Why consultants say Denmark isn’t any mannequin for U.S. vaccine coverage : NPR

Well being Secretary Robert F. Kennedy Jr., a long-time vaccine critic, has made it clear he thinks American kids get too many vaccines.

Earlier this month, President Trump issued a memorandum directing Kennedy and the appearing director of the CDC to align the U.S. with greatest practices on childhood vaccine suggestions from peer nations, and it particularly talked about Denmark. That would imply fewer photographs in opposition to fewer illnesses.

However critics say you may’t merely undertake one other nation’s vaccine schedule within the U.S., which has a really completely different inhabitants and completely different well being dangers.

“It is like becoming a sq. peg in a spherical gap when our objective is to forestall illness,” says Josh Michaud, affiliate director for world and public well being coverage at KFF.

Denmark recommends routinely vaccinating all kids in opposition to simply 10 illnesses. Within the U.S., the immunization schedule requires routine common vaccination in opposition to 16 illnesses. It was 17 illnesses till final week, when the Facilities for Illness Management and Prevention formally dropped the advice to vaccinate all newborns in opposition to hepatitis B.

However Denmark has created its immunization schedule in a really completely different context than that of the U.S., notes Dr. Sean O’Leary, chair of the Committee on Infectious Illnesses for the American Academy of Pediatrics.

“It is like evaluating a cruise ship to a kayak,” says O’Leary, a professor of pediatrics and infectious illnesses on the College of Colorado Faculty of Drugs.

Totally different populations, completely different well being methods

For starters, Denmark’s inhabitants is about 6 million folks – roughly that of Wisconsin – in comparison with greater than 343 million folks within the U.S. Denmark additionally lacks the racial and ethnic variety and large revenue disparities which might be prevalent within the U.S. Denmark additionally has a extremely unified well being system, with a nationwide well being registry that mainly tracks everybody from beginning to dying, Michaud says.

“And so if there are outbreaks or if there are instances of those illnesses, they will simply determine them,” Michaud says. “They will deal with them, get them into care, and in addition observe down contacts, if that is wanted for the actual illness we’re speaking about.”

What’s extra, Danish households get a couple of 12 months of paid parental go away — between the 2 mother and father — to allow them to keep house with their infants, who probably aren’t uncovered to as many illnesses. Plus, Denmark has free, common well being care. So for instance, if an toddler is hospitalized with RSV – a illness which Denmark doesn’t routinely vaccinate in opposition to however the U.S. does – then the system will take up the price, so it isn’t a barrier to getting care.

That is very completely different from the U.S., the place many individuals wrestle to entry well being care, says Dr. Jake Scott, an infectious illness specialist at Stanford College Faculty of Drugs.

“We’ve got fragmented insurance coverage, we have thousands and thousands uninsured, we do not have a nationwide well being registry and we have monumental gaps within the continuity of care,” Scott says. “And we use broader vaccine suggestions as a result of our system cannot reliably determine and observe up with each particular person in danger.”

The U.S. additionally has greater charges of childhood weight problems and bronchial asthma than Denmark, Scott notes, which places these youngsters at greater threat of some illnesses.

“What illnesses do they need to carry again?”

All of those complicated variations have led the U.S. to create a unique immunization schedule than Denmark’s – one which places a larger emphasis on illness prevention slightly than administration, says Dr. William Moss, an epidemiology professor on the Johns Hopkins Bloomberg Faculty of Public Well being and director of the college’s Worldwide Vaccine Entry Middle.

“The rationale why international locations, notably in Europe, have completely different vaccination schedules shouldn’t be as a result of they think about the vaccines to not be protected or that the vaccines do not work,” Moss says. And I feel it is crucial that individuals perceive that.”

Scaling again America’s vaccine schedule to mannequin Denmark’s on this very completely different context places America’s kids at actual threat, O’Leary says. “It is like, what illnesses do they need to carry again to the U.S.? Which illnesses do they need youngsters to be hospitalized for that they are not shielded from? I merely do not get it.”

Which nation is the outlier?

In his presidential memo, Trump known as the U.S. “a excessive outlier within the variety of vaccinations beneficial for all kids” in comparison with peer international locations.

However whenever you have a look at the 30 international locations which might be a part of the European Middle for Illness Prevention and Management, the U.S. could be very a lot according to them, says Michaud of KFF.

“In actual fact, it’s Denmark that appears to be the outlier right here by way of recommending only a few vaccines,” he says. “Within the case of Germany, France and Italy, we could be speaking about 15 or extra vaccines.”

Even in comparison with different Nordic international locations with comparable well being methods, Denmark is “unusually minimalist,” says Scott of Stanford. “Sweden, Norway, Finland – all of them cowl extra illnesses.”

It is unclear what Kennedy may do subsequent. The Well being and Human Companies Division notified the press final Thursday that it was going to make “an announcement relating to kids’s well being” with the CDC the subsequent day. However HHS canceled the press convention hours later. Media reviews counsel the administration had deliberate to announce an overhaul of the childhood vaccination schedule. HHS spokesperson Andrew Nixon declined to debate the matter.

In an e-mail to media, the HHS stated the announcement had been postponed till after the primary of the brand new 12 months.

Specialists say it is legally murky whether or not the well being secretary might overhaul vaccine coverage by merely asserting it in a press convention, with out going via the standard course of for deliberating such modifications.

Kennedy technically has broad authority in setting vaccine coverage, says Dorit Reiss, a legislation professor on the College of California, San Francisco whose analysis focuses on authorized and coverage points associated to vaccines. However merely asserting such a significant change by way of press convention — slightly than going via the CDC’s Advisory Committee on Immunization Practices — might open up the Trump administration to authorized challenges, she says.

“The method makes them very weak to authorized challenges,” Reiss says.