Why experts say Denmark is no model for U.S. vaccine policy : NPR

Health Secretary Robert F. Kennedy Jr., a longtime critic of vaccines, has made clear that he believes American children are receiving too many vaccines.

Earlier this month, President Trump released memorandum directed Kennedy and the acting director of the Centers for Disease Control and Prevention to bring the U.S. into line with best practices in other countries' childhood vaccination recommendations, and it specifically mentioned Denmark. This could mean fewer vaccinations against fewer diseases.

But critics say the U.S. can't simply adopt another country's vaccination schedule, with a very different population and different health risks.

“It's like putting a square peg in a round hole when our goal is to prevent disease,” says Josh MichaudDeputy Director for Global and Public Health Policy at KFF.

Denmark recommends regularly vaccinating all children against just 10 diseases. In the United States, the vaccination calendar provides for routine universal vaccination against 16 diseases. There were 17 diseases until last week when the Centers for Disease Control and Prevention formally abandoned its recommendation to vaccinate all newborns against hepatitis B.

But Denmark has developed its vaccination schedule in a completely different context than the US, notes Dr. Sean O'LearyChairman of the Committee on Infectious Diseases of the American Academy of Pediatrics.

“It's like comparing a cruise ship to a kayak,” says O'Leary, a professor of pediatrics and infectious diseases at the University of Colorado School of Medicine.

Different populations, different healthcare systems

For starters, Denmark has a population of about 6 million people—about the same as the population of Wisconsin—compared to Denmark's population. more than 343 million people In the US, Denmark also lacks the racial and ethnic diversity and wide income inequality that prevail in the US. Denmark also has a highly unified health care system, with a national health registry that essentially tracks every person from birth to death, Michaud says.

“And so if there are outbreaks or cases of these diseases, they can be easily identified,” says Michaud. “They can treat them, provide care for them, and also do contact tracing if necessary for the specific disease that we're talking about.”

Moreover, Danish families receive about a year of paid parental leave (for two parents) so that they can stay at home with their children, who are potentially not susceptible to as many illnesses. In addition, Denmark has free and universal healthcare. So, for example, if an infant is hospitalized with RSV—a disease for which vaccinations are not routinely given in Denmark but are done in the United States—then the system will absorb the cost, so it is not a barrier to receiving care.

This is very different from the US, where many people have difficulty accessing health care, he says. Dr. Jake Scottinfectious disease specialist at Stanford University School of Medicine.

“We have fragmented insurance, we have millions of uninsured, we don't have a national health care registry, and we have huge gaps in continuity of care,” Scott says. “And we are using broader vaccine recommendations because our system cannot reliably identify and track every person at risk.”

The U.S. also has higher rates of childhood obesity and asthma than Denmark, Scott notes, putting these children at higher risk for some diseases.

“What diseases do they want to bring back?”

All of these complex differences have led the U.S. to create a different vaccination schedule than Denmark, one that places more emphasis on preventing disease rather than treating it, he says. Dr. William MossProfessor of Epidemiology at Johns Hopkins Bloomberg School of Public Health and Director of the International Vaccine Access Center.

“The reason countries, especially in Europe, have different vaccination schedules is not because they think the vaccines are unsafe or ineffective,” Moss says. And I think it's very important that people understand that.”

According to O'Leary, the reduction of America's vaccination schedule along the lines of Denmark's in this very different context puts American children at real risk. “It’s like: What diseases do they want to bring back to the United States? What diseases do they want to hospitalize children for that they are not protected from? I just don't understand.”

Which country is the exception?

In his presidential memo, Trump called the U.S. “a significant outlier in the number of vaccinations recommended for all children” compared to peer countries.

But if you look at the 30 countries that make up the European Center for Disease Prevention and Control, the United States is largely consistent with them, says KFF's Michaud.

“In fact, it is Denmark that seems to stand out in terms of recommending very few vaccines,” he says. “In the case of Germany, France and Italy we can talk about 15 or more vaccines.”

Even compared to other Scandinavian countries with similar health systems, Denmark is “unusually minimalist,” says Stanford's Scott. “Sweden, Norway, Finland – they all cover more diseases.”

It's unclear what Kennedy might do next. Last Thursday, the Department of Health and Human Services notified the press that it was going to make a “children's health announcement” the next day at the Centers for Disease Control and Prevention (CDC). But hours later, HHS canceled the press conference. Media reports it is believed that the administration planned to announce a revision of the childhood vaccination schedule. HHS spokesman Andrew Nixon declined to discuss the matter.

In an email to media, HHS said the announcement was delayed until New Year's Day.

Experts say it is legally unclear whether the health minister could revise vaccine policy simply by announcing it at a news conference, without going through the usual process of discussing such changes.

Kennedy technically has broad authority to set vaccine policy, says Dorit Reissis a law professor at the University of California, San Francisco, whose research focuses on legal and policy issues surrounding vaccines. But simply announcing such a major change at a news conference rather than through the CDC's Advisory Committee on Immunization Practices could open the Trump administration up to legal challenges, she says.

“This process leaves them very vulnerable to legal problems,” Reiss says.