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Medical student Umayr R. Shaikh discusses his article “The impact of CDC’s new childhood immunization guidance.” Umayr argues that recent CDC changes, moving vaccines like flu, Hep B, and meningococcal from universal recommendation to shared decision making, risk normalizing preventable illness. He highlights how his medical training now focuses on diagnosing diseases that should be rare footnotes. The conversation explores the danger of treating public health as an individual choice, warning that this shift will disproportionately harm vulnerable populations and widen health inequities. Discover why rebuilding trust in evidence based prevention is critical to avoiding a future of predictable outbreaks.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Umayr R. Shaikh. He is a medical student. Today’s KevinMD article is “The impact of the CDC’s new childhood immunization guidance.” Umayr, welcome to the show.
Umayr R. Shaikh: Thank you for having me.
Kevin Pho: All right, so we were talking offline. I know that you are in between your third and fourth years of medical school. What led you to write this article and send it over to KevinMD?
Umayr R. Shaikh: Yeah, absolutely. I always love sharing with people that even though I am in medical school, my background is actually in speech and debate. When I was in college, I was a double major in communications and Spanish. I was really inspired to enter into the field of medicine during the COVID-19 pandemic by watching figures like Dr. Fauci and other public health officials take the stage. I realized the importance and power of communication within medicine. That is something I have always sought to bring as a unique lens to medical education.
Now, as someone who is in between my third and fourth years of medical school, I am seeing firsthand the impact that communication, messaging, and public health are having on the health and well-being of our country. With this piece, I was reading the stories about the new changes in the immunization guidelines that came out in January. I was thinking to myself that it was a throwback to my preclinical days where we had learned about these diseases. We had been told that we should know them for our boards, but we were probably not going to see them. So I remember going through the lessons and thinking about Koplik spots, coryza, and conjunctivitis, which is measles. Everyone sort of had a good laugh about it. They thought we had to know this for boards but didn’t really have to worry about it.
I had been reading all these stories about these diseases that had long been almost completely eradicated coming back and being at a higher prevalence than they had been previously. I told myself I wanted to take my communications background and my skill in writing and telling a story and combine it with a very pressing public health issue. I wanted to see who would be interested in reading it. That was the main inspiration behind this article.
I also wanted to provide a student’s perspective. I feel like I had seen a lot of things written from attending physicians, which is fantastic, but I think when you are a student going through this, you see things from a very different lens. You are up and coming in this system, and it is new to you. When it changes so much in a small period of time, it is easy to feel confused and overwhelmed. What I also wanted to do is provide a roadmap for my fellow students and say that they have power. They have the ability to take this into their own hands and really be stewards for the future of public health.
Kevin Pho: For those who aren’t familiar with the changes in the vaccine guidelines back in January, just give us a synopsis of what has changed.
Umayr R. Shaikh: Yes, absolutely. There were quite a few changes that were made in terms of recommendations. I believe that it was something that came from the rationale that we want to focus on shared decision-making and individualized risk assessment rather than general blanket guidelines. The rationale was that not all children have exposure risk to certain diseases. For some vaccinations, the severe outcomes are statistically concentrated in specific populations. So the argument was that universal recommendations may not be necessary when disease burden is highly stratified by risk.
There were different arguments on every side. From the policymaker perspective, they were saying that as disease prevalence falls, the mandatory or universal approaches that we have now can be reconsidered. It was also really important that the language used to recommend and advise parents and their kids changed. Namely, the number of conditions for which the vaccines were universally recommended shifted to risk-based stratification and went from 17 to about 11. There were some vaccines like rotavirus, influenza, COVID-19, hepatitis A, hepatitis B, and meningococcus that were put into shared decision-making or risk-based categories instead of universal recommendations.
The other thing is the process by which this was done. Historically, vaccine recommendations have been shaped by the ACIP, or the Advisory Committee on Immunization Practices, which is an independent panel that reviews safety and effectiveness. Those structures were altered under current leadership at the CDC and HHS. Some people say this occurred by removing independent experts and replacing them with appointees that are aligned with changes to vaccine policy. Groups including the AAP, or the American Academy of Pediatrics, and other medical organizations have urged federal judges and courts to block these changes. They argued that they are not backed by the same standard of evidence by which they were set and that they could possibly endanger public health. There are some states and professional groups that have said they are going to continue to follow the older evidence-based schedule rather than the CDC’s newly issued guidance. So I think it is important to have an understanding of the two sides of that story.
Kevin Pho: By reframing what previously were compulsory vaccines under this paradigm of shared decision-making and individual risk stratification, what do you think about that? How is that going to impact our public health going forward if we shift to this new paradigm?
Umayr R. Shaikh: I think that it is going to have a tremendous impact on public health one way or another. I think that we are unfortunately going to start to see some of these diseases that previously we say existed in the footnotes of history or the margins of medicine start to come back in ways that we really haven’t seen in recent history. I think measles is a great example of this. Seeing the rise in incidence in certain areas of the country such as Texas over the past few months is concerning. That is an area that is on the cusp of losing its immunization status. I fear that things like that may start to happen for these other diseases that I mentioned previously.
At the same time, there is the technical aspect of it when you look at the statistics, but beyond that, I want to mention something very powerful that Dr. Fauci refers to as the normalization of untruths. Beyond just the immediate impact of the disease, seeing people’s trust in the public health system and in physicians continuing to waver and weaken is something that is particularly concerning to me. In medicine, we are trained to learn the disease, the biology, and the pathophysiology. What we don’t learn is how to communicate effectively, how to tell stories, how to talk to patients, and how to interface with public health and systems.
We must realize that the health of people, communities, and families is seamlessly intertwined with the health and well-being of our systems. I fear that this normalization and fear that we are seeing in the general public is going to continue to widen. The onus really falls on us as health professionals to prioritize learning how to communicate with the general public instead of using jargon. We must avoid heavy terms that only we in the medical community can understand. Let’s focus on telling stories and interfacing with people where they are so that they can understand that we are really trying to help them and provide guidance to keep them healthy.
Kevin Pho: So historically, as you know, the United States has an individualistic streak. It runs throughout our history and that paradigm of individual choice and shared decision-making is surely going to resonate with a vast proportion of our patients. How do you square the effects of public health with our culture of individualism and the fact that that is going to resonate with some patients?
Umayr R. Shaikh: I think it is a great question, and it is something we have been seeing more and more even in areas outside of medicine. I think of areas like social media and all of these different areas where consumerism and individualism are really pushed on us. We are led to believe that it is all about what you want and what is best for you with very little look towards the side or the other people that it affects. I think there are a couple of ways to go about it.
I think the first is reconciling that there are some areas of our life that are individualistic. We need to maintain our mental health and we need to maintain what is good for us. But at the same time, there are things that are not individualistic. There are elements of our society, and even just using the word society implies that there are things that are collective within our country. One of those things is health.
I think it is important too to realize that shared decision-making may not necessarily mean that someone doesn’t want a vaccine or doesn’t want to do something. Shared decision-making can just as easily be empowering. We can have these difficult conversations with our patients the right way and communicate to them that yes, it is their decision. It is their child, it is their body, and it is their immune system. That is absolutely true. But we can expand from that and say that one of the reasons why we have the health that we do and the eradication of these diseases essentially that we do is because people understand that everyone needs to take accountability for the greater good when it comes to health.
When it is framed from a value-based perspective rather than a paternalistic directive saying that you need to do this because it will protect people and protect you, we shift the tone of that conversation. We say that we recommend you do this because it is genuinely in your best interest and it is in the best interest of the people around you. I think that cognitive reframing and that messaging are incredibly important. If we frame it like that, people will start to realize that not only is this best for me, but it is also good for the people around me, and I should help do my part.
Kevin Pho: Another argument I hear in favor of these changes is that the administration wants to align our vaccine schedules more to those of other countries. I always hear Denmark and Japan cited most frequently. What do you think about that particular argument?
Umayr R. Shaikh: Yeah. I have been seeing that as well, and I think that is really important. I think the policies in those other countries are also very closely tied to the health infrastructure that they have. If we were to look at parallels between these other countries that have these vaccination schedules that perhaps are not as stringent or rigorous, we must look at it in the context of their overall health care system. We must see the infrastructure they have in place and see how easy it is for people to get the medical care and attention that they need.
In the U.S., we have a system that is dominated by insurance and incredibly long wait times, where you need referrals for specialists and all these different things. Our health care systems just fundamentally work on a different level. I actually think that the policies that we have adapted up until these more recent recommendations came out have been a part of the reason why we have remained as healthy as we have. Even then, if you look at the statistics for global health or the overall health of the U.S., it lags rather significantly behind that of other developed nations. I think that tells a huge part of the story.
If we had easier access to health care, better coverage, and better resources available for people, things would be different. We were just talking about individualism versus collectivism a moment ago. These other societies are very invested in the health of their community. As long as we continue to have this individualistic culture guiding us in the U.S., we would need these strict recommendations to maintain that same level of health. I think if we wanted to adapt what those other nations were doing, we would need to see a big cultural shift in our mindset in order for that to really keep us at the same level of our health.
Kevin Pho: I want to get back to the patient communication piece. Clearly you mentioned that you have a background in speech and debate. In our exam rooms when we talk about health care and vaccines in particular, there is really nothing more politicized than that. Chances are one out of every two patients will either disagree or agree with what you recommend in the exam room regarding vaccines. What are some tips you could share with physicians who may not have that background in debate to navigate some of those discussions?
Umayr R. Shaikh: Absolutely. Thank you for asking that. I feel like this is an important thing. As I was saying earlier, in medical school we have our OSCEs and didactic sessions, but we have very little practical application of this. We don’t practice it nearly enough. I think the first thing is coming at it from the point of view of the patient. Ask what is important to them and what they value for their health and the health of their kids and loved ones.
Too often, from personal experience being a kid, a provider would come into the room and say they are going to give you these shots today. You feel like asking what is going on because they just told you what you needed to do. They didn’t tell you anything. They have a chart on the wall. If you have questions, they tell you to look at the chart because this is what is recommended at this stage. But in my experience, sitting down with patients and saying that there are a couple of things we would like to do at their visit today works better. I just want to get a sense of what is important to them, how they feel their health is right now, and if there are any changes they would like to make. That not only disarms the patient in terms of defensiveness, but it really makes them feel like they are being listened to and that this doctor wants what is best for them.
You might get a myriad of responses from that. They might say they think their health is good and they don’t want to do anything. Or they might say they feel like they could be better and ask if there are any things that they should be doing. Depending on the avenue the patient gives you, then you could sort of pivot accordingly. But I would say some baseline communication principles in any of those circumstances would be to say that we have these recommendations based on their age and preexisting conditions. Here are some things that we would recommend, and one of those things involves a vaccination. We explain what the vaccination is, what some of its possible side effects are, and why the net benefit would outweigh the long-term harm. It is completely their decision, but we want to be in line with the goals that they told us, and this is something that can help them achieve that.
If you frame it from that point of view, even if they disagree with vaccinations as a principle, they will say that this doctor really is listening to them and hearing what is valuable to them. The other thing too is not pressuring them at a certain time. This is something I have seen a lot more physicians incorporate recently. They tell patients to take some time and think about it because it doesn’t need to be done today. If they have any questions, they can call the office, and whatever they can answer, they are more than happy to do. It is just a matter of being open. Instead of coming at it from the perspective that this is what you need to do, pointing to a chart on the wall, and insisting it must be done today, you use a different approach. That is when you are going to start to see patients shrink back. So it is really all about that framing.
Kevin Pho: Now, as we talked about, you are in between your third and fourth years of medical school. From what you are seeing, not only in your medical school but others as well, how are they teaching students to navigate the increasingly political environment of health information?
Umayr R. Shaikh: Yeah, thank you for asking that. I feel like I kind of have a front-row seat to this being a medical student in Washington, D.C., where all of these changes are happening. We see it in front of us every single day. I would say that there has been more of an emphasis placed on patient-centered communication than I think previous generations of medical students have had. I have talked to a lot of my physician mentors, and they said that these OSCEs that you have now and these communication exercises are not things that they did. I think there is a movement in the right direction to have these difficult conversations with patients.
That being said, I don’t think it is all the way there yet. I think there are still things that are missing. One of those big things is policy education. I did my Master’s of Public Health before starting medical school, and I entered into medicine with that policy perspective. Now whenever I learn about something new in the world of medicine, one of my first thoughts is how this shakes out at the national level and at the health policy level. I think that is an action step that a lot of medical schools can take. They are doing the right thing with regards to communication and are slowly getting there. Let’s build health policy into that too. Let’s learn how lobbying works. Let’s learn how legislation works. Let’s learn how these changes that have come so quickly and undone so much work over the past century have taken place.
When we do that, we empower our physicians and our aspiring physicians to take an active role in advocacy. Being in D.C., there are always these events happening on Capitol Hill for one thing or another. All these different groups have their days in Congress where they go and talk to representatives. The turnout from physicians needs to be higher. Not only that, we need to learn how to advocate for ourselves. One of the things we don’t learn is public speaking and how to communicate an easy and difficult message. Breaking it down into an easy-to-understand manner and then disseminating that to a large audience is a huge skill. If we were to start building that as physicians, I think we would see a big shift in public health with regards to how the public sees us.
Kevin Pho: We are talking to Umayr R. Shaikh. He is a medical student. Today’s KevinMD article is “The impact of the CDC’s new childhood immunization guidance.” Umayr, let’s end with some take-home messages for the KevinMD audience.
Umayr R. Shaikh: Absolutely. I have a couple of take-home messages. The first is for students. You have power. You are the future of the health care system. You are the center of it, and it is so important that you prioritize learning how to communicate and advocate for not only your patients but for yourself and for your community.
The second take-home message is to physicians who are currently practicing. Help inspire the next generation of us to really be on the front lines of this advocacy work. Tell us in your experience what we need to do and then help us shape our careers accordingly. At the same time, the way you communicate with your patients models that for us younger students so we can better interface and connect with a growing population of people that is growing increasingly distrustful of the medical system.
Finally, for patients themselves. What we do in medicine is for you. It is to take care of you and to help you in any way that we can. Ask us questions. Don’t be afraid to ask us about whatever concerns you may have. We are here to help you. We are here to serve, and we want to help you take the most control of your health as you can. We ultimately want what is best for you.
Kevin Pho: Umayr, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.
Umayr R. Shaikh: Thank you so much, Dr. Kevin. I really appreciate it.