U.S. Childhood Vaccination Schedule Reduction: A Closer Look
The U.S. childhood vaccination schedule has seen a significant reduction, with federal health officials claiming that the previous guideline recommended far more vaccines than what is typical in peer countries.
But, is that really the case? Has cutting down the recommended vaccines from 18 to 11 actually aligned the U.S. with other wealthy nations?
Two words: no and no.
An analysis indicates that although the former U.S. schedule aimed to protect against more diseases, it was only a few more than what many countries in Europe, the Middle East, Asia, and Australasia recommend. The data, gathered from a World Health Organization database, shows that guidelines from various nations present different counts.
For instance, South Korea and Brazil recommend vaccinations against 18 diseases each, while Greece suggests 17. In this analysis, the inclusion of the RSV vaccine for all infants also contributes to the overall count of recommended vaccinations.
Interestingly, the new U.S. schedule now addresses fewer diseases than all but one of the 20 peer countries used to justify the changes. The only exception is Denmark, which currently recommends vaccines for just 10 diseases. However, Denmark is considering adding the chickenpox vaccine, pending evaluation by their health authorities.
The revised U.S. schedule also suggests fewer vaccines than various other nations, including Israel, Turkey, and even Guinea-Bissau, which offers vaccines for 12 diseases. The announcement regarding this change was made recently.
The analysis presented by Høeg from the FDA and Kulldorff from HHS concludes that the U.S. is out of step with other nations regarding the number of diseases included in its vaccination schedule.
However, many vaccine experts push back against this perspective. They argue that the notion the U.S. gives more vaccines is misleading. For example, Durbin from Johns Hopkins believes the U.S. is actually in line with what other countries do.
The analysis reviewed vaccine schedules across 38 countries, which collectively recommended vaccinations for an average of 14 diseases. The only nation with as few recommended vaccinations as Denmark was Vietnam, which is expanding its own schedule to include four more vaccines.
Moss, from the Johns Hopkins School of Public Health, emphasizes that developing an immunization schedule is complex. It involves various considerations, such as the disease burden and the unique healthcare system in place. He notes that just because Denmark doesn’t include a particular vaccine doesn’t imply it’s harmful—it’s about tailored decisions for each country.
Hviid, a leading epidemiologist in Denmark, concurs, explaining that public health strategies should align with the local population’s context, healthcare systems, and disease prevalence.
The U.S. schedule now targets 11 diseases, including measles, mumps, and rubella, as well as chickenpox. However, the most recent updates have eliminated recommendations for several vaccines, like RSV and hepatitis vaccines.
The vaccines that have been excluded will still be available for children deemed at risk, but the universal recommendation has changed. This presents a shift towards shared decision-making between parents and healthcare providers.
Comparing vaccination schedules among countries poses challenges due to different disease exposures and unique health contexts. For example, some regions recommend specific vaccines for diseases not common in the U.S., like Japanese encephalitis in parts of Asia.
Also, there’s variability in how vaccines are recommended based on gender or age groups. For instance, some countries advocate for only girls to receive HPV vaccines, while others include boys. The U.S. utilizes a different framework, particularly in considering RSV monoclonals that act like vaccines but aren’t classified as such.
National immunization advisory groups weigh many factors when determining which vaccines to recommend, including cost-effectiveness and the risk scale involved.
While it’s true that the approach to vaccinations in the U.S. has changed in recent years, the older systems aimed to minimize diseases significantly. As a result, illnesses that were previously widespread are now much less common, creating a sense of safety among many families.
The challenge lies in the perception that because these diseases are now rare, there is less urgency for vaccination. Yet, experts emphasize that this trend can reverse quickly if vaccinations decrease. There’s no doubt about that.
