Q&A: A Growing Divide Between Federal Vaccine Policy and Clinical Practice

In an interview with Pharmacy Times, Lora Sparkman, MSN, RN, vice president of patient safety and quality for Relias, discusses how recent changes to federal vaccine recommendations have created confusion for parents and placed clinicians in difficult positions as they strive to follow evidence-based guidelines. She explains that many physicians are continuing to rely on scientific consensus and professional associations rather than shifting federal guidance, leading to a disconnect between policy and practice. Sparkman warns that increased variation in vaccine decision-making threatens patient trust, equity, and safety, particularly among vulnerable populations. She emphasizes the critical role of health systems, pharmacists, and associations in supporting clinicians through education, alignment, and a continued focus on science-driven care.

Pharmacy Times: Can you introduce yourself and explain your current role?

Lora Sparkman, MSN, RN: My name is Lora Sparkman. I am the vice president of patient safety and quality for Relias. I work very closely with our client-facing teams and clinical teams, with many of the largest acute care health systems across the country.

Pharmacy Times: With 6 vaccines removed from the CDC’s recommendations list, how do these changes affect vaccine accessibility, coverage decisions, and equity for pediatric patients?

Sparkman: There is a lot wrapped into that question, but it really creates confusion for consumers and parents about what the right thing to do is. It also puts clinicians and pediatricians in a tough position, because they are trained to follow evidence-based guidelines. What is happening, and what has happened at the federal level, is a massive upheaval of traditional practice around immunization schedules.

Pharmacy Times: How are physicians navigating the practical challenges that come with more nuanced vaccine conversations, particularly around documentation, insurance reimbursement, and liability concerns?

Sparkman: I think everyone is still trying to navigate this change. The associations, the AMA and AAP, have already come together to say they are going to follow the evidence-based guidelines. There is this notion of shared decision-making for the vaccines that have been removed from the schedule, which leaves a lot of opportunity for variation in how it is explained, communication skills, and the relationship between the provider and the parents. You can see that there is opportunity for negative implications by doing that.

Pharmacy Times: From a patient safety and quality perspective, why are clinicians diverging from federal vaccine recommendations, and what factors are driving this disconnect between policy and real-world clinical practice?

Sparkman: Physicians who are scientific and extremely educated are following a scientific model. What has happened in this administration is such a change from practice and how pediatricians operate in their practices and clinics. They relied on the federal administration and the CDC to deliver what used to be open and transparent science and guidance, and that has changed. There are a lot of personal opinions and non-science information driving some of these changes, and from what I can see, physicians are just not having it.

Pharmacy Times: What risks does this misalignment between federal guidance and frontline practice pose for patient trust, especially among parents who are already uncertain about vaccines?

Sparkman: That is a great question, because there has already been a small contingency that had distrust in the health system. Where we are currently is adding to the chaos around guidance and evidence-based guidelines. When that is further disrupted, it creates more variation, and when you vary from evidence-based practice standards, more people slip through the cracks. We are going to see increased outbreaks where these vaccines had been doing their job effectively. Physicians will have to continue to follow the data, report the data, and carry this burden in their offices through one-on-one education with parents.

Pharmacy Times: What role can health systems and pharmacists play in helping clinicians interpret evolving vaccine guidance while maintaining confidence in their clinical judgment?

Sparkman: My hope is that they stay the course and follow the research and the evidence. Is there an opportunity to incorporate shared decision-making more effectively? Yes, I think that is appropriate, but it does not change the science. Informed and safe decision-making is where we need to end up, and I hope the payer market also recognizes this. My fear is with managed Medicaid plans, because these are vulnerable populations. Social determinants of health are a major factor, and this adds to the fragility of that population. If payers put more burden on providers who care for Medicaid patients, patient safety and quality will be at risk.

Pharmacy Times: Looking ahead, what steps can health systems take to better align policy, physician practice, and patient communication to ensure vaccine decisions remain evidence-based and patient-centered?

Sparkman: There is already a good bit of work underway. The two very large and important associations have come together, and they are watching this very carefully. It is a fluid situation, but there are significant improvements and alignment among health systems and providers. This is a challenge and adds burden, especially as health systems and providers are coming out of COVID and resetting, and this feels like a curveball. Still, they are on the right path, coming together to develop recommendations, which is exactly the role of associations.

Pharmacy Times: Is there anything you would like to add?

Sparkman: One of the biggest elements of this is the variation that is occurring and will continue until there is federal, state, and payer alignment. We have to continue to educate and train providers and make sure they stay up to date. Not every pediatrician is active in their association, so it is important for health systems to maintain oversight, keep their finger on the pulse of vulnerabilities, and address them quickly using science and evidence-based practice.