Who Should the Public Trust on Medical and Vaccination Matter - A Comparative Analysis of the United Kingdom and the United States

26th January 2026

Federal health officials are unilaterally reducing the number of recommended pediatric immunizations in response to an order from President Trump, the most significant reshaping of the vaccine schedule since Trump took office and empowered health secretary Robert F Kennedy Jr, a long-time critic of childhood shots.

Vaccination policy occupies a uniquely sensitive space in public life. It involves science, ethics, risk, and collective responsibility, while also touching on deeply held values such as personal choice and trust in authority.

Recent changes to vaccination programmes in the United States—particularly regarding meningococcal disease—have reignited debate about who should guide such decisions.

Should the public place greater trust in elected politicians, or in independent medical and scientific experts? A comparison between the United Kingdom and the United States provides a useful lens through which to examine how trust is built, sustained, or damaged in medical decision-making.

The Role of Medical Expertise in Vaccination Policy

Vaccination policy is not simply about whether a vaccine works. It requires interpretation of complex and evolving evidence: disease incidence, transmission patterns, severity of outcomes, vaccine safety, effectiveness over time, population-level impact, and behavioural responses. These judgements are made under uncertainty, often with incomplete data, and must balance rare risks against potentially catastrophic outcomes.

Medical experts—such as epidemiologists, immunologists, infectious-disease specialists, and public-health scientists—are trained to weigh these factors. They also understand that low incidence does not equate to low importance, particularly for diseases like meningococcal infection, which is uncommon but can progress rapidly to death or permanent disability. For this reason, most high-income countries rely on independent expert advisory committees to guide vaccination policy.

Politicians, by contrast, are generalists. Their expertise lies in governance, legislation, and public communication, not in assessing immunological or epidemiological evidence. While they play a vital role in implementing health policy, they are poorly positioned to lead technical medical decisions.

The United Kingdom - Trust Through Independent Expertise

In the UK, vaccination policy is guided by the Joint Committee on Vaccination and Immunisation (JCVI), an independent body of scientific and medical experts. JCVI reviews evidence on disease burden, vaccine effectiveness and safety, population modelling, and cost-effectiveness. Its recommendations are published, transparent, and subject to professional scrutiny.

When the UK adjusts its immunisation schedule—such as introducing routine MenB vaccination for infants, offering MenACWY to adolescents, or withdrawing routine MenC vaccination for babies—these changes are explicitly linked to epidemiological evidence and long-term surveillance data. Even when decisions are controversial, the process by which they are made is visible and consistent.

This separation between political authority and scientific judgement is crucial for public trust. Politicians generally accept and implement JCVI recommendations rather than publicly contesting them. As a result, the public can reasonably believe that vaccination policy is driven primarily by evidence rather than ideology. Trust does not depend on blind faith in institutions, but on confidence in the process.

The United States - Politicisation and Fragmented Trust

The United States has traditionally followed a similar expert-led model through bodies such as the Advisory Committee on Immunization Practices (ACIP). However, recent changes—particularly the reclassification of some vaccines, including meningococcal ACWY, from routine recommendation to "shared clinical decision-making"—have been perceived by many clinicians as politically influenced rather than evidence-driven.

The problem is not that shared decision-making is inherently flawed. In some contexts, it is appropriate. However, for diseases that are rare, fast-moving, and severe, this approach can be dangerous in practice. Evidence shows that when vaccines move from routine to optional categories, uptake often falls—not because people actively refuse, but because discussions do not happen, time is limited, and "optional" is interpreted as "unnecessary."

What has particularly damaged trust in the US context is the perception that these changes were made without new, published scientific evidence showing they would be safe at a population level, and without full, transparent endorsement from expert advisory bodies. When major medical organisations publicly object and politicians proceed regardless, the public is exposed to open conflict between science and politics.

In an already polarised society, this has predictable effects. Some people feel reassured that politicians are "challenging experts" and promoting choice. Others conclude that health policy is being shaped by ideology rather than evidence. The result is not increased trust, but fragmented and polarised trust.

Shared Decision-Making and the Illusion of Choice

One of the most significant but under-appreciated aspects of recent US changes is the behavioural impact of "shared clinical decision-making." In theory, it empowers patients. In practice, it often reduces protection.

Clinicians operate under severe time constraints, and vaccines that are not routine are less likely to be discussed. Insurance coverage may become less automatic, introducing financial and administrative barriers. For parents, the absence of a strong recommendation is a powerful signal that a vaccine is not important. This is particularly problematic for meningococcal disease, where the rarity of cases masks the severity of outcomes.

Medical experts understand these dynamics and factor them into policy decisions. Politicians often do not. This difference in perspective further supports the argument that expert guidance should dominate vaccination policy.

Trust, Transparency, and Process

Public trust in health policy depends less on agreement with every decision and more on confidence that decisions are made competently, transparently, and independently of political ideology. When evidence changes and policies adapt accordingly, trust can be maintained—provided the reasoning is clear and the process credible.

The UK model demonstrates how this can work: independent expert review, published rationale, and political restraint. The recent US experience shows the opposite risk: when politicians appear to override or bypass medical expertise, trust erodes not only in politicians but in public health institutions more broadly.

Once lost, trust is difficult to rebuild. Future vaccination campaigns—even those grounded firmly in evidence—may be met with scepticism because the process itself has been compromised.

Who Should Be Trusted?

The comparison between the UK and the USA leads to a clear conclusion. On medical and vaccination matters, the public should primarily trust independent medical experts, not politicians. This does not diminish the role of democratic governance. Politicians are essential for funding, legislation, and communication. But their role should be to support, not supplant, scientific judgement.

Where politicians respect the boundaries of expertise, trust is more stable. Where those boundaries blur, trust fragments along political lines. In matters of vaccination—where decisions affect not only individuals but entire populations—the cost of misplaced trust can be measured in preventable illness, disability, and death.

Vaccination policy is a test of how societies balance expertise, democracy, and trust. The UK and the USA offer contrasting lessons. The UK shows that deferring to independent medical expertise fosters stability and confidence, even when difficult decisions are made. The US experience illustrates how politicisation, even when framed as choice or reform, risks undermining public trust and weakening public health protection.

Ultimately, trust should follow competence and evidence. In medicine and vaccination, that means trusting those trained to understand risk, uncertainty, and prevention—and ensuring that political power is exercised in service of science, not in competition with it.

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