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

[ad_1] <img src="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/1024x664+0+0/resize/1100/quality/50/format/jpeg/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2F08%2Fc2%2F61f671234403a7a3298794348bb4%2Fgettyimages-2571727.jpg" data-template="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/1024x664+0+0/resize/{width}/quality/{quality}/format/{format}/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2F08%2Fc2%2F61f671234403a7a3298794348bb4%2Fgettyimages-2571727.jpg" class="img" alt="Guards march in the courtyard of Fredensborg Palace in Denmark. The northern European country of around 6 million people has been suggested as a model for U.S. childhood vaccination policy." fetchpriority="high"/> Guards march within the courtyard of Fredensborg Palace in Denmark. The northern European nation of round 6 million individuals has been steered as a mannequin for U.S. childhood vaccination coverage. Scott Barbour/Getty Pictures Europe/Getty Pictures cover caption

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Scott Barbour/Getty Pictures Europe/Getty Pictures 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 finest practices on childhood vaccine suggestions from peer nations, and it particularly talked about Denmark. That would imply fewer photographs in opposition to fewer ailments.

However critics say you'll be able to'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 stop 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 ailments. Within the U.S., the immunization schedule requires routine common vaccination in opposition to 16 ailments. It was 17 ailments 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 Ailments 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 ailments on the College of Colorado Faculty of Medication.

Totally different populations, completely different well being methods For starters, Denmark's inhabitants is about 6 million individuals – roughly that of Wisconsin – in comparison with greater than 343 million individuals within the U.S. Denmark additionally lacks the racial and ethnic variety and broad revenue disparities which can be prevalent within the U.S. Denmark additionally has a extremely unified well being system, with a nationwide well being registry that principally tracks everybody from beginning to dying, Michaud says.

"And so if there are outbreaks or if there are circumstances of those ailments, they will simply establish them," Michaud says. "They'll deal with them, get them into care, and in addition monitor down contacts, if that is wanted for the actual illness we're speaking about."

What's extra, Danish households get a few yr of paid parental go away — between the 2 mother and father — to allow them to keep residence with their infants, who probably aren't uncovered to as many ailments. 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 soak 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 battle to entry well being care, says Dr. Jake Scott, an infectious illness specialist at Stanford College Faculty of Medication.

"We've got fragmented insurance coverage, we have got thousands and thousands uninsured, we do not have a nationwide well being registry and we have got monumental gaps within the continuity of care," Scott says. "And we use broader vaccine suggestions as a result of our system cannot reliably establish and comply with up with each individual in danger."

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

"What ailments do they need to carry again?" All of those advanced variations have led the U.S. to create a unique immunization schedule than Denmark's – one which places a better emphasis on illness prevention reasonably than administration, says Dr. William Moss, an epidemiology professor on the Johns Hopkins Bloomberg Faculty of Public Well being and director of the varsity's Worldwide Vaccine Entry Heart.

"The rationale why international locations, notably in Europe, have completely different vaccination schedules will not be as a result of they take into account the vaccines to not be secure or that the vaccines do not work," Moss says. And I believe it is essential 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 ailments do they need to carry again to the U.S.? Which ailments 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 referred to as the U.S. "a excessive outlier within the variety of vaccinations advisable for all kids" in comparison with peer international locations.

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

"In reality, it's Denmark that appears to be the outlier right here when it comes to 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 ailments."

It is unclear what Kennedy would possibly 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 stories 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 mentioned the announcement had been postponed till after the primary of the brand new yr.

Consultants 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 by way of the standard course of for deliberating such adjustments.

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