On January 5, the Centers for Disease Control and Prevention (CDC) released a revised, reduced childhood immunization schedule. The number of vaccinations recommended for children was reduced from 17 to 11. These changes were far from routine, and six leading medical groups announced plans to ask courts to throw out the recommendations. Among the groups are the American Public Health Association and the American Academy of Pediatrics.
The recommendations will no doubt complicate the vaccination picture for parents, as many states currently have vaccine regulations that differ from the new CDC schedule. SFS Professor Emily Mendenhall, director of the Science, Technology and International Affairs program and author of the recently released Invisible Illness: A History, from Hysteria to Long Covid, agreed to answer a few questions about the new schedule.
Q. What are the most significant changes in the new CDC childhood vaccine schedule, and what motivated those updates?
A. The updates are mostly ideological and performative. Public health is about collective efforts to protect vulnerable populations. If we rooted these decisions in public health, vaccination coverage would expand, in part to protect children from having to scramble to access healthcare in a system that is, for so many, unaffordable. One contention is how many vaccines a child gets at once; some families engage a more relaxed schedule that means children get fewer vaccines at once. However, removing the six vaccines from the current schedule will only make accessing these vaccines harder to get, because they may not all be covered by insurance and may be harder to get (even though many schools and daycares will require the vaccines for entrance).
Q. How does the CDC typically evaluate safety and effectiveness when deciding to add, remove or adjust vaccines on the childhood schedule? Was the process different for this updated schedule?
A. The CDC is not acting as it normally does. One indication of the lack of normalcy is the fact that the American Academy of Pediatrics has very publicly broken from the CDC vaccine schedule. Still, there are currently regulations about attending public school and having certain vaccinations, which will ensure many families have their children vaccinated in time for school.
Q. This schedule closely mirrors that of Denmark, a country generally believed to have an excellent health care system. Are there reasons why a vaccine schedule might work well for Denmark and not work well for the U.S.?
A. The administration says they are basing the new limited vaccine recommendations on the schedule used in Denmark, which is both a small country and a country that has a free and widely accessible health system. In the United States, our most vulnerable children (particularly those who cannot vaccinate due to disability or illness) will be more at risk for infection for the vaccines removed from the list with lower vaccination rates. At the same time, our healthcare system is fragmented and hard to access, particularly for children who suffer from poverty or illness, causing more risk for those children who do get sick from these infections removed from the vaccine schedule. In Denmark, children would be able to get reliable care when they are sick to nurse them through the illness. That’s not necessarily the case for all children in the United States.
Q. Although this recommended schedule comes from the federal health authorities, in general, who determines which vaccines are required for children and on what schedule?
A. Vaccination schedules are often negotiated between federal regulation and state-level mandates. The 11 vaccines recommended include DTaP (diphtheria, tetanus, pertussis), MMR (measles, mumps, rubella), HPV, varicella, Hib, pneumococcal and polio. These will stay the same. The six vaccines removed from the CDC recommendations include rotavirus, COVID-19, influenza, meningococcal, Hepatitis A and Hepatitis B. The AAP recommends that children receive all of these vaccines, which will play an important role in clinical discussions between parents and their physicians. However, the big question involves what insurers will cover now that the CDC guidance has changed.
Q. Is the CDC supposed to weigh individual choice against public good in making their recommendations? If so, how, and if not, why not?
A. Public health focuses on population health as opposed to individual health. Generally, those individuals who might be at risk from multiple vaccines, such as a child with a compromised immune system, are able to negotiate the vaccination schedule as parents and physicians decide how to keep the child healthy together. The idea of individual choice for generally healthy children is antithetical to public health because the idea is that we vaccinate to protect those most vulnerable among us.
Q. In your opinion as a public health scholar, are these new recommendations likely to cause vaccination rates for any specific virus to fall below recommended levels? Are there recent examples, either domestic or global, that illustrate the consequences of falling vaccination rates?
A. Public health is in a precarious position right now, in part because COVID-19 was so often used as a political weapon, from masking and quarantine to vaccines. It will take a long time to rebuild trust in public health and medicine. However, there are clear recommendations for schools and daycares that are set to keep children healthy and reduce sickness. Because these mandates will most likely stay in place in most states, I don’t think vaccination rates will be changed broadly—unless state-based mandates are dropped. However, I’m mostly concerned about how dropping the CDC recommendations will be a loophole for insurers to drop these vaccines from their plans, causing more financial burdens for parents to get these vaccines. In this way, thinking about these vaccines as “choice” puts more financial burden on working families who benefit from these population-based decisions in the first place.