WASHINGTON, January 26, 2026 — The recent shift in U.S. pediatric vaccine recommendations, spearheaded by Health and Human Services Secretary Robert F. Kennedy Jr., has ignited a fierce debate—largely centered on the move to reclassify six vaccines from routinely recommended to “shared clinical decision-making” (SCDM). This change implies these vaccines might be considered less essential or carry greater risk than those still universally advised.
A Missed Opportunity for Trust
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The debate over vaccine schedules shouldn’t overshadow a crucial point: parents deserve open, honest conversations with healthcare providers about their children’s health.
- While the scientific evidence supporting the safety and efficacy of the six vaccines remains strong, the way vaccination decisions are made needs reform.
- The current “presumptive” approach—telling parents what vaccines their child *needs*—can erode trust and undermine informed consent.
- Reframing SCDM as a standard practice for *all* vaccines, emphasizing shared decision-making, could strengthen public confidence.
- Simply dismissing Kennedy’s concerns as misinformation misses an opportunity to address legitimate anxieties about patient autonomy.
Most public health experts agree the data supporting the safety and effectiveness of the six vaccines hasn’t changed. Yet, in its eagerness to refute Kennedy’s claims, the medical community may be overlooking a valid point: vaccination decisions should ultimately rest with patients and their parents, guided by transparent advice from their doctors.
Informed consent is a cornerstone of medical ethics, and vaccination is no exception. However, many healthcare practitioners have turned informed consent into a formality—a box to check rather than a genuine discussion. It’s often viewed as a time-consuming obstacle to achieving high vaccination rates. While efficiency is important, prioritizing it over patient agency is a disservice.
For years, SCDM has been reserved for vaccines with more debatable risk-benefit profiles. “Routine” vaccines, the vast majority, have carried an implicit message: don’t question it, just do it. This approach, while effective in maximizing vaccine uptake and minimizing disease, can feel dismissive to parents with legitimate concerns.
The Presumptive Approach and Its Pitfalls
Many pediatricians are advised to take a “presumptive” approach, as outlined on the CDC’s website, which recommends stating which vaccines a child needs as if parents are already on board. While this boosts compliance, it can feel dismissive and disrespectful.
Kennedy’s motives may be suspect—he likely aims to undermine vaccine confidence—but that doesn’t invalidate his argument. Public health officials are making two key communication errors in responding to the new policy. First, equating SCDM with “optional” reinforces the very fear they’re trying to dispel. Media coverage largely reflects this framing, with pro-vaccine commentators echoing the idea that the government is suggesting vaccines are now a matter of choice.
Second, viewing parental choice as a threat grants Kennedy the moral high ground. Why not redefine SCDM as the practical application of informed consent—a fundamental ethical principle? Parents always have the right to decide about their children’s healthcare. A less automatic, more thoughtful approach to vaccination discussions could build trust and legitimacy.
In fact, a more expansive approach to shared decision-making—applying it to *all* vaccines—could be beneficial. The previous schedule reserved SCDM for vaccines with less clear benefits. I propose every vaccine discussion be a shared decision, with recommendations varying in strength but all subject to genuine informed consent.
This shift isn’t just about democracy and ethics; it’s about risk communication. Authoritarianism breeds distrust and resistance. This holds true for Kennedy’s approach and for public health’s tendency to sideline patient agency.
A Path Forward: Confidence Through Conversation
The paradox is this: controlling the narrative doesn’t demonstrate confidence in vaccine science; it reveals a lack of faith in our ability to persuade. By prioritizing presumption over persuasion, public health has inadvertently aided Kennedy’s efforts.
Experts should clearly and publicly state: Kennedy is wrong about vaccine risks and the scientific basis of routine childhood immunizations. However, parents are entitled to make informed decisions, and healthcare providers should guide them with honest information. Shared clinical decision-making is the appropriate framework—not because the evidence is weak, but because agency matters. Most parents, after a genuine discussion, will choose vaccination. Those who don’t have the right to decide, and respectful dialogue should continue.
While the new schedule may temporarily deter some parents, a long-term shift toward respect could rebuild trust and ultimately increase vaccine uptake. The question is no longer whether respecting agency is conducive to acceptance; the new schedule has already put it front and center. The choice now is whether to embrace this change or resist it.
I advocate for supporting this change. Continue to emphasize the scientific evidence, but relinquish control over parents’ decisions.
Peter M. Sandman is now retired after spending more than 40 years as a risk communication researcher, writer, and consultant. He has tried to put everything he knows on his website.
