In a sweeping shift on Jan. 5, federal health officials revised the U.S. childhood immunization schedule, narrowing which vaccines are recommended for all children and moving several into a “shared clinical decision-making” category.

As both a physician and a mother, my stomach dropped when I read the schedule for myself.

With no regard for the agency’s usual expert panel process, Robert F. Kennedy Jr., U.S. Health Secretary and Jim O'Neill, the CDC’s acting director, unilaterally removed the recommendation that all children receive four vaccines: influenza, rotavirus, meningococcal disease, and hepatitis A. These once-routine, scientifically-proven vaccines are no longer recommended by the nation's foremost health agency.

I fear that the impact of this policy will be devastating and children, especially those from low income families, will pay the highest price. 

For many who feel like modern parenting is already one long consent form, “shared decision-making” may come as a relief—more choice and less pressure. “Shared clinical decision-making” can be a good thing in medicine when it means a real, thoughtful conversation that respects families’ values and circumstances.

But here’s the issue: in the United States, moving vaccines from “routine” to “optional” doesn’t make life simpler. It just changes who has to do the work, and who pays the price when the work doesn’t get done. 

Labeling life-saving vaccines as “routine” communicates to parents that vaccines are simple, important, and worth doing. Meanwhile, “shared clinical decision-making” suggests that they are negotiable. And in our busy lives, “negotiable” can quickly become “not........

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