Shared Decision-Making & Vaccines: Expert Insights

The concept of discussing vaccine benefits and risks with patients – often called shared clinical decision-making – isn’t a recent shift in medical practice, despite gaining more attention in recent months. While some vaccine recommendations have moved to this model, the underlying principle of informed consent and collaborative conversations between clinicians and patients has long been a cornerstone of healthcare. Understanding this context is crucial as updated guidance from organizations like the CDC evolves.

What’s Changing in Vaccine Recommendations?

In January 2025, the Advisory Committee on Immunization Practices (ACIP) clarified its recommendations around shared clinical decision-making for several vaccines. So that for certain immunizations, a doctor and patient should have a detailed conversation about the individual’s specific circumstances, weighing the potential benefits against potential risks, before deciding whether or not to proceed. The CDC’s guidance outlines these recommendations, which currently include Meningococcal B (MenB) vaccination for adolescents and young adults aged 16–23 years, Hepatitis B (HepB) vaccination for adults aged 60 years and older with diabetes mellitus, Human papillomavirus (HPV) vaccination for adults aged 27–45 years, Pneumococcal conjugate vaccination (PCV20 or PCV21) for adults aged 65 years and older who have completed specific prior vaccine series, and additional doses of COVID-19 vaccination for those who are moderately or severely immunocompromised.

This differs significantly from routine vaccinations, like the measles, mumps, and rubella (MMR) vaccine, which are broadly recommended for nearly all children. Routine recommendations are based on population-level data demonstrating widespread benefit. Shared clinical decision-making, however, is reserved for situations where the benefits and risks are more closely balanced, or where individual factors play a larger role in the decision.

How Does Shared Decision-Making Work in Practice?

Shared clinical decision-making isn’t simply a doctor presenting information. It’s a process. Clinicians are expected to counsel patients about the vaccine, explaining how it works, its potential benefits, and possible side effects. Patients, in turn, are encouraged to share their concerns, values, and preferences. A guide from the Common Health Coalition emphasizes that this process has always been part of good medical practice, even if it wasn’t always formally labeled as “shared clinical decision-making.”

The American Academy of Pediatrics (AAP) has also weighed in, noting that this approach has historically been used for immunizations that are beneficial for some, but not necessarily all, children. The AAP’s resource highlights that in January 2026, the CDC broadened the scope of vaccines subject to shared clinical decision-making, including rotavirus, COVID-19, influenza, hepatitis A and B, and meningococcal disease. However, it’s important to note that AAP experts have expressed disagreement with some of these changes.

Beyond the Conversation: Individualized Risk Assessment

The core of shared clinical decision-making lies in individualized risk assessment. For example, the recommendation for HepB vaccination in adults 60 and older with diabetes isn’t a blanket statement. It acknowledges that individuals with diabetes are at higher risk of complications from hepatitis B, but the decision to vaccinate should still be made after a discussion considering their overall health status and potential risks.

What Does This Mean for Patients?

For patients, this shift means a more active role in their healthcare decisions. It’s an opportunity to inquire questions, express concerns, and understand the rationale behind vaccine recommendations. It’s also a reminder that there isn’t always a single “right” answer when it comes to medical care. The best course of action is the one that aligns with an individual’s values and circumstances, informed by the best available evidence.

However, it’s crucial to remember that shared decision-making doesn’t mean a patient can demand a vaccine against medical advice, or that a clinician is obligated to administer a vaccine a patient doesn’t aim for. It’s a collaborative process, but the clinician’s expertise and medical judgment are essential.

Understanding the Nuances of Vaccine Guidance

It’s important to distinguish between different types of vaccine recommendations. Routine recommendations are based on strong evidence of widespread benefit and are generally recommended for everyone in a specific age group. Catch-up recommendations are for individuals who missed earlier doses. Risk-based recommendations are for those with specific health conditions or exposures that increase their risk of infection. Shared clinical decision-making recommendations, as outlined by the CDC, are reserved for situations where the benefits and risks are more balanced and individual factors are paramount.

What’s Next for Vaccine Recommendations and Guidance?

The ACIP continually reviews vaccine recommendations as new data emerge. This includes ongoing surveillance of vaccine effectiveness, monitoring for adverse events, and evaluating the impact of new variants of infectious diseases. The CDC regularly updates its immunization schedules and guidance based on these reviews. Clinicians are expected to stay informed about these changes and incorporate them into their practice. Patients can find the most up-to-date information on the CDC website and by consulting with their healthcare providers.

research continues into improving vaccine development and delivery, as well as understanding the factors that influence vaccine hesitancy. These efforts will contribute to more informed and effective vaccination strategies in the future.