According to reports, the Department of Health and Human Services (HHS) is considering making further changes to federal recommendations for childhood vaccines to align with those of other peer countries, particularly Denmark. This follows a meeting earlier this month of the CDC’s Advisory Committee on Immunization Practices (ACIP) where childhood vaccine schedules in the two countries was compared (and changes to the childhood vaccine schedule were made), as well as a subsequent memorandum issued by President Trump calling for HHS to begin a “process to align U.S. core childhood vaccine recommendations with best practices from “peer, developed countries”.
Adopting Denmark’s schedule wholesale would mean fewer vaccines recommended for U.S. children through age 18. When looking at vaccines that are universally recommended for children in each country, the Danish schedule includes vaccines against 10 diseases while in the U.S., 16 diseases are included (now that hepatitis B is no longer universally recommended). The six additional vaccines recommended by the U.S. target respiratory syncytial virus (RSV), rotavirus, varicella, hepatitis A, and meningococcal disease. While the U.S. recommends more pediatric vaccines compared to many peer countries, Denmark is an outlier on the other extreme as it recommends fewer. According to the European Centers for Disease Control’s (ECDC) vaccine scheduler tool, none of the other 29 ECDC countries recommends a schedule that targets just 10 diseases. In fact, many countries recommend vaccines for 15 or more diseases including Germany, Greece, Ireland, Italy, and Poland; Austria’s schedule targets 17 diseases, even more than the U.S. now.
Each country has its own process and its own unique set of circumstances when it comes to determining vaccine recommendations, and each has developed their childhood vaccination schedule after years of reviewing and weighing available evidence in light of many factors, such as differences in health delivery systems, insurance coverage, public health system capacity, and national priorities. As such, there are good reasons why different countries have different vaccine schedules, but to date no developed country has made its vaccination decisions based only on what a “peer” country does.
To be clear, Denmark is not basing its schedule on a different scientific reading of the efficacy of the vaccines in question. Denmark’s health authority has placed an emphasis on recommending vaccines that reduce children’s risk of death or serious harm. As one example, while Denmark experiences some rotavirus infections in children each year, the infection rarely leads to deaths or long-term harm for children in a country where there is universal health coverage, good access to health care, and lower levels of inequality compared to the U.S. Denmark’s neighbors Norway and Finland do include the rotavirus vaccine, as does the U.S., which prior to introducing the vaccine experienced an estimated 2.7 million infections annually causing 55,000 to 70,000 hospitalizations and 20 to 60 deaths in children under five.
Revisiting vaccine recommendations is warranted from time to time when new evidence is introduced or circumstances have significantly changed. ACIP and CDC have already taken some steps to chip away at long-standing federal recommendations for childhood vaccines, but using Denmark’s vaccine schedule would be a shift of a much greater magnitude. Adopting Denmark’s vaccine schedule, as HHS Secretary Kennedy’s vaccine advisors have suggested, would likely lower childhood vaccination rates in the U.S. as certain vaccines become harder to access.
Importantly, states ultimately have the authority to decide what vaccines to recommend or require, and a growing number have already distanced themselves from CDC changes so far. A Denmark-based federal vaccine schedule could accelerate and expand that trend.