evidence: The 2023 shared clinical decision-making RSV vaccination recommendation was made in the setting of uncertainty in some portions of the evidence profile. RCTs of both protein subunit vaccines (GSK Arexvy and Pfizer Abrysvo) were underpowered to demonstrate protection against RSV-associated hospitalization or death, and enrolled few participants who were frail or aged ≥75 years. Although both vaccines were well-tolerated and exhibited an acceptable safety profile, a small number of inflammatory neurologic events, including GBS, were observed after RSV vaccination in clinical trials. Because of the small number of GBS cases in the trials, it was unclear whether they represented an association between RSV vaccination and GBS or occurred because of chance alone. Acknowledging these uncertainties, in June 2023 ACIP recommended shared clinical decision-making to encourage providers and patients to consider individual risk of RSV disease (2); however, shared clinical decision-making has drawbacks. Providers find it confusing and time-consuming to implement (12,13). After one season of RSV vaccine availability, vaccination coverage among adults with chronic medical conditions has been only modestly higher than that among adults without conditions (14).