What Pharmacists Should Know
- Moving vaccines from routine recommendations to shared decision-making may reduce uptake, as families often interpret the change as uncertainty about vaccine importance.
- Pharmacists will face operational challenges, including limited access to patient medical histories, increased documentation, and reduced ability to use population-based reminder tools.
- The HPV schedule change to a single dose may jeopardize coverage for the second dose, despite its continued role in evidence-based cancer prevention.
In an interview with Pharmacy Times®, Jeffery A. Goad, PharmD, MPH, professor of pharmacy practice at Chapman University School of Pharmacy, discussed the potential public health implications of the US Department of Health and Human Services’ (HHS) shift toward shared clinical decision-making for pediatric vaccines. Goad emphasized that this change represents a move away from population-level prevention strategies toward individualized risk assessment, which carries significant consequences in the US health care environment.
Although HHS has stated that insurance coverage will remain unchanged for vaccines moved into shared decision-making or high-risk categories—including coverage under Medicaid, CHIP, and private insurance—Goad expressed particular concern regarding changes to the human papillomavirus (HPV) vaccine schedule. Under the new guidance, HPV vaccination has been reduced to a single dose, despite the American Academy of Pediatrics continuing to recommend a 2-dose series for optimal cancer prevention. Goad warned that this discrepancy may jeopardize insurance coverage for the second dose, potentially undermining evidence-based cancer prevention efforts.
Goad also highlighted the broader impact of shifting vaccines out of routine recommendations. Families may interpret this change as uncertainty about vaccine importance, which could lead to reduced uptake. Even modest declines in vaccination rates can result in outbreaks of highly transmissible diseases, such as measles. He noted that more than 2000 measles cases were reported last year, with ongoing outbreaks linked to low measles, mumps, and rubella (MMR) vaccination coverage.
“When vaccines move from routine recommendation to shared clinical decision-making, many families interpret that shift as uncertainty or reduced importance.” - Jeffery A. Goad, PharmD, MPH
From a pharmacy perspective, Goad outlined multiple operational and counseling challenges. Pharmacists must help parents understand that policy changes do not reflect changes in vaccine science. Shared clinical decision-making limits the use of population-based tools such as age-based prompts, reminders, and proactive outreach. Community pharmacists often lack access to complete medical histories, yet are expected to conduct individualized risk assessments. Additionally, this model increases documentation and counseling burdens, potentially discouraging proactive recommendations and shifting vaccination to a patient-initiated process.
Ultimately, Goad warned that families who rely most on pharmacy access—those facing language barriers, limited primary care access, or time constraints—may be disproportionately affected, increasing disparities in vaccine uptake.
