Shared clinical decision-making for vaccination: A view through the lens of mid-adult HPV vaccination

In the summer of 2019, the U.S. Advisory Committee on Immunization Practices (ACIP) updated its recommendations for HPV vaccination. The new recommendation regarding adults ages 27-45y (i.e., mid-adults) indicated that a "shared clinical decision-making" (SCDM) approach, rather than a routine recommendation, should be used. The Morbidity and Mortality Weekly Report (MMWR) publication that described this SCDM recommendation included specific conditional guidance and considerations for SCDM. However, some aspects of the guidance are vague, and others are inconsistent with SCDM, which could lead to confusion for adult health care providers and ultimately lead to under-vaccination of eligible individuals who would benefit from HPV vaccination. More recently, in the U.S. there have been policy proposals to shift additional vaccine recommendations from routine to SCDM. In this commentary, we briefly outline the ACIP recommendations, provide a clear overview of SCDM, and then offer potential implementation challenges for this guideline. For both unvaccinated adult patients and the providers who serve them, clear guidance on effective SCDM practices for HPV vaccination is an essential component for addressing the prevention of HPV-related disease. Using the context of mid-adult HPV vaccination, we also discuss the implications of SCDM recommendations for other vaccines.