Survey Shows Significant Gaps in Understanding of Shared Decision-Making

US patients’ understanding of shared clinical decision-making for immunization is significantly lacking, for both themselves and their children, according to dual Annenberg Public Policy Center (APPC) surveys conducted in 2025.¹

“Expecting parents to engage in shared decision-making (SDM) 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,” Patrick E. Jamieson, PhD, director of APPC’s Annenberg Health and Risk Communication Institute, said in a news release. “These vaccines have been part of the recommended childhood schedule because the benefits of taking them substantially outweigh the risks.”

On the first Monday of 2026, the US Department of Health and Human Services (HHS) announced that it will be giving fewer recommendations for childhood vaccines, aligning with other federally funded health care organizations like the CDC and the Advisory Committee on Immunization Practices (ACIP).²

The main focus of this announcement is to narrow the number of required childhood immunizations and place decisions in the hands of providers and parents simultaneously, through SDM. According to Medical Economics, the routine childhood vaccination schedule had a total of 6 vaccines removed: respiratory syncytial virus (RSV), hepatitis A, hepatitis B, dengue, meningococcal ACWY, and meningococcal B.³

These vaccines are now mainly reserved for high-risk groups or through collaboration with providers.

READ MORE: HHS Limits Vaccine Recommendations for Childhood Schedules

Uncovering Gaps in Knowledge of SDM

In the APPC’s presentation of its survey results, they posed the question, “Does the American public understand what SDM means?” The term SDM can easily be extrapolated and understood as 2 or more individuals coming together to make an agreed-upon clinical decision. However, amid recent HHS updates and several vaccine-related changes stemming from ACIP throughout 2025, the collective understanding of SDM may be much more skewed than experts and officials would have guessed.¹

“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,” according to the CDC.⁴ “Rather, shared clinical decision-making recommendations are individually based and informed by a decision process between the health care provider and the patient or parent/guardian.”

To capture the breadth of Americans’ understanding of SDM, APPC conducted a survey of 1699 US adults on their understanding of the new policy back in August 2025. Then, they conducted a follow-up survey of 1637 adults in December 2025 asking about what a “health care provider” is in the context of SDM.¹

The most notable gap in SDM understanding showed that over 2 in 5 survey respondents misinterpreted SDM as being up to the patient or parent to decide whether or not to consult with a provider. However, as the CDC stated, SDM would have to constitute a conversation between the provider and the parent despite their feelings toward these vaccines.

Furthermore, close to 25% of respondents believed SDM meant patients and their parents should consult with other family members when considering specific decisions. Whether it was a new vaccine (13%) or to keep children protected from COVID-19 (12%), over 1 in 10 respondents were unsure of SDM’s meaning.

Where Do Pharmacists Belong Amid SDM?

Finally, participants were also asked about the provider’s role in SDM and which types are best equipped to facilitate SDM properly. Physicians (86%) were ranked first as the key providers in SDM, followed by physician assistants or nurse practitioners (66%), registered nurses (50%), and pharmacists, ranked last at 33%.

“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,” Ken Winneg, PhD, APPC’s managing director of survey research, said.¹

Pharmacists are champions of vaccines and public health efforts across the country. With their ability to step up and provide millions of COVID-19 vaccines during the pandemic—and other vaccines for various diseases—the pharmacist’s medication and immunization expertise places them in the same spot as their peers in the vaccination space.⁴

However, US pharmacists continue to fly under the radar regarding their clinical skills and the care they can provide to communities of all types. But the collective advocacy of pharmacists expanding their reach across health care is separate from the policies HHS and the Trump Administration are putting into motion regarding vaccines.

“The fact is, pediatricians already do this all day every day…routinely have long, detailed conversations with families about vaccines,” Sean T. O’Leary, MD, MPH, chair of the Committee on Infectious Diseases for the American Academy of Pediatrics, told to The 19th.⁵ “Changing a recommendation to shared clinical decision-making doesn’t change that; it just makes things more confusing for parents and clinicians.”

READ MORE: Immunization Resource Center

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REFERENCES

1. CDC urges ‘shared decision-making’ on some childhood vaccines; many unclear about what that means. Annenberg Public Policy Center. January 6, 2026. Accessed January 7, 2026. https://www.annenbergpublicpolicycenter.org/cdc-urges-shared-decision-making-on-some-childhood-vaccines-many-unclear-about-what-that-means/

2. Owermohle S. HHS will overhaul childhood vaccine schedule to recommend fewer shots. CNN Health. January 5, 2026. Accessed January 5, 2026. https://www.cnn.com/2026/01/05/health/childhood-vaccine-schedule-overhaul

3. Littrell A. CDC updates childhood immunization schedule; routine list narrowed to 11 diseases. Medical Economics. January 5, 2026. Accessed January 7, 2026. https://www.medicaleconomics.com/view/cdc-updates-childhood-immunizationochedule-routine-list-narrowed-to-11-diseases

4. ACIP shared clinical decision-making recommendations. CDC. January 7, 2026. Accessed January 7, 2026. https://www.cdc.gov/acip/vaccine-recommendations/shared-clinical-decision-making.html

5. Rodriguez B. What does the new childhood vaccine schedule actually mean for your family? The 19th. January 6, 2026. Accessed January 7, 2026. https://19thnews.org/2026/01/cdc-reduced-childhood-vaccine-schedule/