The Evolving Childhood Vaccine Schedule: Weighing Ethical Concerns, Considering AAP’s Guidelines

Our roundtable series, Clinical Insights: Childhood Vaccine Schedule Changes, discusses the ongoing changes being made to the pediatric vaccine schedule, the inner workings of the current Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP), and how all of this is impacting US public health.

One of the biggest shifts in US vaccine policy has been the move from universal vaccinations to what the regulatory agencies are calling “shared-decision making,” which they claim means vaccines are a decision between the clinicians and families. Clinicians make the point that providers have always explained the benefits of vaccination before considering immunizations for their patients. So, in reality this is not changing.

However, this shift that has put some universal vaccines into this shared-decision making category could leave a potential chilling effect for clinicians deciding if they should recommend administering them. Additionally, this could leave open the door for insurers to not reimburse for immunizations.

“With everything being so up in flux, we hope that insurance providers continue to cover these vaccines, but it makes it a little bit easier for them to say, hey, we're going to follow ACIP. ACIP doesn't recommend this. Now we don't want to pay for this vaccine anymore,” said Jacinda Abdul-Mutakabbir, PharmD, MPH, assistant professor of clinical pharmacy and antimicrobial resistance researcher at UC San Diego.

Another major development on the vaccine recommendation front is that the American Academy of Pediatrics (AAP) has stepped in and offered vaccine guidelines that mirror the previous pediatric immunization schedule the Centers for Disease Control and Prevention had set-up before the current administration took over and changed it. As an experienced pediatrician, Sharon Nachman, MD, chief of pediatric infectious diseases, Stony Brook Children's Hospital explains the specialty’s expertise in understanding the value of immunization.

“We are the expert in your child, and that's why we are recommending these vaccines to be used, and that's why our academy is also recommending it,” Nachman said.