Tracy Beth Hoeg, a top Food and Drug Administration official, has presented Denmark as a model for administering fewer childhood vaccines in the US. Photo / The Washington Post
The Trump administration plans to shift the federal Government away from directly recommending most vaccines for children and suggest they receive fewer shots to more closely align with Denmark’s immunisation model, according to two people familiar with the matter.
Federal health officials are weighing vaccine guidance that would encourage parents to talk to a doctor to make decisions for most shots, according to the people who spoke on the condition of anonymity to describe internal deliberations. This approach would mark a fundamental shift in the healthcare system that generally relies on federal health agencies to guide how patients are protected against disease.
It was not immediately clear which shots would no longer be recommended. The plans are still in flux, the people said, but broadly align with US President Donald Trump’s directive this month to consider recommending fewer shots, referring to the United States as an “outlier” among developed countries. He said any changes to the country’s vaccine schedule should continue to preserve access to currently available shots.
Health Secretary Robert F. Kennedy jnr has been critical of the childhood vaccine schedule for years and has called for additional scrutiny, even though he told senators during his confirmation hearings that he supports the schedule.
Andrew Nixon, a spokesman for the Department of Health and Human Services, said of the planned revisions to vaccine recommendations: “Unless you hear it from HHS directly, this is pure speculation.” The potential shift to more closely align with Denmark’s schedule was first reported by CNN.
The current US schedule calls for vaccinations to protect against 18 infectious diseases, including Covid-19, according to a Food and Drug Administration presentation in December, compared with calls for vaccinations to protect against 10 infectious diseases in Denmark. Denmark does not recommend vaccinating children for influenza, respiratory syncytial virus (RSV) and chickenpox, among other common pathogens.
Public health experts say comparisons to Denmark are misleading, noting the countries differ sharply in population, health systems and disease burden. They argue what works in Denmark’s small, universal healthcare system does not easily translate to the larger and more diverse US population with uneven access to quality care.
“You don’t just superimpose policies from other countries without context on to the United States,” said Demetre Daskalakis, who oversaw the Centres for Disease Control and Prevention’s centre for respiratory diseases and immunisation before he resigned from the agency in August. “This is not gold standard science.”
Unlike Denmark, the US is planning a more limited approach for recommending vaccines to children known as shared clinical decision-making, which has not been reported. This means people should consult a doctor, pharmacist or other medical professional before getting a shot, and insurers would still be required to pay for them. It’s not clear how broad the shift would be and when it would happen.
This type of recommendation is usually made when there is uncertainty about the benefits and risks, said David Higgins, an assistant professor of paediatrics at the University of Colorado Anschutz Medical Campus. By applying it broadly to many vaccines that are now routinely recommended, it creates the false impression that experts are divided on the best way to protect health, he said.
“I have never been more concerned about the future of vaccines and children’s health than I am now,” Higgins said.
In practice, vaccination is often already done in consultation with doctors, who explain the risks and benefits to patients. But critics of the shared clinical decision-making approach say it takes the Government out of the business of providing powerful endorsements and can confuse doctors.
A 2016 survey found most paediatricians and family doctors did not know private insurers are required to cover vaccines recommended under this model.
Under Kennedy, the CDC has already shifted recommendations for some vaccines under this talk-to-a-doctor approach, including for Covid and the hepatitis B vaccine for children. In the case of adults seeking Covid vaccines, the shift has had little practical impact at major pharmacy chains such as CVS where the shots are still routinely administered without prescriptions.
Kennedy, the founder of a prominent anti-vaccine group, has previously decried the “exploding vaccine schedule” and blamed it for the rise of chronic disease, autism and food allergies in the United States. Medical experts have said more vaccines are available now to combat more diseases, arguing the link has no basis in evidence.
In a Truth Social post this month, Trump wrote that “many parents and scientists have been questioning the efficacy of this ‘schedule,’ as have I!”
The plan to redo the current US schedule “kicked into high gear” immediately after Trump’s directive, one person familiar with the plan said. Two experts who were consulted – Martin Kulldorff, recently named a chief science officer at HHS, and Tracy Beth Hoeg, a top official at the Food and Drug Administration – have expressed concern about the number of vaccinations in the US schedule.
Hoeg gave a presentation two weeks ago comparing the US to Denmark during a meeting of the CDC’s federal vaccine advisory committee. One of her slides, titled “Danish Vaccination Schedule Benefits”, said the country makes more time for overall health at doctors’ appointments and decreases the “medicalisation of childhood”.
The Denmark schedule does not include seasonal respiratory vaccines, such as RSV, the leading cause of infant hospitalisations in the US, or influenza for children. During last year’s flu season, the CDC reported 280 pediatric influenza-associated deaths, the highest number since the 2009-2010 swine H1N1 swine flu pandemic.
Denmark also does not recommend vaccinating against hepatitis B for all infants, as well as hepatitis A and rotavirus for any infants and children.
Higgins, the Colorado paediatrician, said many clinics and paediatricians will simply say they don’t recommend the Denmark schedule, which will worsen parental confusion. School vaccination requirements are set by state laws, and most require some of the vaccines that aren’t on the Denmark schedule, Higgins said.
Denmark has universal prenatal care and strong social services. Virtually every pregnant woman in Denmark receives consistent medical attention and testing for serious diseases that can be passed to their babies throughout their pregnancy, including hepatitis B, Tom Frieden, a former CDC director, recently wrote.
About one in four pregnant patients in the US deliver babies without adequate prenatal care, according to a report by the March of Dimes.
“We do not believe in the one-size-fits-all approach nor the approach of choose one random alternate national schedule and adopt it,” said James Campbell, vice-chairman of the American Academy of Pediatrics’ infectious diseases committee.
Del Bigtree, Kennedy’s former communications director during his presidential run and the leader of an anti-vaccine group, said he’d support shifting to a Denmark model for vaccination, adding the “medical freedom” movement has always touted that country.
“Our belief is there are just too many vaccines,” Bigtree said. “It’s very exciting but it still won’t solve my major issue that vaccines aren’t mandated.”
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