"Shared Decision-Making" for COVID-19 Vaccination Signals "Optional" to Too Many, Says Kelly Moore, MD, MPH

In a significant departure from pandemic-era universal vaccination recommendations, the CDC's Advisory Committee on Immunization Practices (ACIP) now recommends shared clinical decision-making for COVID-19 vaccines, focusing on individual risk-benefit analysis rather than universal recommendations.

In a recent interview with Patient Care,© Kelly Moore, MD, MPH, president and CEO of immunize.org and a respected public health voice with decades of experience, discussed the tension the change is creating and the potential for confusion. She articulated a concern echoed across the public health community: that policy language designed ostensibly to promote individual vaccine autonomy may simultaneously undermine uptake among those historically less likely to receive the vaccine or who face travel, economic, or other barriers to its access.

The distinction between "recommended for specific groups" and "shared decision-making" matters enormously in translating public health guidance to real-world behavior, Moore explained. ACIP makes shared clinical decision-making recommendations when individuals may benefit from vaccination, but broad vaccination of people in that group is unlikely to have population-level impact. The mechanism places responsibility on patients and providers to weigh individual risk-benefit profiles—a reasonable approach on its surface. But clinicians and epidemiologists recognize a troubling risk: people unfamiliar with scientific nuance, or predisposed to vaccine skepticism, may interpret shared decision-making as permission to decline vaccination entirely.

Her comments in the short video above illuminate the gap and the real-world stakes when that gap widens.

The following transcript has been lightly edited.

Patient Care: What risk do you see of this recommendation being construed more broadly as a signal that COVID-19 vaccination is either optional or unnecessary?

Kelly Moore, MD, MPH: I think unfortunately, if someone is predisposed to thinking that COVID-19 vaccination is not important for their health, this decision will underline that, will reinforce their beliefs. So I think that it really does pose a risk to people who are less informed. Although we are relieved that at least the door is not shut to anyone who wants the vaccine, we are relying on people to be demanding the vaccine and our primary care system to actually go out and promote the vaccination to the people they know needed and can benefit from it. And that's unfortunate. We know a lot of people will fall through the cracks and decide that this means I don't need this vaccine this year.

Kelly L Moore, MD, MPH, is the president and CEO of Immunize.org and a leader in national and global vaccine policy and immunization program implementation. She has served in a variety of immunization policy advisory roles with the World Health Organization since 2016, including as chair of its Immunization Practices Advisory Committee. She has a long history with the ACIP as a working group member, liaison representative of the Association of Immunization Managers (2011–2015), and as a voting member (2015–2019).