CDC urges ‘shared decision-making’ on some childhood vaccines; many unclear about what that means

Annenberg Public Policy Center of the University of Pennsylvania

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PHILADELPHIA – On Jan. 5, the Centers for Disease Control and Prevention (CDC) dramatically reduced the number of recommended childhood vaccinations from 17 to 11, citing practices in other wealthy nations, including Denmark, Germany, and Japan. The CDC said that parents could choose to have their children receive some previously recommended vaccines, including those for flu, rotavirus, Covid-19, meningitis, and hepatitis A and B, after “shared clinical decision-making.”

The CDC’s announcement followed other similar moves by federal health officials. In December, the CDC’s vaccination advisory committee, whose members were handpicked by longtime vaccine critic Health and Human Services (HHS) Secretary Robert F. Kennedy Jr., voted to scrap the blanket recommendation of a birth dose of the hepatitis B vaccine for all infants. Instead, the Advisory Committee on Immunization Practices, or ACIP, replaced that guidance with the recommendation that the vaccine be given automatically only to infants whose mothers test positive for hepatitis B. Infants whose mothers do not test positive for hepatitis B could get vaccinated against it if their parents choose to do so after taking part in shared clinical decision-making.

Two months earlier, the CDC updated its immunization schedules to also recommend shared clinical decision-making for Covid-19 vaccination among everyone age 6 months and older. 

ACIP defines shared clinical decision-making vaccinations (on a web page dated Jan. 7, 2025) as “individually based and informed by a decision process between the health care provider and the patient or parent/guardian.” Health care providers to discuss vaccination with, according to the CDC, include primary care physicians, specialists, physician assistants, nurse practitioners, registered nurses, and pharmacists.

Does the American public understand what shared decision-making means?

In a pair of nationally representative panel surveys of U.S. adults conducted in August and December, the Annenberg Public Policy Center (APPC) asked Americans about their understanding of this new policy from federal health authorities. In an August 2025 survey of 1,699 U.S. adults, APPC asked about Americans’ understanding of “shared decision-making.” In a follow-up survey in December 2025, an APPC survey asked 1,637 respondents about their understanding of what a “health care provider” is in the context of shared decision-making.

The surveys find significant gaps in Americans’ understanding of shared decision-making when it comes to getting vaccinated and having their babies and children vaccinated against potentially deadly illnesses.

“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, director of APPC’s Annenberg 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.”

An incomplete understanding of ‘shared decision-making’

The August 2025 survey asked what respondents thought shared decision-making means when the CDC recommends it in the context of whether to get a new vaccine. It also asked respondents about the meaning of shared decision-making specifically regarding vaccinating children against Covid-19. In both cases, respondents could select as many responses as apply. The survey found that:

• More than two-thirds (68%) know shared decision-making means they should review their or their child’s medical history with their health care provider before deciding whether the vaccine is right for them or their child. The same proportion (68%) say this regarding a Covid-19 vaccine for healthy children and teens.
• 1 in 5 people (22%) think shared decision-making also means that “taking the vaccine may not be a good idea for everyone but would benefit some.” One in 5 (20%) also chose this regarding vaccination of children against Covid-19. The ACIP web page notes that “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.”
• However, more than 2 in 5 people incorrectly say shared decision-making means it’s up to an individual whether to consult with their health care provider before taking a vaccine about whether it would be a good idea. In the surveys, 42% say this about taking a new vaccine and 45% say this about having a child vaccinated against Covid-19.

In fact, ACIP’s shared clinical decision-making recommendations do not suggest that patients get vaccines without talking to their health care provider; they only state that clinicians can decide which patients to discuss particular vaccinations with. In addition, the surveys find that:

• About a quarter of those surveyed say shared decision-making means they should discuss the vaccination decision with their family (23% for any vaccine; 25% regarding children and the Covid-19 vaccine). However, discussing the decision with family is not a part of the ACIP shared clinical decision-making recommendations.
• Over 1 in 10 are not sure what shared decision-making means, either for a new vaccine (13%) or for vaccinating children against Covid-19 (12%).

Few know a pharmacist can be part of shared decision-making

When asked about “shared decision-making” with a “health care provider,” many Americans are not sure who would be included among that group. Survey respondents were provided with six options and asked to select as many as apply.

Predictably, the vast majority of U.S. adults (86%) choose a physician. Two-thirds (66%) choose a physician assistant or nurse practitioner.

But only half (50%) choose registered nurse, and just a third (33%) choose pharmacist.

“With many vaccines available at pharmacies without a prescription, it is important for Americans to know they can talk to their pharmacist directly about their vaccination decisions,” said Ken Winneg, APPC’s managing director of survey research.

Small groups of respondents selected other practitioners as health care providers, including clinical social worker (8%) and acupuncturist (3%). Neither of those professions is included in ACIP’s list of health care providers to share in clinical shared decision-making. A small proportion are not sure (7%) and just 1% choose none of the options as a “health care provider.”

Annenberg Science and Public Health (ASAPH) survey

The survey data come from the 25th and 26th waves of a nationally representative panel of U.S. adults conducted for the Annenberg Public Policy Center by SSRS, an independent market research company. Wave 25 (n=1,699) of the Annenberg Science and Public Health Knowledge (ASAPH) survey was fielded Aug. 5-18, 2025. Wave 26 (n=1,637) was fielded Nov. 17-Dec. 1, 2025. The margin of sampling error (MOE) for both waves is ± 3.5 percentage points at the 95% confidence level. All figures are rounded to the nearest whole number and may not add to 100%. Combined subcategories may not add to totals in the topline and text due to rounding.

Download the topline and the methods reports.

The policy center has been tracking the American public’s knowledge, beliefs, and behaviors regarding vaccination, Covid-19, flu, RSV, and other consequential health issues through this survey panel since April 2021. APPC’s ASAPH survey team includes research analyst Laura A. Gibson; Patrick E. Jamieson, director of the Annenberg Health and Risk Communication Institute; and Ken Winneg, managing director of survey research.

See other recent Annenberg health survey news releases:

• MMR vaccine safety: As measles cases rise, views of MMR vaccine safety and effectiveness and willingness to recommend it drop (Dec. 22, 2025)
• Whooping cough: Cases of whooping cough remain high, but knowledge about the disease still low (Dec. 18, 2025)
• Hepatitis B vaccine: Although public overwhelmingly supports hepatitis B vaccine for a newborn, partisan differences exist (Dec. 5, 2025)
• Vaccine safety: Americans more likely to trust American Medical Association than CDC on vaccination safety (Dec. 3, 2025)
• Measles and the MMR vaccine: Public not highly knowledgeable about safety of MMR vaccine or risks of getting measles (Oct. 30, 2025)

The Annenberg Public Policy Center was established in 1993 to educate the public and policy makers about communication’s role in advancing public understanding of political, science, and health issues at the local, state, and federal levels.

US recommends fewer childhood vaccines in major shift


By AFP
January 5, 2026


The US will no longer recommend that every child receive immunizations against several diseases including rotavirus and influenza - Copyright AFP Annela NIAMOLO

The Trump administration on Monday overhauled the United States’ pediatric vaccine schedule, upending years of scientifically backed recommendations that reduced disease with routine shots.

The dramatic shift — announced by the US health department, which is led by long-time vaccine skeptic Robert F. Kennedy Jr. — means the country will no longer recommend that every child receive immunizations against several diseases including rotavirus and influenza.

The Centers for Disease Control and Prevention instead will recommend that shots preventing those illnesses as well as hepatitis A, hepatitis B and meningococcal disease be administered for select groups of high-risk individuals or when parents and a child’s doctor deem them warranted, rather than as standard practice.

The agency had already shifted to this recommendation model for Covid-19 shots in 2025.

At the end of 2024, the CDC was recommending 17 pediatric immunizations for all individuals, the agency said. Now that number is 11.

President Donald Trump praised the changes, noting that the “MAHA Moms” — a base of online influencers who ardently support Kennedy’s agenda — “have been praying for these common sense reforms for many years.”

Trump’s message heralding the schedule overhaul followed a TruthSocial post rife with false statements about vaccine safety and recommendations that contradict scientific consensus.

The decision follows Trump’s directive last month that health officials compare the US vaccine schedule to peer countries abroad.

They were notably focused on Denmark. The new US recommendations now more closely resemble that country’s schedule.

“After an exhaustive review of the evidence, we are aligning the US childhood vaccine schedule with international consensus while strengthening transparency and informed consent. This decision protects children, respects families, and rebuilds trust in public health,” Kennedy said in a statement.

But medical and public health experts slammed the overhaul.

Sean O’Leary, chair of the American Academy of Pediatrics Committee on Infectious Diseases, said “the US child vaccine schedule is one of the most thoroughly researched tools we have to protect children from serious, sometimes deadly diseases.”

“It’s so important that any decision about the US childhood vaccination schedule should be grounded in evidence, transparency and established scientific processes, not comparisons that overlook critical differences between countries or health systems,” he told journalists.

Experts at the Vaccine Integrity Project, an initiative out of the University of Minnesota, recently noted that the US had already been in line with global consensus.

Denmark, project researchers said, represents more of an outlier among “peer countries” than a standard.

“Denmark’s schedule reflects a set of choices made in a small, highly homogeneous country with a centralized health care system that guarantees universal access to care, low baseline disease prevalence, and strong social infrastructure,” the group wrote.

“Those conditions do not apply to the United States, not even close.”



– ‘More confusing for parents’ –



Senator Bill Cassidy, whose deciding vote confirmed Kennedy’s controversial appointment as health chief last year, said that “changing the pediatric vaccine schedule based on no scientific input on safety risks and little transparency will cause unnecessary fear for patients and doctors.”

The Republican, himself a doctor, said doing so would “make America sicker.”

States have the authority to mandate vaccinations, but generally CDC recommendations wield significant influence over state policies.

US officials have said that access as well as insurance coverage of vaccines should remain in place, even for shots not broadly recommended by the federal government.

“All vaccines currently recommended by CDC will remain covered by insurance without cost sharing,” said Mehmet Oz, the administrator of the federal health insurance programs.

“No family will lose access. This framework empowers parents and physicians to make individualized decisions based on risk, while maintaining strong protection against serious disease.”

But public health authorities warned that the changes would only sow doubt and confusion, especially as vaccine skepticism has mushroomed in the wake of the pandemic.

O’Leary said the shift “just makes things more confusing for parents and clinicians.”

“Tragically, our federal government can no longer be trusted” to provide vaccine recommendations, he added.