OPINION:
Health and Human Services Secretary Robert F. Kennedy Jr.’s vaccine policy is health care noblesse oblige of the most craven, grievous and callous variety. It’s also an opportunity to advance vaccine acceptance. Really.
Fact: Americans overwhelmingly embrace vaccines for themselves and their children, and they vote with their arms. During the 2023- 2024 school year, 92.7% of kindergartners received the measles, mumps and rubella vaccine. This is lower than the 93.1% of the previous school year and the 95.2% of 2019-2020, before the COVID-19 pandemic, but it’s important for context. Americans believe in vaccines.
Context is crucial, considering that the Centers for Disease Control and Prevention, citing practices in other wealthy nations, including Denmark, Germany and Japan, reduced the number of recommended childhood vaccinations Monday from 17 to 11. The CDC said 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.”
What’s the opposite of shared decision-making? That would be “informed decision making,” in which the physician informs and the patient decides. To most people, most parents and most physicians, that means “Doctor knows best.” Ah, for the days of Marcus Welby.
The bottom line is that the halcyon days of “Trust me; I’m a doctor” are over. The inconvenient truth is that, since COVID-19 came to America, trust must be earned. Pearl-clutching and name-calling on social media and in medical journals are a gift to anti-vaxxers who enjoy the attention, chief among them Mr. Kennedy. It is the public health equivalent of farting into the wind.
When denied attention, Mr. Kennedy reverts to his status as the Looney Tunes dragon. Here is the headline: “Sound Science + Shared Decision Making + Respectful Engagement = Victory for Vaccines.”
The battle won’t be won on the traditional playing fields of academic white papers and expert advisory panels. Mr. Kennedy’s stacked CDC Advisory Committee on Immunization Practices defines shared clinical decision-making vaccinations (on a webpage dated Jan. 7, 2025) as “individually based and informed by a decision process between the health care provider and the patient or parent/guardian.”
In other words, patients (otherwise known as “people”) should discuss vaccinations with their primary care physicians, nurse practitioners, registered nurses, pharmacists and anyone else they view as a trusted health care resource. If the pro-vaccine establishment can’t accept that premise, we lose. There is no victory in going down with the ship. The stakes are too high and the opposition too low.
It’s important to note that the Advisory Committee on Immunization Practices’ shared clinical decision-making recommendations do not suggest patients get vaccines without talking with their health care providers. What they do say is that health care providers should decide with which patients they should discuss vaccinations.
Pro-vaxxers should go beyond that and aggressively encourage people (also known as parents) to start these conversations. When we do that, sound, science-based decision-making prevails. We must own rather than deride shared decision-making.
According to a survey by the Annenberg Public Policy Center of the University of Pennsylvania (APPC), 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 a vaccine is right for them or their child. The same proportion (68%) say this regarding a COVID-19 vaccine for healthy children and teens.
When asked about “shared decision-making” with a “health care provider,” many Americans were not sure who would be included among that group. Survey respondents were provided with six options and asked to select as many as apply.
Most U.S. adults (86%) choose a physician. Two-thirds (66%) choose a physician assistant or nurse practitioner. Only half (50%) choose a registered nurse, and just a third (33%) choose a 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, managing director of survey research at the APPC.
Welcome to 2026. It’s not about what experts say (sorry, bow-tied experts). It’s about what patients (otherwise known as “the people”) think and, more important, how they choose to act.
Correction: A previous version of this piece misidentified Mr. Winneg’s workplace.
• Peter J. Pitts, a former associate commissioner at the Food and Drug Administration, is president of the Center for Medicine in the Public Interest and a visiting professor at the University of Paris School of Medicine.
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