challenges for patients to get vaccinated.

Every American should have the choice to protect themselves and their children against dangerous diseases. America historically has taken a proactive approach to prevention of infectious diseases given the diversity of its populations. The changes to the childhood vaccine schedule without the use of sound and credible scientific evidence puts our leadership – and the health of American children and families – at risk.

Learn more at PhRMA.org/Vaccines.

Mike Ybarra

Michael Ybarra, M.D., is an emergency physician and Chief Medical Officer at PhRMA. He also serves as Senior Vice President in Advocacy and Strategic Alliances. In these roles, he leads PhRMA’s stakeholder engagement and strategic partnerships on federal and international health policy issues. He is PhRMA’s liaison representative to the Advisory Committee on Immunization Practices and is the co-convener of PhRMA’s R&D Leadership Forum. Dr. Ybarra continues to see patients clinically in the emergency department at MedStar Georgetown University Hospital.

Follow Mike on LinkedIn and X.

Mike Ybarra

How the Vaccines for Children program protects America's kids

October 14, 2026

Why smart vaccine policy matters

August 3, 2026

New study: HPV vaccination helps prevent cervical cancer deaths

July 21, 2026

New research reinforces the importance of hepatitis B vaccination at birth

May 21, 2026

World Immunization Week: Putting preventable diseases in the past

April 24, 2026

ICYMI: Measles resurgence could cost U.S. nearly $8 billion over five years

April 15, 2026

Changes to America’s childhood vaccine schedule fail to protect our nation's kids

January 13, 2026

New study: Measles setbacks harm health and America’s economy

October 28, 2025

Why the hepatitis B vaccine matters

October 21, 2025

Vaccines and autism: Decades of scientific evidence find no link

September 22, 2025

Why the vaccine injury program matters

August 18, 2025

Recognizing the importance of vaccination for American health and security

August 4, 2025

Answering common questions on mRNA technology

July 17, 2025

What to know about vaccine ingredients: Aluminum and thimerosal

June 24, 2025

World Immunization Week: Highlighting the importance of vaccines for public health

April 28, 2025

What you need to know: Measles and the MMR vaccine

March 10, 2025

Improved treatments continue to lead to declining cancer mortality rates in the U.S.

February 25, 2025

Preventing and fighting disease: A look at the biopharmaceutical progress made for patients in 2024

February 3, 2025

Recognizing the value of disease prevention with Dr. Len Friedland from GSK

December 12, 2024

Leveraging the power of vaccines to prevent antimicrobial resistance

October 31, 2024

From the emergency department to the CDC Advisory Committee: Key takeaways from ACIP’s recent meeting

October 30, 2024

The Patient Perspective: Vaccines

October 23, 2024

How to protect your children’s health this school year

August 22, 2024

New Report: Vaccines continue to drive improved health outcomes

July 16, 2024

Showcasing the promise of biopharma at ASCO 2024

June 28, 2024

World Vaccine Congress: Building on vaccine success

April 1, 2024

WHO Pandemic Agreement offers opportunities and risks for American innovators

November 20, 2023

New Report: 1,600 cancer treatments and vaccines in clinical development

November 9, 2023

What you should know about protecting your health this fall

October 16, 2023

A conversation with Dr. Mike Ybarra on the current state of COVID-19

June 27, 2023

What they are saying: Experts reinforce that TRIPS waiver expansion is harmful and unnecessary

April 13, 2023

PhRMA provides comments and testimony to USITC investigation on COVID-19 medicines and the TRIPS Agreement

March 30, 2023

Celebrating the success of the COVID-19 vaccines, and looking to the future

March 27, 2023

What we’ve learned from three years of fighting COVID-19

March 20, 2023

Word of the Month: What is TRIPS?

November 29, 2022

What you should know about RSV

November 15, 2022

Word of the Month: Long COVID

October 19, 2022

Protecting against influenza: A conversation with David Ross, Vice President, Commercial Operations, North America, CSL Seqirus

October 13, 2022

Partnerships are driving global COVID-19 treatment access

September 22, 2022

ICYMI: PhRMA’s Ubl pens op-ed on IP waiver for COVID-19 technologies

July 15, 2022

New Data: COVID-19 vaccine global production capacity projected to exceed 20 billion doses this year

February 24, 2022

What you need to know about newly authorized COVID-19 antiviral treatments

February 22, 2022

Guest Blog: COVID-19 vaccines are the key to keeping kids healthy

February 16, 2022

Global COVID-19 vaccination matters now and for the future

November 29, 2021

Understanding breakthrough COVID-19 infections

November 11, 2021

The important role of antivirals in the fight against COVID-19

October 6, 2021

A year and a half later: The biopharmaceutical industry remains committed to beating COVID-19

September 8, 2021

Recognizing National Immunization Awareness Month

August 31, 2021

Driving further innovation is critical to global vaccine equity

August 24, 2021

Supporting country readiness to boost global vaccine access

August 12, 2021

Ensuring global vaccine equity requires eliminating trade and regulatory barriers

August 5, 2021

Setting the record straight: Addressing common misconceptions about the COVID-19 vaccine

August 4, 2021

Increasing global access to vaccines by optimizing production

July 29, 2021

Guest post: Retired medics return to the field to take on vaccine delivery and disaster relief

July 23, 2021

Guest Post: A patient’s story of the long-term health impacts of COVID-19

July 21, 2021

Dose sharing as a part of the COVID-19 global vaccine equity strategy

July 20, 2021

Promoting global vaccine equity while protecting innovation

July 15, 2021

Data shows COVID-19 vaccines are creating a pathway to a strong U.S. recovery

July 2, 2021

Americans 12 years of age and older are eligible for COVID-19 vaccines

June 17, 2021

ICYMI: PhRMA president and CEO Stephen J. Ubl joins other industry leaders for a conversation on COVID-19 vaccines with Axios

May 21, 2021

Supporting India during the devastating coronavirus surge

May 20, 2021

PhRMA CAREs Grant request for proposals: Addressing inequities in access to COVID-19 testing, therapeutics and vaccines

May 6, 2021

Ron Busby, Sr., President and CEO of the U.S. Black Chambers, Inc. on improving vaccine confidence in community

May 5, 2021

Patient safety is at the heart of COVID-19 vaccine R&D

April 26, 2021

Data shows that Americans are relying on vaccines to get us through the pandemic

April 22, 2021

Diversifying clinical trials and fighting disease requires equity and trust

April 12, 2021

Building confidence in the COVID-19 vaccine through education

March 22, 2021

ICYMI: WSJ showcases breakthrough science of COVID-19 vaccines and implications for future medicines

March 8, 2021

Intellectual property is the key to vaccine development, manufacturing and technology sharing

March 5, 2021

Coming together to fight COVID-19: A conversation with Paul Perreault, CEO and Managing Director of CSL

February 24, 2021

Fighting variants of COVID-19

February 22, 2021

Growing trend: Increased vaccine confidence

January 28, 2021

Guest post: How COVID-19 underscores the importance of public confidence in vaccines

December 7, 2020

Understanding the emergency use authorization process for COVID-19 vaccines

November 12, 2020

Flu Season 2020: Why it’s time to talk to your doctor today about getting a flu shot

October 8, 2020

Coming together to fight COVID-19: A conversation with Albert Bourla, Chairman & CEO of Pfizer, Inc.

September 17, 2020

Coming together to fight COVID-19: A conversation with Paul Hudson, CEO of Sanofi

September 2, 2020

Supporting access to vaccines for Part D beneficiaries

August 12, 2020

New report shows more than 400 medicines and vaccines in development to tackle infectious diseases, including COVID-19

July 21, 2020

PhRMA’s Lori Reilly joined CSG to discuss the industry’s response to COVID-19 and what it means for states

July 13, 2020

How biopharmaceutical researchers are ensuring COVID-19 vaccines will be safe and effective

June 29, 2020

Guest Post: From lab to jab: Vaccine development to prevent COVID-19

June 11, 2020

What scientific experts are saying about vaccine safety

June 4, 2020

New report shows nearly 260 vaccines in development, including dozens for COVID-19

April 23, 2020

ICYMI: Continued biopharmaceutical action on COVID-19

March 6, 2020

Why vaccines work in the fight against measles and other infectious diseases

February 13, 2019

Medicare Monday: Helping beneficiaries access vaccines

December 18, 2017

New report and event examine the new era of vaccines

November 9, 2017

Medicare Monday: Strengthening access to vaccines for seniors

August 14, 2017

Vaccines