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.
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Mike Ybarra