Doctors fear this week’s unprecedented changes to federal vaccine recommendations will stoke vaccine hesitancy even more, pose challenges for pediatricians and parents and ultimately lead to more illness and death among children. The Trump administration cut the number of routine childhood vaccines, recommending that all kids be immunized against 11 diseases. Vaccines against seven other illnesses are now recommended only for at-risk children or through “shared decision-making” with a health care provider. Health Secretary Robert F. Kennedy Jr. said the changes strengthen transparency and informed consent. But doctors say the new recommendations are sowing confusion, especially around the notion of shared clinical decision-making.