Primary care visits have had to evolve structurally to accommodate shared decision-making around vaccines, often by integrating pre-visit education or decision aids. Practices that use digital questionnaires or nurse-led prep sessions before the provider enters the room can preserve time while still honoring the shared decision-making process. Without these supports, visits can run longer than scheduled, increasing pressure on clinicians and clinic workflows.
As health care is moving toward shared decision-making (SDM), the way primary care visits will be carried out will also change significantly. Most patients have a 15-minute appointment that involves routine administrative checks. In the past, vaccines such as Hepatitis B and influenza would have been given the "default" recommendation and administered without a discussion; in the future, we must have a complex and nuanced discussion regarding the individual patient's risk-benefit ratio for these vaccines. In order to provide this SDM style of care, the physician will need to interpret data rather than provide care through a standardized protocol.Increased administrative demands are one effect I envision from this change. I also envision a rise in unnecessary visits to acute care settings due to the decrease in universal recommendations and the fragmentation of vaccination status among various communities. This will place more burden on specialists—such as pediatric pulmonologists and infectious disease specialists—who will now see more children with complications from previously well-controlled pathogens. The decrease in universal recommendations also complicates school entry requirements, making it imperative for primary care offices to be at the center of managing conflicting state and federal guidelines. This shift away from population-wide mandates is going to set a precedent for how preventive medicine will be practiced in the future. I believe that if we continue down this path of decreasing universal recommendations and moving toward individual SDM, there will ultimately be a shift in federal philosophy toward preventive medicine in areas such as cancer screening and cardiovascular prevention. Eventually, as universal recommendations are no longer present, the primary care physician will become more like a "risk counselor," where the responsibility of preventive outcomes lies with the primary care physician-patient relationship instead of being the responsibility of the public health system. Dr. Shernell Surratt-Gary Osteopathic Medicine Clinical advisor - Aura Wellness
This reform will be an important step toward moving away from an emphasis on universalism, as seen with European systems that utilize a "benchmarking" model for screening and prophylactic treatment recommendations issued by federal agencies. In addition to providing guidance for high-risk patients over population-wide recommendations, it is likely that this reform will influence how federal agencies create clinical guidelines for screening and treatment across multiple areas of preventive medicine. As clinical scenarios change and the "cocooning" effect (i.e., protecting newborns through community immunity) erodes for newborns, a particular area of concern for me is the possibility of increased localized clusters of measles and mumps outbreaks—diseases that require extremely high vaccination coverage in order to prevent spread within communities. If there is a reduction in vaccination coverage among newborns or within localized communities during the transition to this new decision-making model, these clusters could lead to new outbreaks of diseases that were previously considered eradicated in the United States. This year, we must be vigilant in monitoring any changes in local epidemiology in real-time. Physicians in 2026 will be required to transition from universal vaccination recommendations toward epidemiological-based counseling models, whereby they present data on the prevalence of local diseases in their area to parents as part of the shared decision-making process. In order for primary care providers to have access to this type of mapping, we must create a stronger data-sharing infrastructure within the healthcare system. Additionally, practices should be prepared for changes in how they are reimbursed, as the time that is spent on vaccine counseling will need to be adequately compensated in the practice's billing model, rather than being viewed as merely a "check-box" activity. Dr. Michael Genovese https://www.linkedin.com/in/michaelgenovesemd/ Lic.num.NY 236638