Experts question Denmark’s vaccination program as a model for the USA

The United States, a country of 343 million people with a complex and overburdened health care system, is poised to adopt the childhood vaccination recommendations that apply in Denmark, a country of six million people with universal health care. The decision has alarmed health experts in both countries.

Robert F. Kennedy Jr., the U.S. secretary of health and human services, is expected to announce the move in the new year. It would reduce the number of required vaccinations for American children from 17 to 10 and radically change recommended vaccinations, without the consultation process that the United States has relied on for decades.

Instead, Mr. Kennedy is following a presidential directive issued by President Trump on December 5 that said the United States is an “outlier” in the number of vaccinations children receive, pointing to Denmark, Germany and Japan as comparator countries that recommend less.

But public health experts have questioned the comparison with Denmark and the assumptions underlying the expected U.S. move.

“We’re using information from a country the size of one of our states to dictate what should happen to children. And that’s just wrong,” Dr. Kathryn Edwards, Professor Emeritus of Pediatrics at Vanderbilt University Medical Center and well-known vaccine expert.

“The Danish approach to vaccination is relevant for the Danish population,” said Dr. Edwards, who served on the committee recommending vaccines for Americans in the 1990s. “The US approach is appropriate for the USA”

Why does the US say it chose Denmark as a role model?

Reducing childhood vaccinations is a long-standing goal of Mr. Kennedy, who has a deep skepticism about vaccinations.

In a memo in early December, Mr. Trump directed Mr. Kennedy to align U.S. vaccination recommendations with “best practices from peer developed countries.”

Vaccine experts say this is already the case. “We are already in line with our peer nations,” the University of Minnesota’s Vaccine Integrity Project said in a statement. The United States is at the top end of vaccination recommendations, but its schedule follows closely that of Canada, Great Britain, Australia and Germany.

The presidential memorandum on vaccinations for children states that Denmark “recommends vaccinations only for ten diseases with serious risks of morbidity or mortality.”

This makes Denmark a rarity. Data from the Vaccine Integrity Project shows that Denmark recommends fewer vaccinations than many of its European competitors, including other Nordic countries, according to country comparisons in the European Vaccine Information Portal.

Kristian G. Andersen, a Danish-American professor in the department of immunology and microbiology at the Scripps Research Institute in California, said the United States already has one of the best standards for vaccination recommendations.

“Their childhood vaccination program covers almost everything it should,” Dr. Andersen.

“The Danish program does not do that,” he added, pointing out that the Nordic country “has one of the most minimal vaccination programs among wealthy nations.”

“Denmark is the outlier,” said Dr. Andersen. “Not the United States.”

Why does Denmark need fewer vaccinations?

Some of the differences in vaccination schedules, Dr. Andersen, are due to how different countries weigh the costs of care.

“They are economic decisions,” he said. “Authorities look at how many children get sick, how many are hospitalized, how many die, and then calculate the cost of vaccination versus the cost of illness.”

One factor is different cost analyses. Another reason is the difference in the “burden of disease” between countries, i.e. the overall impact of a health problem. Both are strongly influenced by their approaches to healthcare.

Denmark has universal healthcare; This means that Danes can be treated for illnesses more easily and often seek medical help sooner. Most doctor’s visits are not paid for by people.

In the United States, approximately 8 percent of the population is uninsured. Even with health insurance, some American families must decide whether a child is sick enough to justify the potential cost of a doctor’s visit.

“The United States is not the same as Denmark,” wrote Dr. Jennifer B. Nuzzo, the director of the pandemic center at the Brown University School of Public Health, in an email. “In the United States, there is no guaranteed free health care that ensures that every pregnant woman and baby receives regular and appropriate medical care.”

Danish parents have no financial reason to wait to see whether their child is sick enough to warrant a doctor’s visit, experts say. This means children can be screened earlier, which could protect them from dangerous complications.

“The risk of serious consequences from infection is much higher in the United States than in Denmark,” said Dr. Lone Graff Stensballe, professor of pediatric vaccinology at the University of Copenhagen. “That’s why Americans, on average, would need more vaccines,” she said.

“If not everyone has free access to hospitals, vaccinations are even more important,” said Dr. Stensballe, who is also an expert in pediatric infectious diseases at the Danish National University Hospital. “It would be a huge risk and a potential waste of life not to get vaccinated when you don’t have free access to healthcare.”

Why do different countries require vaccines for different diseases?

It is not uncommon for different countries to require vaccinations for different diseases.

Think of Japan. The vaccination plan includes vaccination against the Japanese encephalitis virus, which can cause serious illness and is transmitted by mosquitoes in parts of Asia and the Western Pacific.

Many people infected with the virus have no symptoms, but some develop encephalitis, a dangerous inflammation of the brain. According to the Centers for Disease Control and Prevention, up to 30 percent of people who get encephalitis die. Most cases occur in children, the World Health Organization said.

But the virus does not pose a significant threat in the United States, so the CDC recommends vaccination against Japanese encephalitis only for some travelers to the region.

Denmark’s approach to vaccines against hepatitis B, a serious liver infection, differs from that of many other countries, including the United States.

The disease can spread through unprotected sex, sharing needles, and other types of exchanges of blood and fluids. Pregnant women with hepatitis B can also pass it on to their children during childbirth.

Until recently, the United States required all newborns to be vaccinated against hepatitis B at birth. Vaccination is still required for babies whose mothers are known to be infected or whose status is unknown.

Denmark recommends vaccination only for newborns of infected women. But almost all pregnant women in Denmark are screened for the disease, compared with about 80 percent of pregnant Americans, Dr. Edwards.

Apoorva Mandavilli contributed reporting.