By Maryanne Demasi at Brownstone dot org.

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Former CDC director Tom Frieden and colleagues recently published a JAMA opinion piece condemning the CDC vaccine advisory committee's endorsement of "shared decision-making" for future Covid-19 boosters.

They argued the shift was an ethical lapse — even an "abdication of responsibility" — particularly for older adults.

But what the CDC's Advisory Committee on Immunization Practices (ACIP) proposed was nothing radical. It was the same patient-centred model that should be used across modern medicine.

Which is why the establishment's reaction is so revealing: the moment the subject is "vaccination," even the most basic principles of transparency and informed consent are treated as optional — or worse, as threats.

What ACIP Is Actually Proposing

In September, ACIP recommended that Covid-19 shots should no longer be a blanket policy but instead be decided through shared decision-making.

For older adults and those with underlying conditions, this meant discussing risks, benefits, and uncertainties with their doctors — and making a personalised choice.

This should be standard practice in nearly every other clinical scenario — prostate cancer screening, hormone therapy, antidepressant use in pregnancy, or cardiac surgery.

But vaccines have been placed on a pedestal. Questioning, hesitating, or individualising the decision has been treated as heresy.

The unspoken rule is that both doctors and patients must "trust the science," even when the science is evolving, and individual circumstances differ.

In that climate, ACIP's recommendation wasn't received as a return to ethical practice. It was seen as a direct challenge to a decades-old orthodoxy built on the idea that vaccine decisions are too sacred to be personalised.

The Claim That "Ambiguity Does Not Exist"

Frieden and colleagues insist that for older adults, the benefit–risk calculus is so clear that "ambiguity does not exist," making individualised conversations not just unnecessary but potentially harmful.

They also warn that leaving such decisions to clinicians and patients creates a "vacuum" that other professional groups will rush to fill.

To defend the claim that there is no ambiguity in the benefit of Covid boosters for older adults, they rely heavily on observational data, including a 2025 Veterans study of 160,000 people reporting modest reductions in hospitalisation and death among boosted recipients.

But like all observational research, the data have serious limitations.

The cohort was anything but uniform: different infection histories, different numbers of prior doses, and a high burden of chronic illness that elevates baseline risk regardless of vaccination.

"Real-world" data can offer insights, but it also carries real-world flaws — and it is not a sound basis for shutting down clinical dialogue.

A Shaky Analogy

The authors go further, suggesting that the benefits of Covid boosters for older adults are as absolute as vitamin K prophylaxis for newborns.

But equating a one-off, decades-validated intervention with repeated dosing of a novel mRNA platform in a highly variable adult population is scientifically and ethically indefensible.

Vitamin K is predictable, durable, and biologically straightforward.

Covid boosters operate in a shifting landscape: an evolved virus, continually updated formulations, divergent exposure histories, and dramatically reduced baseline risk.

The analogy works only if vaccines are treated as uniquely simple interventions — when in reality they involve far more complexity, uncertainty, and individual variation.

Why Conversation Is Not "Abdication"

At the heart of the authors' critique is the claim that ACIP "abdicates responsibility" by letting doctors and patients decide.

But that is the very purpose of medicine: to move away from paternalism and toward transparent presentation of evidence — a process that strengthens, not weakens, the relationship between doctor and patien...