The U.S. federal government recently announced big changes to the childhood vaccine schedule. It is reducing the number of vaccines “routinely” recommended for all kids and moving several vaccines into an “optional/shared decision” category instead.
This means they’re only routinely recommending protection against 11 diseases, instead of 17. Those Nerdy Girls and many other public health folks are afraid this will lead to fewer kids having access to vaccines and more kids getting sick and even being at an increased risk of dying.
Did you know? Globally, vaccines have saved over 154 million lives over the last 50 years – let that sink in… and of those 101 million were babies. (thank you to our Friendly Neighbor Epidemiologist Emily who reminded us of this in her recent Substack!)
What does the new vaccine schedule look like?
👍The recommendations for these vaccines haven’t changed:
- DTap and Tdap (Tetanus, Diphtheria and Pertussis, aka whooping cough) – DTap is the first dose, and Tdap is the booster,
- Polio,
- Hib (H. influenzae, not to be confused with flu, is a type of bacteria),
- Pneumococcal (causes a type of pneumonia),
- MMR (measles, mumps, rubella),
- Varicella (aka chickenpox)
‼️The recommendations for these vaccines have been amended:
- HPV – still recommended, but the dose has changed from 2 to just 1
- Hepatitis B – this is now only recommended to high-risk groups and otherwise only under shared decision-making
- Hepatitis A – this is now only recommended to high-risk groups and otherwise only under shared decision-making
- Meningococcal (causes meningitis) – this is now only given to high-risk groups and otherwise available under shared decision-making
- COVID-19 – only available under shared decision-making
- Influenza – only available under shared decision-making
- Rotavirus – only available under shared decision-making
- RSV (monoclonal) – only babies considered high risk* (in this case, this means if the pregnant person is not vaccinated during pregnancy)
* shifting vaccine recommendations to risk groups can lead to missed cases, as it is not always clear who is at high risk.
What is shared decision-making?
Everyone agrees that shared clinical decision making, or SCDM for short, is a good thing in medical care. Simply put, it is when patients have a say in their care. No one disagrees with this important ethical principle. However, in the U.S. healthcare system, primary care clinicians are often forced to fit care into as short as 15 minute allotments, so the system has created a care team continuum that allows qualified members of the team (medical assistants, nurses, pharmacists, etc.) to discuss (and deliver) relevant aspects of care, working to ensure patients get what they need over the course of their care (not just in a single visit). The added “shared clinical decision-making” language in the context of these recent changes, means that the vaccines are still available, but only after a conversation between the parent/caregiver and the prescribing clinician at each visit. Requiring shared decision-making can create bottlenecks or delay access to vaccines.
What does routine mean in this context?
Routine recommendations make vaccination straightforward and efficient in our system as described above (short visits)—they’re built into electronic systems, allow clinicians (including pharmacists, nurses, medical assistants, etc) to vaccinate people directly, and they send out a signal that the evidence strongly supports vaccination.
Importantly, routine vaccination is not instead of shared decision making. Both coexist. Families always have and continue to be encouraged to ask any questions they have of any member of the care team.
⚖️ Health Equity Alert:
When the system limits access, it creates a barrier for families who have already limited access to healthcare, fewer options for primary care, or difficulty securing appointments.
In this case, families may no longer be able to discuss and receive vaccines from a wide spectrum of clinicians, like nurses or pharmacists. (We still do not know the full impact). The fear is that this will shrink the opportunity for folks to receive their vaccines if they need to discuss this with a doctor, Certified Nurse Midwife (CNM), Nurse Practitioner (NP) or Physician Assistant (PA), in other words, those who have prescribing privileges. And this might be tied to approved locations, making access even harder.
And even people with easy access to care and private insurance may have trouble accessing vaccines or feel confusion about what is best for their kid. (We have already seen the changes cause confusion in clinical settings, where pediatric patients’ families have been told they can only access a COVID-19 vaccine for their child if they sign a promise to pay for the vaccine if insurance fails to pay–and this is with private insurance coverage.)
You can read more about shared decision-making in this post from You Can Know Things – thank you for breaking it down for us!
What are the issues with the new schedule?
🤓 Science has not changed. These vaccines have protected children for decades from illnesses that can cause long-term health problems, and sometimes death. It’s important to remember that the benefits of the vaccines greatly outweigh their risks. They’re still recommended by the American Academy of Pediatrics (AAP) and other major health organizations, regardless of the US Federal government changes. You can find the AAP vaccine schedule here.
As of right now, the vaccines should still be accessible and covered for those who want them. But finding them could get harder in certain states, only time will tell.
🤔 If people can still access them, then what’s the issue? This policy may confuse folks. People may think the vaccines that are now optional are not as important, and therefore leave their kids at risk of preventable complications. It is also possible that this will make it harder for families to access vaccines in some settings (like pharmacies).
Ultimately, the worry is that this could lead to more kids getting sick with preventable diseases.
🇩🇰The schedule was likely modeled on Denmark’s, a country with a very different healthcare system and makeup of its inhabitants. Unlike the US, Denmark has universal healthcare and a much smaller population (6 million vs 340 million). And the US is over 220 times the size of Denmark (Denmark is roughly half the size of Maine!), so even rural areas have reasonable access to healthcare. Denmark has a “leaner” vaccine schedule, because it is built around its specific needs. A country like the US has other challenges that need to be taken into consideration when thinking about vaccine policy. And because there are gaps in the US healthcare system, a broader schedule provides a safety net for those who might otherwise fall through the gap (think rural areas, folks who can’t take time off, marginalized communities, those with disabilities, etc.)
Bottom line: The benefits of vaccines far outweigh their risks. Scaling back the vaccines recommended to all children in the US from 17 to 11 diseases will result in more disease and a greater risk of long-term complications or even death. Remember, you still have a right to get your kid vaccinated, even if they are not in a high risk group, and the American Academy of Pediatrics (AAP) recommends you do so.
Resources for more information:
The Evidence Collective – In Response: Routine Childhood Vaccination Schedule Announcement
American Academy of Pediatrics – CDC plan to remove universal childhood vaccine recommendations ‘dangerous and unnecessary’
American Academy of Pediatrics – Fact Checked: U.S. Vaccine Recommendations are Appropriate for Children in the United States
