CDC Urges ‘Shared Decision-Making’ on Some Childhood Vaccines; Many Unclear About What That Means

On Jan. 5, the Centers for Disease Control and Prevention (CDC) dramatically reduced the number of recommended childhood vaccinations from 17 to 11, citing practices in other wealthy nations, including Denmark, Germany, and Japan. The CDC said that 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.”

The CDC’s announcement followed other similar moves by federal health officials. In December, the CDC’s vaccination advisory committee, whose members were handpicked by longtime vaccine critic Health and Human Services (HHS) Secretary Robert F. Kennedy Jr., voted to scrap the blanket recommendation of a birth dose of the hepatitis B vaccine for all infants. Instead, the Advisory Committee on Immunization Practices, or ACIP, replaced that guidance with the recommendation that the vaccine be given automatically only to infants whose mothers test positive for hepatitis B. Infants whose mothers do not test positive for hepatitis B could get vaccinated against it if their parents choose to do so after taking part in shared clinical decision-making.

Two months earlier, the CDC updated its immunization schedules to also recommend shared clinical decision-making for Covid-19 vaccination among everyone age 6 months and older.

ACIP defines shared clinical decision-making vaccinations (on a web page dated Jan. 7, 2025) as “individually based and informed by a decision process between the health care provider and the patient or parent/guardian.” Health care providers to discuss vaccination with, according to the CDC, include primary care physicians, specialists, physician assistants, nurse practitioners, registered nurses, and pharmacists.

Does the American public understand what shared decision-making means?

In a pair of nationally representative panel surveys of U.S. adults conducted in August and December, the Annenberg Public Policy Center (APPC) asked Americans about their understanding of this new policy from federal health authorities. In an August 2025 survey of 1,699 U.S. adults, APPC asked about Americans’ understanding of “shared decision-making.” In a follow-up survey in December 2025, an APPC survey asked 1,637 respondents about their understanding of what a “health care provider” is in the context of shared decision-making.

The surveys find significant gaps in Americans’ understanding of shared decision-making when it comes to getting vaccinated and having their babies and children vaccinated against potentially deadly illnesses.

“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, 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.”

An incomplete understanding of ‘shared decision-making’

The August 2025 survey asked what respondents thought shared decision-making means when the CDC recommends it in the context of whether to get a new vaccine. It also asked respondents about the meaning of shared decision-making specifically regarding vaccinating children against Covid-19. In both cases, respondents could select as many responses as apply. The survey found that:

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 the vaccine is right for them or their child. The same proportion (68%) say this regarding a Covid-19 vaccine for healthy children and teens.
1 in 5 people (22%) think that shared decision-making also means that “taking the vaccine may not be a good idea for everyone but would benefit some.” One in 5 (20%) also chose this regarding vaccination of children against Covid-19. The ACIP web page notes that “Unlike routine, catch-up, and risk-based recommendations, shared clinical decision-making vaccinations are not recommended for everyone in a particular age group or everyone in an identifiable risk group.”*
However, more than 2 in 5 people incorrectly say shared decision-making means it’s up to an individual whether to consult with their health care provider before taking a vaccine about whether it would be a good idea. In the surveys, 42% say this about taking a new vaccine and 45% say this about having a child vaccinated against Covid-19.

In fact, ACIP’s shared clinical decision-making recommendations do not suggest that patients get vaccines without talking to their health care provider; they only state that clinicians can decide which patients to discuss particular vaccinations with. In addition, the surveys find that:

About a quarter of those surveyed say shared decision-making means they should discuss the vaccination decision with their family (23% for any vaccine; 25% regarding children and the Covid-19 vaccine). However, discussing the decision with family is not a part of the ACIP shared clinical decision-making recommendations.
Over 1 in 10 are not sure what shared decision-making means, either for a new vaccine (13%) or for vaccinating children against Covid-19 (12%).

Few know a pharmacist can be part of shared decision-making

When asked about “shared decision-making” with a “health care provider,” many Americans are not sure who would be included among that group. Survey respondents were provided with six options and asked to select as many as apply.

Predictably, the vast majority of U.S. adults (86%) choose a physician. Two-thirds (66%) choose a physician assistant or nurse practitioner.

But only half (50%) choose registered nurse, and just a third (33%) choose 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, APPC’s managing director of survey research.

Small groups of respondents selected other practitioners as health care providers, including clinical social worker (8%) and acupuncturist (3%). Neither of those professions is included in ACIP’s list of health care providers to share in clinical shared decision-making. A small proportion are not sure (7%) and just 1% choose none of the options as a “health care provider.”

Annenberg Science and Public Health (ASAPH) survey

The survey data come from the 25^th and 26^th waves of a nationally representative panel of U.S. adults conducted for the Annenberg Public Policy Center by SSRS, an independent market research company. Wave 25 (n=1,699) of the Annenberg Science and Public Health Knowledge (ASAPH) survey was fielded Aug. 5-18, 2025. Wave 26 (n=1,637) was fielded Nov. 17-Dec. 1, 2025. The margin of sampling error (MOE) for both waves is ± 3.5 percentage points at the 95% confidence level. All figures are rounded to the nearest whole number and may not add to 100%. Combined subcategories may not add to totals in the topline and text due to rounding.

Download the topline and the methods reports.

The policy center has been tracking the American public’s knowledge, beliefs, and behaviors regarding vaccination, Covid-19, flu, RSV, and other consequential health issues through this survey panel since April 2021. APPC’s ASAPH survey team includes research analyst Laura A. Gibson; Patrick E. Jamieson, director of the Annenberg Health and Risk Communication Institute; and Ken Winneg, managing director of survey research.

See other recent Annenberg health survey news releases: