U.S. Health Secretary Robert F. Kennedy Jr. has expressed the view that American children receive a high number of vaccines. President Trump recently issued a memorandum directing Kennedy and the acting director of the Centers for Disease Control and Prevention (CDC) to review and align U.S. childhood vaccine recommendations with "best practices" from other nations, specifically citing Denmark. This directive could lead to a reduction in the number of vaccines or targeted diseases.
Vaccine Schedule Comparison
Denmark's routine childhood immunization schedule currently recommends vaccinations against 10 diseases. In contrast, the U.S. schedule has called for routine universal vaccination against 16 diseases. This number was 17 until the CDC recently revised its recommendation, removing universal hepatitis B vaccination for newborns.
Challenges to Adopting Denmark's Model
Experts indicate that directly adopting Denmark's immunization schedule in the U.S. presents significant challenges due to fundamental differences between the two countries.
- Population and Demographics: Denmark has a population of approximately 6 million, similar to Wisconsin, compared to over 343 million in the U.S. The U.S. also exhibits greater racial and ethnic diversity and wider income disparities than Denmark.
- Healthcare Systems: Denmark operates a unified health system, featuring a national health registry that tracks individuals from birth. This system facilitates the identification and treatment of disease outbreaks and contact tracing. The U.S. healthcare system is characterized by fragmented insurance coverage, a significant uninsured population, the absence of a national health registry, and gaps in care continuity. Dr. Jake Scott, an infectious disease specialist at Stanford University School of Medicine, notes that U.S. vaccine recommendations are broader partly because the system may not reliably identify and follow up with every at-risk individual.
- Parental Leave and Disease Exposure: Danish families typically receive about a year of paid parental leave, potentially reducing infants' exposure to diseases. Denmark also provides free, universal healthcare, meaning costs for conditions like RSV hospitalization (a disease not routinely vaccinated against in Denmark, but included in U.S. recommendations) are covered by the system.
- Health Risks: The U.S. records higher rates of childhood obesity and asthma than Denmark, which can increase vulnerability to certain diseases.
Dr. William Moss, an epidemiology professor at Johns Hopkins Bloomberg School of Public Health, clarifies that variations in vaccine schedules among countries, particularly in Europe, are not typically based on concerns about vaccine safety or efficacy.
Denmark's Position Among Peer Nations
While President Trump's memo referred to the U.S. as a "high outlier" in vaccine recommendations, Josh Michaud of KFF states that the U.S. schedule is largely consistent with those of the 30 countries within the European Center for Disease Prevention and Control. Michaud suggests Denmark appears to be an outlier, recommending fewer vaccines, with countries like Germany, France, and Italy recommending 15 or more. Dr. Jake Scott adds that other Nordic countries, such as Sweden, Norway, and Finland, cover more diseases than Denmark.
Upcoming Announcements and Legal Considerations
The Department of Health and Human Services (HHS) postponed a planned announcement concerning "children's health" and the childhood vaccination schedule, rescheduling it for after the new year.
Legal experts, including Dorit Reiss, a law professor at the University of California, San Francisco specializing in vaccine-related legal issues, state that the Health Secretary possesses broad authority in setting vaccine policy. However, implementing significant policy changes without following established procedures, such as consultation with the CDC's Advisory Committee on Immunization Practices, could potentially expose the administration to legal challenges.