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The Trump administration has been shaking up childhood vaccinations. One recent change drops the recommendation that all kids get six immunizations, long considered routine. Instead, they're now in a category called shared clinical decision-making. NPR health correspondent Rob Stein explains what that means.
ROB STEIN, BYLINE: Shared clinical decision-making. Sounds pretty wonky but also kind of pretty good.
WENDY PARMET: In theory, shared clinical decision-making sounds great.
STEIN: Wendy Parmet studies health care policy at Northeastern University.
PARMET: It's the idea that a patient or, in the case of a child, the patient's parents and the clinician talk together and decide what is appropriate. It's sort of an idea that we all know, of informed consent and having a conversation with your doctor. You know, should I have surgery or should I not have surgery?
STEIN: But shared clinical decision-making is usually reserved for complicated medical calls where the answer is muddy, like which men need regular PSA prostate cancer testing? Should someone get surgery or physical therapy for back pain? Vaccine critics argue that's the case with these six immunizations, and administration officials say the change is designed to restore trust in vaccines. But doctors like Jake Scott at Stanford say there's no ambiguity about these inoculations, which protect against hepatitis, the flu, meningitis, RSV and a dangerous stomach bug called rotavirus.
JAKE SCOTT: These vaccines, you know, have clear evidence of benefit for all children. So moving them to shared decision-making doesn't reflect the scientific uncertainty that the category exists for, so it manufactures this sort of uncertainty where no uncertainty really exists.
STEIN: And, Scott says, dropping these vaccines to a lower spot in the new CDC vaccine hierarchy sows confusion. And there are practical implications like deleting automatic electronic medical record alerts when shots are due.
SCOTT: Moving it from routinely recommended to shared clinical decision-making has a dramatic effect on the practical delivery of vaccination.
STEIN: And while the administration says the decision shouldn't affect whether government programs or private insurance pay for the immunizations, some legal experts say they may not be guaranteed. Dorit Reiss studies vaccine policies at UC Law San Francisco.
DORIT REISS: There's a number of problems there. First of all, they can change their interpretation later. Second, if a private insurer wanted to challenge this and say, this vaccine is no longer recommended, I don't have to cover it, they probably have some good arguments.
STEIN: Even with insurance, parents may now get hit with copays for those extra conversations with swamped pediatricians. Another big question is, does this make vaccine makers and doctors vulnerable to getting sued? Many lawyers don't think so, but some argue that it does, and Wendy Parmet from Northeastern says that uncertainty is alarming.
PARMET: We don't quite really know whether shared clinical decision-making will be considered as sufficient enough of a recommendation to provide the liability protection. And if it doesn't do that, then there are real concerns about whether manufacturers will continue to make vaccines.
STEIN: Which means vaccines may become unavailable, and even the possibility of lawsuits could be enough to intimidate doctors.
PARMET: One kid gets sick the next day. Even if it has nothing to do with a vaccine, are they going to be the ones, you know, held responsible and someone's going to say, you had the nurse do it without talking to the doctor?
STEIN: Making doctors hesitant to recommend the immunizations, and that means imposing shared clinical decision-making could leave more kids more vulnerable to dangerous infections. Rob Stein, NPR News. Transcript provided by NPR, Copyright NPR.
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