The U.S. models vaccine guidance after Denmark — but forgets the social safety net

This week, the U.S. Department of Health and Human Services changed its recommended childhood vaccine schedule to model that of Denmark. The new recommendation means fewer vaccine recommendations. Health officials will continue to recommend the measles, mumps and rubella vaccines and those against polio, chickenpox and HPV.

But now they are only recommending vaccinations against meningococcal disease, hepatitis B, and hepatitis A to children who broadly face a higher risk of infections. The move is not a surprise to health officials nationwide, as it was reported by CNN late last month. But it does reflect a bigger fallacy that has long surrounded the vaccine debate and been a talking point of anti-vaccine campaigns: if they do it in Europe, they can do it in the United States.

“A major fallacy is assuming that policies that work in one country will automatically work in another,” Josh Michaud, the associate director of global health and public health policy at KFF, told Salon. “European countries differ significantly from the U.S. in terms of demographics, health care systems, social safety nets, and public health infrastructure, all of which shape their policy choices.”

Michaud said the U.S. has its own scientific institutions and experts who are capable of reviewing evidence and developing guidelines specific for the country. “Relying on guidelines developed elsewhere risks overlooking local conditions and realities that matter for effective public health policy,” Michaud said.

Michaud pointed out that when it comes to European comparisons, there is also “selected use” of them.

“Many European countries have universal health coverage, stronger social welfare programs, and stricter gun laws than the U.S., yet those policies are rarely cited as models by officials here,” he said. “Instead, the focus has been narrowly placed on Denmark’s vaccine recommendations.”

Michaud said that experts across peer countries generally agree on “the underlying science of vaccine safety and efficacy.” It’s not that Denmark doesn’t recommend some vaccines because they’re not safe, but instead because of differences of the data and how that data is applied within the context of each country and its population.

Recently, Science spoke to Jens Lundgren, an infectious disease specialist at the Copenhagen University Hospital, who said vaccine schedules should be based on a population’s needs. For example, when asked about meningococcal diseases, Lundgren said it’s not really a “public health problem” in Denmark. “We feel that there are other vaccines that should be higher on the list at the moment, at least in the Danish context,” he said.

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“It’s problematic to base U.S. vaccine policy on simply copying another country,” Michaud said. “Vaccine decisions depend on factors that vary widely across nations, including health care delivery systems, insurance coverage, public health capacity, and national priorities.”

He added Denmark is not a good model for the U.S. to follow because it is “an outlier among peer countries.” Of the countries that the HHS compared the U.S. to, Denmark is the only one to recommend vaccines against as few as 10 diseases.

The American Academy of Pediatrics said the move from the HHS was “dangerous and unnecessary.”

“The United States is not Denmark, and there is no reason to impose the Danish immunization schedule on America’s families,” Dr. Andrew Racine, AAP’s president, said in a statement. “America is a unique country, and Denmark’s population, public health infrastructure, and disease-risk differ greatly from our own.”

Racine said that the AAP will continue to publish its own childhood vaccine recommendations.

What concerns many public health experts is the confusion this will cause parents in America.

“Reclassifying vaccines for six diseases from routine recommendations to “shared clinical decision-making” adds complexity for both providers and parents,” Michaud said. “Combined with mixed messaging from the CDC, clinicians and other groups, this change risks reducing vaccination rates and increasing cases of vaccine-preventable diseases.”

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