Trump Officials Keep Comparing the U.S.’s Vaccine Schedule to Denmark’s. They’re Missing the Point
Trump Officials Keep Comparing the U.S.’s Vaccine Schedule to Denmark’s. They’re Missing the Point
The U.S.’s and Denmark’s health systems are starkly different, so it makes sense that their vaccination schedules would differ, too
Dado Daniela via Getty Images
At a controversial meeting of the U.S. Centers for Disease Control and Prevention’s vaccine advisory panel recently, members voted to remove a long-standing recommendation that all babies get a first dose of the hepatitis B vaccine at birth. Public health experts derided the move, which goes against evidence that the shot is safe and effective. Members of the CDC’s Advisory Committee on Immunization Practices (ACIP) and agency officials cited a curious rationale for the change: a need to align the U.S.’s vaccine schedule with Denmark’s.
Shortly after the meeting, President Donald Trump ordered the CDC to fast-track a review of the U.S. vaccination schedule to align with that of other “peer, developed countries,” including Denmark. But there’s something rotten in this comparison.
The U.S. and Denmark have starkly different populations, disease rates and health care systems. It makes sense that they have different vaccination policies.
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“The United States is not Denmark,” says Katelyn Jetelina, an epidemiologist who writes a popular health newsletter and who previously advised the CDC on its COVID policy. “The health care and safety net system of the United States is drastically different than other high-income countries around the world. We should expect country-level policy decisions to vary.”
The U.S. has more than 340 million people; Denmark’s population is a little more than six million. Denmark is also much more demographically and economically homogenous than the U.S. And the countries have different 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 receive treatment. In the U.S., about 85 percent of pregnant people are screened, and many never get treatment. Hepatitis B is a liver infection, and if it is left untreated and becomes chronic, it can lead to cirrhosis, liver cancer and death.
The U.S. and Danish health care systems are incomparable. With the exception of Medicare and Medicaid, the U.S. system operates largely on privately funded insurance. Denmark has a universal health system that is paid for by the government, and all residents have access to free care. The CDC’s advisory panel made no mention of this difference during its recent meeting, and the Trump administration has no appetite for a universal health care system in the U.S.
“Managing and following a small population with universal health care is much different than an enormous population with multiple delivery systems and multiple payers,” says Kathryn Edwards, a professor of pediatrics at Vanderbilt University Medical Center. It’s “like comparing apples and oranges.”
Jetelina concurs. In Denmark, people are less likely to fall through the cracks of their health system, she says, whereas the U.S. has a “very different health care capacity, and we don’t have a safety net.”
A consequence of universal health care systems is that countries like Denmark are also more likely than the U.S. to take cost-effectiveness into consideration when deciding which vaccines to recommend and to whom. Even though providing vaccines is generally far cheaper than treating a disease, it still costs money. For example, in the U.K., which also has state-funded universal health care, flu vaccines aren’t routinely recommended for children because the shots are more cost-effective in older adults. Similar logic may explain why the hepatitis B vaccine isn’t universally given at birth in Denmark.
A lot of the discussion at the December 5 ACIP meeting focused on hypothetical risks from the hepatitis B vaccine in babies born to people who test negative for the disease; there was very little emphasis on the societal benefits of widespread vaccination.
When it comes to targeting vaccination only to individuals born to parents who are known to have hepatitis B, Jetelina says, “we’ve tested this before.” Prior to 1991, the U.S. attempted to vaccinate only people at high risk for hepatitis B. “Even when mothers screened negative for hep B and the birth dose was withheld, thousands of children did end up infected via another member of the household,” she says. In contrast, after ACIP recommended a universal birth dose in 1991, cases declined dramatically: in children, teens and young adults up to age 19, cases of acute hepatitis dropped by 99 percent from 1990 to 2019.
The push to alter the U.S. hepatitis B vaccine recommendation 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—rely on collective action to protect those who cannot protect themselves, such as immune-suppressed people, older adults and young babies.
“I’m concerned about that,” Jetelina says. “If we land too much on individualism, diseases are going to come back.”
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