Georgia physicians navigate new vaccine recommendations with skepticism

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The Centers for Disease Control and Prevention Roybal campus as seen through the front fence on Aug. 11, 2025.

Credit: Sofi Gratas/GPB News

Shortly after 8 a.m., Dr. Rachel McDiehl begins seeing patients at her obstetrics and gynecology practice in Decatur. She tears sanitary paper off a patient exam chair.  

“That's the sound that I hear in the background of my daily life,” she says, before moving down the hall.  

McDiehl sees about two dozen patients during an average shift. Almost everyone on this day will be getting a vaccine from her, she says, or at least, talking about getting one.  

On the schedule are vaccines for her pregnant patients proven to protect both parent, and baby. That includes shots that prevent serious illness from respiratory viruses, as well as one vaccine that helps build antibodies to whooping cough that can be passed onto a baby before they’re born.  

“We could have someone who is due for Tdap, flu, COVID, and RSV all on the same day,” McDiehl said. “That's a lot of vaccines to get all at once.” 

So, she works with patients to create a schedule that’s safe and effective for them. McDiehl knows it can be overwhelming to talk about, especially since pregnant patients follow much more nuanced recommendations than children. 

“I feel like I am constantly using shared decision-making,” McDiehl said.  

The new immunization recommendations for children and adolescents developed by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, or ACIP, put an emphasis on that very practice — one McDiehl said she’s already been implementing in her exam rooms for years.

The ACIP does that by moving six immunizations — for hepatitis A, hepatitis B, rotavirus, meningitis, influenza and COVID-19 — under a new category, called “Immunizations Based on Shared Clinical Decision-Making.”  

Some are also recommended only if children are considered high-risk by their doctor, such as if they are immunocompromised or have a blood disorder.  

Essentially, what the emphasis on shared-clinical decision-making tells doctors and patients is that it is up to them to decide together whether the benefits of those vaccines outweigh any associated risks.  

This is a departure from the CDC’s previous take on vaccine schedules, which used the approach of universal recommendations.  

• RELATED: One conversation at a time, pediatricians hope to prevent the spread of infectious diseases 

McDiehl argues that most physicians have already been engaging in these shared-clinical decision-making conversations the ACIP says it wants.  

But she thinks those new guidelines would work best alongside universal vaccine recommendations. Without them, she worries patients might come in misinformed about the safety of vaccines, or be unwilling to even talk at all.  

“If they're making that vaccination decision out of fear, as opposed to out of, like, based upon the facts and the evidence that we know surrounding these vaccines, that scares me,” McDiehl said.  

Of top concern for McDiehl is any possible decrease in uptake of the hepatitis B vaccine. Hepatitis B can cause severe liver damage, and sometimes death, in babies. The CDC previously recommended that all babies get the vaccine at birth.  

Now, it only lists the hepatitis B shot as universally recommended for babies with hepatitis B-positive mothers.  

“Hepatitis B is actually one of the blood-borne pathogens that is the easiest to catch, even more so than HIV,” McDiehl said, adding that he virus can even stay alive on dried blood. "Somehow your baby ends up coming into contact with that ... Like, it is a life-threatening condition.” 

Her policy is to screen and vaccinate all pregnant patients for hepatitis B.  

When the CDC decided to remove six vaccines from its universal recommendations for kids, it didn't cite any new evidence for doing so. 

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Mahogany Brown (top left) watches with her daughter Mahailley as Mahogany’s infant son Memphis Exum receives one of a number of vaccinations during a routine visit to pediatrician in Eastman, Ga., in 2025.

Credit: Grant Blankenship / GPB News

Missing collaboration 

Soon after the U.S. Department of Health and Human Services gave its stamp of approval on the CDC’s new immunization recommendations, other trusted physician groups put out their own guidelines.  

The American Academy of Pediatrics' recommended schedule, made public on Jan. 26, lists all 17 childhood vaccines previously universally recommended by the CDC. It is endorsed by the American Academy of Family Physicians, the American College of Obstetrics and Gynocology and others.  

Dr. Walt Orenstein is a professor emeritus at Emory University and associate director of the Emory Vaccine Center who ran the United States Immunization Program for 16 years at the CDC.  

"Normally, what is done is the development of what was called a harmonized schedule," he said.  

In other words, that's when the government and trusted physician groups, like the American Academy of Pediatrics, work together on vaccine guidelines. That cooperation largely ended with the replacement of all former ACIP members last summer by HHS Secretary Robert F. Kennedy Jr., a decision made in order to “re-establish public confidence in vaccine science,” Kennedy said in a statement.

Orenstein says now, with the ACIP’s deviation from that harmonized schedule, it may feel like there’s no one trusted vaccine schedule. Doctors and patients will have to choose which one to follow.  

"This was a unilateral decision," Orenstein said. "And so now what we are going to see is different immunization schedules ... which could be very, very confusing, and can lead to drops in coverage."

He means coverage against illness, which can lead to a loss of the community benefits of immunization. 

Another problem: If enough patients are put off by vaccines, doctors may not know which ones to stock anymore.  

"And in fact, it may cause them perhaps not even to order some of the vaccines because they don't know what the uptake will be," Orenstein said. 

Another concern held by Orenstein and others is that insurance companies could hesitate to cover vaccines no longer routinely requested or universally recommended by the federal government’s top public health agency.  

The new ACIP guidelines include the assurance that all vaccines included in the CDC’s schedule will remain accessible and covered by private and public insurance.  

A new normal 

As far as physician Monica Newton is concerned, the primary effect of the CDC’s new emphasis on shared clinical decision-making is that it opens the door to more transparent conversations with patients who may be wondering how to navigate all these changes.  

"It's helped us to up our game in terms of sharing the decision-making with the patients," she said.  

But Newton, a Northeast Georgia doctor and chapter president of the Georgia Academy of Family Physicians, said she expects her over 3,000 members to follow a vaccine schedule more in line with the previous ACIP recommendations.  

"The important thing to remember is the evidence really hasn't changed," she said. "It isn't like we've discovered that some of these vaccines don't work or that they're not needed."

For instance, an ongoing national outbreak of measles has been credited, in part, to a steady decrease in vaccination rates. For herd immunity against measles, research suggests a 95% vaccination rate is necessary in any given community. Serious measles infections have so far killed three unvaccinated people.

All 11 people in Georgia who have contracted the virus over the span of the outbreak were unvaccinated, as reported by the Georgia Department of Public Health.

• RELATED: After another measles case in Georgia, public is urged to 'check their vaccination status'   

Down the line, Newton worries the CDC’s new guidelines could greenlight changes at the state level, such as what shots are required for kids to attend school.  

"They're almost forecasting to states, like, "These are the things you should require and not require,'" Newton said.  

In Georgia, the vaccine schedule for any child attending a Head Start program, child care, pre-kindergarten, nursery facility or school is set by the Georgia Department of Public Health. Department spokesperson Nancy Nydam Shirek said in a statement that, for now, there are no planned changes to the state’s immunization schedule.