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

Guards parade through the courtyard of Fredensborg Palace in Denmark. The northern European country, with a population of about 6 million, has been suggested as a model for U.S. childhood vaccination policy.

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Scott Barbour/Getty Images Europe/Getty Images

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

Earlier this month, President Trump issued a memorandum directing Kennedy and the acting CDC director to align the United States with best practices in childhood vaccine recommendations from peer countries, and it specifically mentioned Denmark. This could mean fewer vaccines against fewer diseases.

But critics say you can’t simply adopt another country’s vaccination schedule in the United States, which has a very different population and different health risks.

“It’s like fitting a square peg into a round hole when our goal is to prevent disease,” says Josh Michaud, associate director of global policy and public health at KFF.

Denmark recommends routinely vaccinating all children against only 10 diseases. In the United States, the vaccination schedule provides for universal and systematic vaccination against 16 diseases. There were 17 illnesses until last week, when the Centers for Disease Control and Prevention officially dropped the recommendation to vaccinate all newborns against hepatitis B.

But Denmark created its vaccination schedule in a very different context than the United States, notes Dr. Sean O’Leary, chair of the American Academy of Pediatrics’ Committee on Infectious Diseases.

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

Different populations, different health systems

For starters, Denmark’s population is about 6 million – about the same as Wisconsin’s – compared to more than 343 million in the United States. Denmark also lacks the racial and ethnic diversity and wide income disparities that prevail in the United States. Denmark also has a highly unified health care system, with a national health registry that essentially tracks everyone from birth to death, Michaud says.

“And so if there are outbreaks or if there are cases of these diseases, they can easily identify them,” says Michaud. “They can treat them, get them treated and also do contact tracing, if that’s necessary for the particular illness that we’re talking about.”

Additionally, Danish families get about a year of paid parental leave – between both parents – so they can stay home with their babies, who are potentially not exposed to as many illnesses. Additionally, Denmark has free and universal healthcare. So, for example, if an infant is hospitalized for RSV – a disease that Denmark does not routinely vaccinate against but the United States does – then the system will absorb the cost, so it will not be a barrier to getting care.

That’s very different from the United States, where many people have difficulty accessing health care, says Dr. Jake Scott, an infectious disease specialist at Stanford University School of Medicine.

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

The United States also has higher rates of childhood obesity and asthma than Denmark, Scott notes, putting these children at higher risk of certain diseases.

“What diseases do they want to bring back?”

All of these complex differences have led the United States to create a different vaccination program than Denmark’s — one that places more emphasis on disease prevention rather than management, says Dr. William Moss, a professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health and director of the school’s International Vaccine Access Center.

“The reason why countries, especially in Europe, have different vaccination schedules is not because they consider vaccines to be unsafe or not to work,” says Moss. And I think it’s very important that people understand that. »

Scaling back the U.S. vaccination schedule to model itself on Denmark’s in this very different context puts American children in real danger, O’Leary says. “It’s like, what diseases do they want to bring back to the United States? What diseases do they want kids hospitalized for that they’re not protected against? I just don’t understand.”

Which country is an outlier?

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

But if we consider the 30 countries that are part of the European Center for Disease Prevention and Control, the United States is very much in line with them, believes KFF’s Michaud.

“Actually, it’s Denmark that seems to be the exception here in terms of recommending very few vaccines,” he says. “In the case of Germany, France and Italy, we could be talking about 15 or more vaccines.”

Even compared to other Nordic 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. The Department of Health and Human Services informed the press last Thursday that it would make “an announcement regarding children’s health” with the CDC the next day. But HHS canceled the press conference hours later. Media reports suggest the administration had planned to announce an overhaul 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 after the first of the new year.

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

Kennedy technically has broad authority in setting vaccine policy, says Dorit Reiss, a law professor at the University of California, San Francisco, whose research focuses on legal and policy issues related to vaccines. But simply announcing such a significant change via a news conference — rather than going through the CDC’s Advisory Committee on Immunization Practices — could expose the Trump administration to legal challenges, she says.

“The process makes them very vulnerable to legal challenges,” says Reiss.