Trump officials keep comparing the US vaccine schedule to Denmark. they’re missing the point
The US and Denmark have completely different health systems, so it makes sense that their vaccination programs would also be different
Dado Daniela via Getty Images
At a recent controversial meeting of the U.S. Centers for Disease Control and Prevention’s vaccine advisory panel, members voted to remove a long-standing recommendation that all infants receive the first dose of hepatitis B vaccine at birth. Public health experts ridiculed the move, which flies in the face of evidence that the shot is safe and effective. Members of CDC’s Advisory Committee on Immunization Practices (ACIP) and agency officials cited an odd rationale for the change: the need to align the U.S. vaccine program with Denmark’s.
Immediately after the meeting, President Donald Trump ordered the CDC Track reviews fast US vaccination program to align with other “peer, developed countries”, including Denmark. But there is something wrong with this comparison.
The US and Denmark have very different populations, disease rates, and health care systems. It makes sense that their vaccination policies are different.
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“The United States is not Denmark,” says Caitlin Jetlina, an epidemiologist who writes a popular health newsletter and who previously advised the CDC on its COVID policy. “The health care and health care system of the United States is quite different than that of other high-income countries around the world. We should expect variation in country-level policy decisions.”
There are more than 340 million people in the US; The population of Denmark is a little more than 60 lakhs. Denmark is also more demographically and economically homogeneous than the US and the countries have varying burdens of disease.
Take hepatitis B – there were 99 new cases of chronic hepatitis B in Denmark in 2023, compared with more than 17,000 new cases in the U.S. Denmark also screens practically every single pregnant person for the disease, and most of those who test positive get treatment. In the US, about 85 percent of pregnant people are tested, and many never get treatment. Hepatitis B is a liver infection, and if it is not treated and becomes chronic, it can lead to cirrhosis, liver cancer, and death.
The US and Danish health care systems are incomparable. With the exception of Medicare and Medicaid, the US system operates largely on privately funded insurance. Denmark has universal health system Which is paid for by the government, and all residents have access to free care. The CDC’s advisory panel made no mention of this gap during its recent meeting, and the Trump administration has no appetite for a universal health care system in the US.
“Managing and adhering to a small population with universal health care is very different than managing a large population with multiple delivery systems and multiple payers,” says Katherine Edwards, MD, professor of pediatrics at Vanderbilt University Medical Center. It’s “like comparing apples and oranges.”
Jetlina agrees. People in Denmark are less likely to fall victim to the flaws of their own health system, she says, whereas the US “has very different health care capacity, and we don’t have a safety net.”
One consequence of universal health care systems is that countries like Denmark are also more likely than the US to take cost-effectiveness into account when deciding which vaccines to recommend and to whom. Although providing vaccines is generally much cheaper than treating a disease, it still costs money. For example, in the UK, which also has state-funded universal health care, Flu vaccines are not routinely recommended for children Because shots are more cost-effective in older adults. Similar reasoning may explain why hepatitis B vaccination is not universally given at birth in Denmark.
Much of the discussion at the December 5 ACIP meeting focused on hypothetical risks from the hepatitis B vaccine in infants born to people who tested negative for the disease; Little emphasis was placed on the social benefits of widespread vaccination.
When it comes to targeting vaccination only at individuals born to parents who have hepatitis B, Jetlina says, “We’ve tested this before.” Before 1991, the US attempted to vaccinate only people at high risk for hepatitis B. “Even when mothers tested negative for hep B and doses were stopped at birth, thousands of babies still became infected through another household member,” she says. In contrast, after the universal birth dose was recommended by ACIP in 1991, cases declined dramatically: in children, adolescents, and young adults up to 19 years of age, cases of acute hepatitis 99 percent decline From 1990 to 2019.
The effort to change U.S. hepatitis B vaccine recommendations fits into a broader effort by the Trump administration and many Republican lawmakers to prioritize individual freedoms over collective action. Yet strong public health systems – and vaccination in particular – depend on collective action to protect those who cannot protect themselves, such as immuno-suppressed people, older adults and young children.
“I’m worried about that,” says Jetlina. “If we get too individualistic, the diseases will come back.”
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