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December 14, 2025
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Add Us On GoogleAdd SciAmThe U.S.’s and Denmark’s nicely being programs are starkly assorted, so it makes sense that their vaccination schedules would fluctuate, too
By Tanya Lewis edited by Claire Cameron & Clara Moskowitz
Now no longer the U.S.
Dado Daniela by strategy of Getty Pictures
At a controversial meeting of the U.S. Centers for Disease Protect an eye on and Prevention’s vaccine advisory panel no longer too prolonged ago, individuals voted to take away a prolonged-standing recommendation that every one babies procure a first dose of the hepatitis B vaccine at starting up. Public nicely being consultants derided the transfer, which matches towards evidence that the shot is safe and efficient. Individuals of the CDC’s Advisory Committee on Immunization Practices (ACIP) and company officers cited a habitual rationale for the trade: a necessity to align the U.S.’s vaccine agenda with Denmark’s.
Shortly after the meeting, President Donald Trump ordered the CDC to rapid-song a overview of the U.S. vaccination agenda to align with that of other “peek, developed international locations,” including Denmark. Nevertheless there’s one thing immoral on this comparison.
The U.S. and Denmark contain starkly assorted populations, illness charges and nicely being care programs. It makes sense that they contain assorted vaccination policies.
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“The United States is no longer Denmark,” says Katelyn Jetelina, an epidemiologist who writes a most in style nicely being newsletter and who previously knowledgeable the CDC on its COVID policy. “The nicely being care and security receive machine of the United States is very much assorted than other excessive-earnings international locations around the world. We are able to also merely aloof quiz country-stage policy decisions to vary.”
The U.S. has more than 340 million folk; Denmark’s inhabitants is moderately more than six million. Denmark is also a long way more demographically and economically homogenous than the U.S. And the international locations contain assorted burdens of illness.
Rob hepatitis B—there contain been ninety nine original circumstances of chronic hepatitis B in Denmark in 2023, compared with more than 17,000 original circumstances in the U.S. Denmark also shows almost each pregnant person for the illness, and most of these who take a look at lumber procure therapy. In the U.S., about 85 percent of pregnant folk are screened, and loads never procure therapy. Hepatitis B is a liver an infection, and whether it is left untreated and becomes chronic, it goes to lead to cirrhosis, liver cancer and demise.
The U.S. and Danish nicely being care programs are incomparable. With the exception of Medicare and Medicaid, the U.S. machine operates largely on privately funded insurance protection. Denmark has a universal nicely being machine that’s paid for by the authorities, and all residents contain procure true of entry to to free care. The CDC’s advisory panel made no demonstrate of this disagreement for the duration of its most up-to-date meeting, and the Trump administration has no appetite for a universal nicely being care machine in the U.S.
“Managing and following a minute inhabitants with universal nicely being care is a long way assorted than a big inhabitants with rather a lot of provide programs and rather a lot of payers,” says Kathryn Edwards, a professor of pediatrics at Vanderbilt University Scientific Center. It’s “love evaluating apples and oranges.”
Jetelina has the same opinion. In Denmark, folk are less seemingly to descend by the cracks of their nicely being machine, she says, whereas the U.S. has a “very assorted nicely being care ability, and we make no longer contain a security receive.”
A final result of universal nicely being care programs is that international locations love Denmark are also more seemingly than the U.S. to take rate-effectiveness into consideration when deciding which vaccines to suggest and to whom. Even supposing providing vaccines is continually a long way less pricey than treating a illness, it aloof costs money. For instance, in the U.Ok., which also has relate-funded universal nicely being care, flu vaccines aren’t automatically immediate for formative years due to the photos are more rate-efficient in older adults. Same good judgment might well well well merely show why the hepatitis B vaccine isn’t universally given at starting up in Denmark.
Hundreds of the discussion at the December 5 ACIP meeting centered on hypothetical dangers from the hepatitis B vaccine in babies born to other folks that take a look at unfavorable for the illness; there used to be miniature or no emphasis on the societal advantages of frequent vaccination.
When it comes to targeting vaccination greatest to folk born to other folks who’re acknowledged to contain hepatitis B, Jetelina says, “we’ve tested this prior to.” Prior to 1991, the U.S. tried to vaccinate greatest folk at excessive possibility for hepatitis B. “Even when mothers screened unfavorable for hep B and the starting up dose used to be withheld, hundreds of formative years did pause up contaminated by strategy of another member of the household,” she says. In incompatibility, after ACIP immediate a universal starting up dose in 1991, circumstances declined dramatically: in formative years, kids and younger adults up to age 19, circumstances of acute hepatitis dropped by ninety nine percent from 1990 to 2019.
The push to alter the U.S. hepatitis B vaccine recommendation matches into a broader effort by the Trump administration and loads Republican lawmakers to prioritize individual freedoms over collective action. Yet solid public nicely being programs—and vaccination in particular—rely on collective action to provide protection to these who can no longer provide protection to themselves, such as immune-suppressed folk, older adults and younger babies.
“I’m all in favour of that,” Jetelina says. “If we land too noteworthy on individualism, diseases are going to attain abet.”
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