CDC Vaccine Rollback Highlights Gaps in Public Understanding of Shared Decision-Making

The CDC’s recent decision to scale back recommended childhood vaccinations and place greater emphasis on shared clinical decision-making has revealed widespread public confusion about the policy, according to new national surveys from the Annenberg Public Policy Center (APPC).¹ Although federal health officials describe shared decision-making as a framework for individualized discussions between families and health care providers, many Americans mistakenly interpret the guidance as signaling uncertainty about vaccine safety or as giving parents the option to vaccinate without consulting a clinician. These misunderstandings, experts warn, could potentially undermine confidence in routine, long-established childhood immunizations.

“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, PhD, director of APPC’s Annenberg Health and Risk Communication Institute, in a statement. “These vaccines have been part of the recommended childhood schedule because the benefits of taking them substantially outweigh the risks.”

His statement underscores a broader concern that public misperceptions could complicate efforts to maintain high vaccination coverage in the US.

Last year, the CDC and its Advisory Committee on Immunization Practices updated the child and adolescent immunization schedules to reflect shared clinical decision-making for certain vaccines.² Parents of infants born to hepatitis B–negative mothers are now advised to work with their health care provider to decide whether and when to start the hepatitis B vaccine series, including the option to delay the birth dose if chosen. The guidance also recommends consulting providers before administering subsequent doses and considering antibody testing to assess protection.

Shared decision-making was also applied to COVID-19 boosters, with recommendations focused on individuals at higher risk for severe disease rather than blanket administration for all adults or children.³ In addition, the CDC updated guidance for toddlers, advising that varicella (chickenpox) vaccination be given separately from the combined measles, mumps, and rubella vaccine. This change was based on evidence showing that separating the vaccines reduces the risk of febrile seizures while maintaining effective protection against chickenpox. Together, these updates reflect a broader shift toward individualized, risk-informed vaccination discussions rather than one-size-fits-all recommendations.

To understand public awareness of these policy changes, APPC conducted 2 nationally representative panel surveys of US adults in August (n = 1699) and December 2025 (n = 1637).¹ The surveys assessed Americans’ understanding of shared clinical decision-making in the context of vaccines for themselves and their children. Results indicate that although a majority of respondents (68%) correctly understood that shared decision-making involves reviewing medical history with a health care provider, significant misconceptions remain. More than 40% incorrectly believed it allows individuals to make vaccine decisions without consulting a clinician, roughly a quarter thought it requires discussion with family members, and over 10% were unsure of what the term means in practice.

Awareness of which professionals can participate in shared decision-making was also limited. Most respondents identified physicians (86%) and physician assistants or nurse practitioners (66%), but only half recognized registered nurses, and just a third identified pharmacists as capable participants. These findings are especially relevant given the increasing availability of vaccines at pharmacies without a prescription.

“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, PhD, APPC’s managing director of survey research, in a statement.

Overall, the surveys highlight widespread gaps in Americans’ understanding of shared decision-making and the roles of different health care providers in vaccination decisions. The findings suggest that public health authorities need to provide clearer guidance and communication to ensure that parents and patients can make informed choices in consultation with qualified clinicians. By improving public understanding, health officials can strengthen confidence in vaccines, support safer and more individualized health care decisions, and reinforce the public health benefits of routine immunization.

References

1. CDC urges ‘shared decision-making’ on some childhood vaccines; many unclear about what that means. APPC. January 5, 2026. Accessed January 7, 2026. https://www.annenbergpublicpolicycenter.org/cdc-urges-shared-decision-making-on-some-childhood-vaccines-many-unclear-about-what-that-means/

2. ACIP recommends individual-based decision-making for hepatitis B vaccine for infants born to women who test negative for the virus. News release. CDC. December 5, 2025. Accessed January 7, 2026. https://www.cdc.gov/media/releases/2025/2025-acip-recommends-individual-based-decision-making-for-hepatitis-b-vaccine-for-infants-born-to-women.html

3. CDC immunization schedule adopts individual-based decision-making for COVID-19 and standalone vaccination for chickenpox in toddlers. News release. CDC. October 6, 2025. Accessed January 7, 2026. https://www.cdc.gov/media/releases/2025/cdc-immunization-schedule-adopts-individual-based-decision.html