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This week, the Centers for Disease Control and Prevention announced sweeping changes to the childhood vaccine schedule, removing broad recommendations for immunization against such diseases as flu, hepatitis A, rotavirus, and meningitis. Until recently, the U.S. vaccine schedule called for routine protection against 17 diseases; the changes lower that number to 11 diseases. There’s no new science that would support such a colossal change, and the American Academy of Pediatrics and public health experts alike continue to recommend the evidence-backed former schedule. The unusually unilateral declaration comes a month after President Donald Trump issued a memorandum directing the CDC and the Secretary of Health and Human Services—aka longtime anti-vaccine activist RFK Jr.—to “align U.S. core childhood vaccine recommendations with best practices from peer, developed countries.”
These “peer, developed countries” mentioned are Denmark, which recommends vaccinations for 10 diseases; Japan, which recommends 14; and Germany, which recommends 15. Fifteen! Fifteen is a lot more than America’s new number, 11, is it not? In the days since the new schedule announcement, vaccine experts have repeatedly pointed out that Denmark is actually the outlier from the “peer” countries for having such a parsimonious schedule. And there’s a key difference between us and Denmark: Denmark has free universal health care. If their health care system was a road, it would be smooth, and they’re able to drive the Porsche that is fewer vaccinations, epidemiologist Katelyn Jetelina writes in her Substack. It would be silly—and dangerous—to attempt to drive that same Porsche through the hazardous terrain that is the U.S. health care system. But that is essentially what we’re doing, she says, by adopting a vaccine schedule akin to Denmark’s.
Because while Denmark has reliable prenatal care, consistent follow-up, and a national health registry that essentially tracks everyone from birth to death, the U.S. … well, the U.S. has literally none of those things. What we do have are the highest maternal mortality rate and infant mortality rate among our “peer” countries. What’s more, we’re one of the only countries in the entire world that does not mandate any paid parental leave, alongside Papua New Guinea, the Marshall Islands, Tonga, and just a few others. Denmark, on the other hand, offers 24 weeks for the mother and 24 weeks for the father, plus a little more for the mother prior to the birth—nearly a year in total. That means that babies are able to stay home longer with their parents, avoiding exposure to diseases that they’re not yet vaccinated for, and that also present a higher mortality risk to infants than to even slightly older children. Americans don’t have the same opportunity. Most licensed child care centers accept babies as young as 6 weeks old, a choice that many parents are forced to make because they need to return to work (if they can afford the child care, which is a whole other discussion).
Day cares are germy places. “Anytime you have a gathering of kids in close quarters, you risk sharing germs,” says Elizabeth Murray, a pediatrician in Rochester, New York. And young children, who are still developing immunity to common germs and also like to stick their fingers in their mouth and eyes, share a lot of germs. Research shows that in their first three years of life, kids in day cares get sick more often with stomach bugs, ear infections, and upper respiratory infections than kids who are cared for at home (again, an option which, in the States, with our lean parental leave, can be very expensive for parents). The more kids there are in the child care setup, the higher the rate of illnesses. Take some vaccines away from that equation—more illnesses still.
While states can still require that kids receive certain vaccines for day care even if they’ve been dropped from the recommended CDC vaccine schedule, it stands to reason that the new recommendations may influence some states to reduce their requirements too. So far, several states including New York, Maryland, and Oregon have released statements that they’re rejecting the new CDC recommendations for school and day care entry requirements. It’s not yet clear what red states will do, though “we’re likely to see states going in very different directions with their own vaccine recommendations, largely along partisan lines,” says Jason Schwartz, an associate professor of public health at Yale University. A long piece in the Tallahassee Democrat titled “What Florida Parents Should Know About New CDC Vaccination Guidelines” ultimately offers little to go by: “We have reached out to the Florida Department of Health to see what its plans are,” the reporter notes.
Regardless, the wild swings in guidance will inevitably cause confusion, notes Schwartz. And “the more we encounter confusion around vaccines,” he says, “the more likely it is that more kids will not receive vaccines that they otherwise could or should.”
What’s certain is that more kids—and families—will suffer in various ways. Even outcomes that fall short of the very worst outcome can still be horrible. Murray points out rotavirus, which lost its general recommendation status with the new schedule. While it’s not a major cause of death, the virus comes with high costs: extremely brutal symptoms of diarrhea and vomiting for children, days of hospitalization, and the high medical bills that come with that. Not to mention the missed days of work—you can’t send your kid to child care when they are sick. “Boy, I definitely remember when we would admit a whole lot of children to the hospital with rotavirus,” says Murray. The vaccine, which was developed in 2006, “wiped it out. I haven’t seen rotavirus in well over a decade.” If rotavirus vaccination rates go down, that’s likely to change. Then there could soon be yet another bug to worry about when parents have to send their infants to day care so that they can head back to work.
