As the CDC rewrites childhood vaccine rules, survey finds confusion over ‘shared decision-making’

On Jan. 5, 2026, the Centers for Disease Control and Prevention (CDC) and the Department of Health and Human Services (HHS) announced that the routine childhood immunization schedule would be scaled back to 11 diseases, down from 17. Several vaccines moved into “high-risk” or “shared clinical decision-making” categories.

In recent polling released by the Annenberg Public Policy Center (APPC), large numbers of adults in the U.S. are unsure what “shared decision-making” actually means when it comes to vaccines. Many either misunderstand the term or say they do not know, raising concerns that the CDC’s revised schedule could add to confusion for both parents and physicians.

“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, Ph.D., 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.”

The survey lands as primary care physicians, pediatricians and pharmacists are tasked with interpreting a rapid series of federal changes that include the following:

1. Shrink the CDC’s list of universally recommended childhood vaccines.
2. Move multiple shots — including influenza, COVID-19, rotavirus and hepatitis A and B — into shared clinical decision-making.
3. Shift the birth dose of hepatitis B for infants whose mothers test negative for the virus to an individualized decision.

What the CDC means by ‘shared clinical decision-making’

The CDC said its routine childhood recommendations will now focus on 11 diseases, in part to align more closely with countries including Denmark, Germany and Japan. Vaccines that are no longer part of the routine list remain available but are now classified under “high-risk” or “shared clinical decision-making” categories.

The CDC’s Advisory Committee on Immunization Practices (ACIP) defines shared clinical decision-making vaccinations as “individually based and informed by a decision process between the health care provider and the patient or parent/guardian.”

In practice, that means clinicians are expected to weigh the benefits and potential risks of a given vaccine, as well as a child’s risk of infection, then talk with parents about whether and when to vaccinate, instead of following one recommendation for every child.

In this framework, health care providers include primary care physicians, specialists, physician assistants (PAs), nurse practitioners (NPs), registered nurses (RNs) and pharmacists.

The APPC’s findings suggest many patients interpret that language differently than federal officials intend.

Most know to review history, but many see an ‘opt-out’

The analysis is based on two waves of the APPC’s Annenberg Science and Public Health Knowledge survey, as follows:

• Wave 25, fielded Aug. 5-18, 2025, with 1,699 adults in the U.S.
• Wave 26, fielded Nov. 17–Dec. 1, 2025, with 1,637 adults in the U.S.

In August, respondents were asked what “shared decision-making” means when the CDC recommends it for a new vaccine, including the COVID-19 vaccination for children.

Some responses aligned with the ACIP’s intent. Sixty-eight percent of respondents understood that shared decision-making means reviewing their or their child’s medical history with a health care provider before deciding whether the vaccine is appropriate. The same share said this when asked about a COVID-19 vaccine for healthy children.

Others saw it as a signal that the benefits of the vaccine are weaker or more limited. Twenty-two percent said shared decision-making means “taking the vaccine may not be a good idea for everyone, but it would benefit some.” For vaccinating children against COVID-19, 20% gave the same answer.

More than 40% of respondents treated shared decision-making as an informal “opt-out” frame.

Forty-two percent said it means it is up to the individual whether to consult a health care provider before taking a new vaccine. Forty-five percent said the same when asked about vaccinating a child against COVID-19.

That interpretation is at odds with the ACIP’s definition.

Shared clinical decision-making, the APPC notes, is not designed to bypass clinicians. Instead, it means vaccines in that category are not recommended for everyone in a given age or risk group; clinicians decide which patients they should talk with about those shots.

The survey also found that approximately one-fourth of respondents believed shared decision-making means discussing the vaccination decision with family members: 23% for any vaccine, and 25% for children and the COVID-19 vaccine. More than 10% said they were unsure what the term means at all: 13% for a new vaccine and 12% for a COVID-19 vaccine for children.

For practices already facing questions about the safety of childhood vaccines, those gaps could mean longer counseling visits and more chances for misunderstanding.

Who is considered a ‘health care provider’?

The December survey wave asked another basic question: When the CDC talks about shared decision-making with a “health care provider,” who do people think that includes?

The responses were as follows:

• Eighty-six percent of respondents selected “physicians” as health care providers in this context.
• Sixty-six percent selected PAs or NPs.
• Fifty percent selected RNs.
• Thirty-three percent selected pharmacists, despite explicit mention of pharmacists in the CDC’s list of providers who can participate in the shared decision-making process.

Smaller groups named clinicians who are not part of the ACIP’s shared decision-making list, with 8% choosing clinical social workers and 3% choosing acupuncturists. Seven percent said they were not sure who counts as a health care provider in this context.

“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, Ph.D., APPC managing director of survey research.

For physicians, patients’ uncertainty over who counts as a health care provider could complicate efforts to share vaccine counseling with NPs and pharmacists as more childhood shots move into shared decision-making.