RFK Jr. may upend how vaccine recommendations are categorized

Under anti-vaccine Health Secretary Robert F. Kennedy Jr., the US health department is considering changing how vaccine recommendations are categorized and described. The move creates the possibility that vaccinations currently considered “routine” or “universal” could be given new designations that sound less definitive or more conditional, such as “recommended with qualification” or recommended based on “shared clinical decision-making.” Kennedy has made no new rules or recommendations for the categories yet. However, he laid out ideas and possibilities in a Request for Information (RFI) posted online Friday and published in the Federal Register on Monday. In the 10-page document, Kennedy poses questions about the current categories and asks the public to weigh in on ideas for how to change or replace them. The deadline to comment on the questions and ideas is September 20. Currently, there are three categories of vaccination recommendations granted by the Centers for Disease Control and Prevention, which is informed by a panel of independent expert advisors, the Advisory Committee on Immunization Practices (ACIP). The three categories are: routine, otherwise considered universal (a recommendation that everyone should get a vaccine); risk-based recommendations (only certain groups at higher risk should get a vaccine); and recommendations based on “shared clinical decision-making,” or SCDM (a flexible but uncommon recommendation for vaccination based on the characteristics, values, and preferences of a patient and the judgment of their healthcare provider). Before Kennedy’s oversight, the CDC and ACIP used an evidence-based decision-making framework to determine which type of recommendation to give a vaccination. There is no clear, evidence-based reason to question the current categories, nor any evidence to support changing to the new categories Kennedy proposes. In his RFI, Kennedy prefaces his efforts only by citing an executive order on vaccines that Trump signed two weeks ago that aimed to slash and overhaul federal vaccine recommendations.