Health Secretary Robert F. Kennedy Jr. has indicated his view that American children receive a higher number of vaccines.
Earlier this month, President Trump issued a memorandum directing Secretary Kennedy and the acting director of the Centers for Disease Control and Prevention (CDC) to align U.S. childhood vaccine recommendations with best practices from peer nations, specifically mentioning Denmark. This directive could lead to a reduction in the number of vaccines administered and the diseases covered.
Expert Perspectives on Schedule Alignment
Critics argue that simply adopting another country's vaccine schedule in the U.S. is not feasible due to significant differences in population and health risks. Josh Michaud, associate director for global and public health policy at KFF, stated, "It's like fitting a square peg in a round hole when our goal is to prevent disease."
Denmark's routine childhood immunization schedule recommends vaccination against 10 diseases. In contrast, the U.S. schedule has historically recommended routine universal vaccination against 16 diseases. This was reduced from 17 diseases last week when the CDC officially dropped the recommendation for universal hepatitis B vaccination for newborns.
Dr. Sean O'Leary, chair of the Committee on Infectious Diseases for the American Academy of Pediatrics, highlighted the differing contexts, stating, "It's like comparing a cruise ship to a kayak."
Divergent Health Systems and Demographics
Differences between the U.S. and Denmark cited by experts include:
- Population Size and Diversity: Denmark's population is approximately 6 million, compared to over 343 million in the U.S. Denmark has less racial and ethnic diversity and fewer wide income disparities than the U.S.
- Health System Structure: Denmark operates a highly unified health system with a national health registry that tracks individuals from birth to death. Michaud noted this system facilitates easy identification, treatment, and contact tracing during outbreaks.
- Parental Leave and Healthcare Access: Danish families receive about a year of paid parental leave, which may reduce infant exposure to diseases. Denmark also provides free, universal health care, meaning the system absorbs costs for illnesses like RSV, which is not routinely vaccinated against in Denmark but is in the U.S.
- U.S. Challenges: Dr. Jake Scott, an infectious disease specialist at Stanford University School of Medicine, described the U.S. system as having fragmented insurance, millions uninsured, no national health registry, and significant gaps in continuity of care. Scott stated, "We use broader vaccine recommendations because our system can't reliably identify and follow up with every person at risk."
- Risk Factors: The U.S. also has higher rates of childhood obesity and asthma, which can increase vulnerability to certain diseases.
Dr. William Moss, an epidemiology professor at Johns Hopkins Bloomberg School of Public Health and director of the school's International Vaccine Access Center, emphasized that differences in vaccination schedules, particularly in Europe, are not due to concerns about vaccine safety or efficacy. Dr. O'Leary expressed concern that scaling back the U.S. schedule to match Denmark's context could expose American children to preventable diseases.
International Comparisons
President Trump's memo characterized the U.S. as "a high outlier in the number of vaccinations recommended for all children" compared to peer countries. However, Michaud of KFF stated that the U.S. schedule aligns closely with 30 countries in the European Center for Disease Prevention and Control. He noted, "In fact, it is Denmark that seems to be the outlier here in terms of recommending very few vaccines," adding that countries like Germany, France, and Italy recommend 15 or more vaccines. Scott characterized Denmark's approach as "unusually minimalist" even compared to other Nordic nations like Sweden, Norway, and Finland, which cover more diseases.
Policy Implementation and Legal Questions
The Health and Human Services (HHS) Department had scheduled an announcement regarding children's health with the CDC, which was subsequently postponed. Media reports suggested this announcement might have involved an overhaul of the childhood vaccination schedule. HHS spokesperson Andrew Nixon declined to comment, stating the announcement was postponed until after the new year.
Legal experts have raised questions regarding the authority of the health secretary to implement significant vaccine policy changes without following established processes. Dorit Reiss, a law professor at the University of California, San Francisco, whose research focuses on vaccine legal and policy issues, indicated that while the secretary holds broad authority, bypassing the CDC's Advisory Committee on Immunization Practices for such a major change could make the administration vulnerable to legal challenges. Reiss stated, "The process makes them very vulnerable to legal challenges."