In an interview with Pharmacy Times®, Jeffery Goad, PharmD, MPH, professor of pharmacy practice at Chapman University School of Pharmacy, discusses recent changes made by the US Department of Health and Human Services (HHS) to the childhood immunization schedule, including the shift of several foundational vaccines into shared clinical decision-making or high-risk categories. Goad explains how these changes may create confusion for families, reduce vaccine uptake, and increase the risk of outbreaks of vaccine-preventable diseases such as measles. He also raises concerns about the reduction of the human papillomavirus vaccine from a 2-dose to a single-dose series, despite ongoing recommendations from major medical organizations.
Goad emphasizes the critical role pharmacists play in providing evidence-based counseling, countering misinformation, and ensuring families continue to receive recommended vaccinations to protect individual and public health.
Pharmacy Times: To begin, could you provide a brief explanation of the recent changes to the childhood immunization schedule?
Jeffery Goad, PharmD, MPH: Sure. The recent HHS policy changes really fundamentally reorganize the childhood immunization schedule into 3 categories now. First, vaccines that remain universally recommended for all children—this is what we've done for decades. Second, vaccines recommended for certain high-risk groups or populations. And third, and probably most consequentially, vaccines that have been moved into a category we’re familiar with called shared clinical decision-making. This is where vaccination is no longer the routine default, but instead depends on an individualized discussion between providers and families.
Under this new policy, several vaccines that have long been considered foundational to childhood protection have been removed from universal recommendation. This includes moving elements of hepatitis B, influenza, hepatitis A, and meningococcal vaccination into either shared clinical decision-making or high-risk categories. In addition, human papillomavirus (HPV) vaccination has been substantially changed. Under the new HHS guidance, HPV vaccination has been reduced from a 2-dose series to a single dose, despite the American Academy of Pediatrics (AAP) continuing to recommend the established 2-dose series for optimal cancer prevention.
These changes were made without a recommendation from the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) and without endorsement from any major medical or pharmacy organization, such as the AAP or the American Pharmacists Association.
HHS has suggested that these changes move the US closer to childhood immunization schedules in countries like Denmark. But that comparison really does not hold up well. Denmark and the United States are fundamentally different in health care infrastructure, population size and diversity, access to care, and disease epidemiology. Denmark, for example, has universal health care coverage, integrated medical records, and highly reliable follow-up. The US, on the other hand, has a health care system that is fragmented and uneven, making clear universal recommendations especially important to prevent children from falling through gaps in care.
Importantly, according to CDC guidance, shared clinical decision-making was originally intended for situations where individuals may benefit from vaccination, but broad vaccination of that group is unlikely to have population-level impact—not for routine childhood vaccines that have historically driven widespread disease prevention.
Pharmacy Times: From your perspective, what are the potential implications of the shift toward shared clinical decision-making for pediatric public health and vaccine uptake?
Goad: This shift represents a move away from population-level prevention toward individualized risk assessment, and that has serious implications in the US context. It’s important to emphasize that HHS has stated there will be no changes in insurance coverage for vaccines moved into shared clinical decision-making or high-risk categories. Vaccines covered under Medicaid, the Children’s Health Insurance Program (CHIP), the Vaccines for Children (VFC) program, and private insurance are expected to remain covered.
However, the change to HPV vaccination is different and potentially more concerning. By reducing HPV vaccination to a single dose under HHS guidance, while AAP continues to recommend a 2-dose series, there’s a real possibility that insurance coverage for the second HPV dose could be jeopardized, even though the second dose remains part of evidence-based cancer prevention.
Beyond insurance, when vaccines move from routine to shared decision-making, many families interpret that shift as uncertainty or reduced importance. Even modest declines in uptake can lead to a resurgence of vaccine-preventable diseases, particularly those that are highly transmissible, such as measles. Last year, there were over 2000 cases of measles, and outbreaks continue to this date in several states. This is driven by low vaccination rates for measles, mumps, and rubella (MMR).
What Pharmacists Should Know
• Recent HHS policy changes have moved several routine childhood vaccines into shared clinical decision-making, potentially reducing vaccine uptake and increasing public health risks.
• Reducing HPV vaccination to a single dose may jeopardize insurance coverage and undermine evidence-based cancer prevention efforts.
• Pharmacists are uniquely positioned to provide trusted, evidence-based guidance to families and help counter misinformation during this period of policy uncertainty.
Pharmacy Times: With changes in recommendations for vaccines historically considered foundational in childhood protection, what challenges do you anticipate pharmacists facing when counseling parents who may be confused or hesitant?
Goad: I think one of the biggest challenges pharmacists will face is helping parents understand that policy changes do not mean the science has changed. When vaccines move from routine recommendation to shared clinical decision-making, the entire practice environment shifts. Pharmacies lose the ability to use population-based tools like age prompts, routine reminders, and clear messaging that makes vaccination accessible and equitable.
Even if coverage remains, the operational barriers created by shared decision-making reduce outreach. They hamper clear advertising that we know works within stores and ultimately leads to lower vaccination rates. It is important to remember, though, that pharmacists are specifically identified by the CDC as health care providers who can perform shared clinical decision-making for vaccines—that has not changed.
However, shared clinical decision-making makes it significantly more challenging for pharmacies to determine who should be vaccinated. Community pharmacies often lack access to complete medical histories, prenatal records, or household exposure data, yet shared decision-making assumes individualized risk assessment. As a result, pharmacists must rely on patients to self-identify risk, which we all know doesn’t always work very well.
Shared clinical decision-making also changes how pharmacists are allowed to communicate. Routine vaccines can be prompted confidently as standard preventive care. Under shared decision-making, messaging becomes qualified and cautious—phrases like “may be appropriate for some individuals”—which reduces urgency, increases confusion, and again leads to lower vaccine uptake.
There are also workflow implications. Shared clinical decision-making places greater documentation and counseling responsibility on pharmacists, which in a busy community setting can discourage proactive recommendations and shift vaccination to a patient-initiated model. The net effect is that families who benefit most from pharmacy access—those with limited primary care, language barriers, or time constraints—are the ones most likely not to get vaccinated.
Pharmacy Times: How important is consistent messaging from health care professionals, including pharmacists, in countering misinformation about childhood vaccines?
Goad: Consistent messaging from health care professionals is essential, especially during periods of uncertainty like we’re going through right now. When pediatricians, family physicians, pharmacists, and public health leaders deliver aligned messages, it reinforces trust. When messages conflict, uncertainty grows, and uncertainty is where misinformation thrives.
Recently, the National Foundation for Infectious Diseases (NFID), along with more than 70 leading medical and public health organizations, signed an NFID letter to HHS calling for US childhood immunization recommendations to remain grounded in transparent, evidence-based review and scientific consensus, warning that unilateral changes risk confusion and harm to children. Clear, consistent communication across health care professionals is critical to maintaining public confidence in vaccines.
Pharmacy Times: What opportunities do recent policy changes present for pharmacists to take a more proactive role in individualized vaccine discussions with families?
Goad: In this environment, pharmacists have an especially important role to play. For childhood and adolescent immunizations, pharmacists should anchor counseling and practice to evidence-based guidance from the AAP and the American Academy of Family Physicians (AAFP), which continue to recommend the routine childhood immunization schedule developed through rigorous scientific consensus.
This includes continued support for the 2-dose HPV vaccination series, which remains the standard recommended by pediatric and family medicine experts for effective cancer prevention. In community pharmacy settings, pharmacists can reinforce messages from AAP and AAFP that vaccines remain covered, evidence-based, and strongly supported by clinical experts, even when federal policy has gone astray. By doing so, pharmacists can help ensure that policy shifts do not translate into missed doses, incomplete series, and more preventable disease.
Pharmacy Times: Is there anything else you’d like to add?
Goad: I want to emphasize just how impactful routine vaccination for children has been in the United States. According to a recent CDC analysis of children born between 1994 and 2023, routine childhood immunizations are estimated to have prevented approximately 508 million cases of illness, about 32 million hospitalizations, and over 1.1 million deaths. That is millions of lives and countless hospital stays avoided. From an economic perspective, those public health gains translate into enormous benefits. From the same CDC study, there are an estimated $540 billion in direct savings from avoided medical care and nearly $2.7 trillion in societal savings when you account for productivity, work time saved, and broader economic impact.
This underscores why routine high vaccine coverage matters—not just for individual children, but for families, communities, and the nation as a whole. It is one of the most powerful public health interventions that we have.
