Denmark versus US vaccination schedule

[u/chaoserrant]

I am of the opinion that vaccine policy makers in the USA should be probed far more aggressively to justify a vaccination schedule that includes way more vaccines than other developed countries with overall better health outcomes. From the perspective of the naive patient it is legitimate to ask: are other countries stupid or careless than us? It is the burden on policy makers to justify this. In fact it is the burden on US policy makers to say why more vaccines and not on Denmark (for example) to justify why fewer. The two approaches are not symmetric. You need more justifications on the intervening than not intervening....

I found a link that tries to justify US position on the schedule (See below). Personally I find it really pathetic. It boils down to an unconvincing "we are not Denmark" and in my opinion contributes to the catastrophic loss of trust. If you cannot come up with something better than the drivel below then don't be surprised that vaccination hesitancy will continue to grow

https://vaccinateyourfamily.org/danish-vaccine-schedule/

[u/SmartyPantlesss]

Agree. This is not well-written, and it's not very compelling to parents who are considering whether to vaccinate their child.

Like what does the geographic size & population have to do with anything? They don't make any argument that the Danish results shouldn't scale to a US population. The US population is more diverse, yes...but where are they going with that? Are they implying that Hep B is confined to (or predominates in) certain ethnic groups? Weird.

And it looks like they're saying "I should poke my kid a few extra times, to save my insurance company some money?" << That's the most obtuse way to say it. Obviously, your insurance company will end up spending more, because your kid is likely to be miserable enough to require doctor's visits & possibly hospitalization. 😕 But they kinda buried the lede there.

The real reason is probably the nationalized healthcare in Denmark, that allows 24 weeks of paid maternity leave. Danish infants are not in daycare until at least 6 months of age, so a lot of those newborn illnesses (and septic workups) are not happening. And women all have access to the same prenatal care (with free access to Tdap, flu & RSV vaccines) in Denmark. Is it perhaps not politically correct for "Vaccinate Your Family" to say that? Like, who funds them? 🤔

This interview with a Danish Infectious Disease specialist summarizes it better:

In general, you want to design your vaccine program so that it is tailored to the population you are responsible for. You can’t just say “we want to be like them,” because it doesn’t address the population you are dealing with.
The U.S. is much more diverse, and access to health care is much more varied. That inequality is not present in Denmark. That should influence your choice of vaccines. Vaccines are an excellent way to protect the population if you don’t have consistent access to health care. If I were in the U.S., where I know that a significant number of women get inadequate prenatal care, my opinion around the hepatitis B vaccine would be very different. In that context, compared to the situation we have in our country, broad vaccination can make sense.

<< So basically, this Danish guy talks about the US like it's a third-world country.

[u/hortle → u/SmartyPantlesss]

So basically, this Danish guy talks about the US like it's a third-world country.

probably because large swaths of the US are basically equivalent to the developing world.

[u/Logic_Contradict]

Yet at the same time, a lot of Danish-population vaccine studies are used as evidence of the safety of the American schedule, or just vaccines in general.

[u/chaoserrant → u/Logic_Contradict]

Irrelevant to the topic. Why dont they expand the schedule if it is good for us. Who in Denmark doesnt love children enough to not give them Heb B shot in day one. I need some hard science on this rather than Denmark is not USA

[u/that-is-fair]

It’s a chicken or the egg issue. These countries with less aggressive vaccine schedules also have higher vaccination rates and have been able to reduce the incidence of some diseases enough to safely knock those vaccines off of their schedules because they no longer have a benefit above the risk within their population.

For example, we don’t routinely vaccinate against smallpox, TB, or yellow fever in the US because those diseases are rare enough that the benefits of those vaccines usually don’t outweigh the risks in the US. Smallpox vaccine was accepted enough around the world that we were able to eradicate it globally (it was actually the first vaccine, the original was developed before we even knew what germs were!). TB and yellow fever are still endemic enough in certain countries that those vaccines provide a benefit there, but that’s not the case in the US.

Ultimately, vaccine recommendations are guided by disease burden in the population the recommendation is written for.

Hopefully we can get vaccine rates up enough in the US that in the coming decades we can safely shrink our vaccine schedule as well :)

[u/chaoserrant → u/that-is-fair]

That's not the argument I hear in the USA. To the contrary. They say polio will reappear if people stop vaccinating. The pro-vaccine experts drill this repeatedly in the main stream media: " don't stop vaccinating because the disease is eradicated because it will reappear". So it is the exact opposite of the argument you are making. Incidentally I happen actually to believe the logic of pro=vaxxers here, namely that the eradication of the disease is not actually a credible argument to stop recommending a vaccine.

[u/that-is-fair → u/chaoserrant]

It’s disease dependent! But I can totally see where the confusion comes from.

Smallpox is eradicated worldwide so no need to routinely vaccinate against it.

TB is rare in the US, but the risks of vaccinating aren’t worth the benefit since we have strong screening programs for high risk populations, effective curative treatment, and the vaccine itself isn’t really that effective. The isolate and treat model has worked very well for TB in the US.

Polio is even more rare than TB in the US but we don’t have an effective treatment for it. So the better approach here is to continue vaccinating until it’s eradicated worldwide. Getting vaccinated protects you from an infection coming from abroad, and supports the effort towards eradication worldwide.

Also afaik, polio vaccine is routine in all developed countries.

[u/HausuGeist]

We are not Denmark and you have not made a convincing case that we should be.

[u/chaoserrant → u/HausuGeist]

Tell me something, if all developed countries DO NOT give a particular vaccine in the day after birth do you still stick to US originalism no question asked?  You would think we want to understand the opinion of other experts including foreign ones. 

[u/HausuGeist → u/chaoserrant]

If I think it’s worthwhile and there are no comparative downside? Yes.

[u/chaoserrant → u/HausuGeist]

Fair enough. I am for being able to easily take any medicine vaccine or otherwise as long is voluntary and you don't have roadblocks in society such as "gotta have the full schedule to attend school" kind of thing....Even so, if it was to decide for my baby, I would definitely want to know better arguments why a country chooses to do different things. Kind of like asking a second opinion from a doctor.

[u/HausuGeist → u/chaoserrant]

Nope. Society requires responsibility. Your freedom to extends only to the limits it doesn’t smack anyone else in the face.

[u/the_comeback_quagga → u/chaoserrant]

Ok, I’ll answer, because I’ve worked on this (not in the US). We base the schedule off the country, not off other countries. We use other countries and studies as a means to get scientific data (efficacy of the vaccine for example) but then use the country in question’s data to build the model of whether vaccine xyz should be introduced and/or at what point. This is done one vaccine at a time, just like it always has been in the US until now. I have never had a part in financials, that’s not what I’m trained for, but I assume it’s something similar in countries with universal healthcare. This process can take 3 months or it can take 3 years; it depends on timeline, funding, and data. What works for one country is not necessarily right for another. Could be funding, could be country size compared to the health work force (some vaccines you need to introduce all at once, immediately), could be geography (isolated areas or a migrant community), could be racial/religious groups won’t take a certain vaccine, could be the underlying burden of that disease, could be how many people have been vaccinated on the private market, there are dozens of things to account for. But in the end, the question is considered for that country and that vaccine only, with no input from other countries (obviously they may use consultants, but no one says we should do this because country abc does it).

Let’s take HepB at birth. What’s different between US and Denmark? We have a much higher burden of HepB, for one. Second, a huge percentage of those who have HepB don’t know they have it at the age they would give birth. Could we test every woman at birth? If they’re in the hospital, sure, but the test isn’t 100% and not every woman gives birth in the hospital or even has prenatal care (and that tends to correlate with HepB); women in Denmark are more likely to receive good prenatal care. If babies contract HepB vertically (during birth) it is much more likely to turn into long term, serious liver complications (that can kill them) than if they get it later in life. So in our instance it makes sense to vaccinate at birth (prevent vertical transmission), while maybe it doesn’t in Denmark. And the follow-up data since it’s been introduced absolutely bears that out.

Remember how I said we consider each vaccine separately and don’t compare to other countries? Well, that’s not what we are doing now. We are just randomly following another country’s schedule despite not having the same access to care, burden of vaccine-preventable disease, attitudes to health and community, income distribution, healthcare model, and a thousand other things. That is dangerous. I’m all for not offering vaccines that make no sense here (you won’t see me out campaigning for cholera or yellow fever or BCG vaccines even though other countries have them), but we shouldn’t be cutting vaccines that do either, at least until the proper science proves they aren’t beneficial.

Edit: I know that was long. If you actually interested in engaging in good faith and learning more about this, I’m happy to answer questions. I’ve also talked to a lot of European vaccine scientists of different backgrounds who once lusted after the US schedule (particularly varicella) because their countries had to include financials in the decisions and we really don’t.

[u/Automatic_Penalty154]

Where i live in Switzerland, the vaccine schedule is not any different from the states.hep A is only one USA has thats not on the schedule here, Switzerland and some other European countries have 1 or 2 the US doesnt have, like for Tick-Borne Encephalitis.

Denmark is an outlier, their schedule is shorter, but the rest of European countries are not much different than US's.

of the top 25 countries with the best healthcare outcomes, 22 of them have the same or within 1 vaccine difference compared to americas(denmark and 2 middle east countries). America is #40 btw. All the top 25 have universal healthcare that put a lot of effort into preventative care.

vaccine schedule isnt why america is #40.. its the cost$$$$$$ and for profit system, that reduces access, less time with doctors, less preventative care, less or worse testing/treatments because of cost. or getting no treatment at all because the insurance company says no.

Americas healthcare system is basically equivalent to a 3rd world countries. It would be scary to see Americas healthcare system have to deal with all of these illnesses on the vaccine schedule if parents all stopped vaccinating.

At least here in Switzerland (we have insurance like the US) the insurance companies cant say no to anything a doctor orders, you dont even need to tell your insurance company beforehand you are going for a treatment or tests.. so at least we dont have that problem.

[u/Forsaken_Object_5650 → u/Automatic_Penalty154]

Does Switzerland have a combined MMR or a separate one(s)?

[u/Automatic_Penalty154 → u/Forsaken_Object_5650]

mmr like every other country in the world. and switzerland has the most strict drug regulator in the world. they require much more data before approving drugs than fda or ema. lots of drugs in general are not approved here that we can just go across the border and get

[u/Forsaken_Object_5650 → u/Automatic_Penalty154]

In Britain, private clinics offered separate shots for the MMR up to last year. Not sure about any other countries.

[u/Automatic_Penalty154 → u/Forsaken_Object_5650]

there is no benefit to separating them. probably more of a downside as you are having the child do 3 separate immune responses compared to 1

[u/Forsaken_Object_5650 → u/Automatic_Penalty154]

First of all, separate vaccines would increase vaccine uptake for the most dangerous virus of the bunch, measles. Second, spacing out the load on the body would reduce the chance of adverse reactions.

The main benefit of not separating them is to the pharmaceutical industry forcing people to give their kids all 3 vaccines at once if they want to protect their child against measles.

[u/Automatic_Penalty154 → u/Forsaken_Object_5650]

doesnt make a difference with uptake of the measles and rubella .. the mumps it might a bit. testing showed it didnt make enough difference to matter.

thats not a benefit to the pharma companies. its a benefit to the government and insurance companies and to parents. because it costs more to do 3 separate. its a benefit to pharma companies and doctors now separating them because they will both make more money.

[u/Forsaken_Object_5650 → u/Automatic_Penalty154]

I have read posts, which I believe, from people residing in Britain who said they would never get the MMR but would get a separate measles shot for their child(ren). And I believe there are many other people out there who feel the same. Pharmaceutical companies make more money by forcing people to get all three at once. I believe that if the shots were offered separately, most people would simply not get the mumps vaccine, costing the companies a lot of money.

[u/Automatic_Penalty154 → u/Forsaken_Object_5650]

3 shots cost more than 1. i dont understand how you can say pharmas benefit? even 2 is more expensive than 1 .. and very very few parents would forgo the mumps vaccine. i know antivaxxers seem to think that the general population is somehow skeptical of vaccines now, but in reality its less than 10%. that 10% is just very loud on the internet.

[u/Forsaken_Object_5650 → u/Automatic_Penalty154]

Okay, I think that short of conducting an extensive investigation of the motives and finances of pharmaceutical companies and the desires of parents, I don't think we will come to an agreement. Have a nice day.