‘Astounding’ vaccine change puts US behind peer countries, experts warn | US news

Experts say the Trump administration’s bombshell announcement that it no longer recommends a full third of childhood vaccines means the United States has gone from leading the world in vaccinations to falling behind other high-income countries in preventing disease.

The move is the latest and most significant move against vaccines by Robert F. Kennedy Jr., a longtime vaccine skeptic and current secretary of the U.S. Department of Health and Human Services (HHS).

“This is the biggest change in our vaccination program in modern American history,” said Jake Scott, an infectious diseases expert and clinical associate professor at Stanford University School of Medicine.

Daniel Jernigan, former director of the National Center for Emerging Zoonotic Infectious Diseases, said it was a “staggering” decision made without scientific evidence or public input that would worsen vaccine access and increase disease outbreaks.

Jernigan said U.S. health officials led by Kennedy “want fewer vaccines,” adding that they are increasing risks and “sowing confusion” for parents and providers while ignoring the benefits of vaccines.

Some vaccines are now only available to “high-risk” groups, including vaccines to prevent hepatitis A, RSV (respiratory syncytial virus), hepatitis B and two types of meningitis. Dengue vaccine will continue to be recommended only in high-risk areas. Other vaccines, including influenza, rotavirus, meningococcal disease, hepatitis A, and hepatitis B, are offered only under shared clinical decision-making; This is a practice that was previously rare and usually requires a doctor’s advice. annoyed like this in November. The CDC will also recommend one dose of the HPV (human papillomavirus) vaccine instead of two.

Health officials said in a press release that this would bring the United States closer to “equal, developed countries” as directed by Donald Trump in December. But most other high-income countries have vaccination programs similar to America’s now-discarded recommendations.

The United Kingdom, Canada, Australia, Japan and most European countries have universal recommendations for childhood influenza, rotavirus and hepatitis B. All except Japan routinely recommend vaccination against meningococcal disease for children. While Canada, Japan and most European countries recommend RSV vaccination for all newborns, Australia recommends RSV vaccination for all pregnant women. The UK only recommends this for people at high risk. The United Kingdom, Canada, Australia, Japan and European countries recommend hepatitis A vaccines for high-risk populations.

Many of these countries routinely recommend vaccines that the United States does not.

Japan added the rotavirus vaccine in 2020, and the United Kingdom moved to recommend the chickenpox vaccine to everyone. Such decisions are frequently made because of the evidence the United States has collected about the safety and effectiveness of these vaccines. Jernigan said U.S. policies are “recognized as leadership in the field of public health policy.”

Many of these countries are “moving toward greater protection” offered by vaccines, Scott said. “Many countries have been expanding their vaccination programs, and many have turned to the United States over the years.”

The new US program is now closer to that of Denmark, a much smaller country with universal health care. “Denmark is an outlier” when it comes to vaccine recommendations, Scott said. They “have the most minimalist childhood vaccination program” among other high-income countries.

The United States itself is an outlier when it comes to healthcare and social safety nets, Scott said. The United States is the only high-income country without universal health care and paid family leave.

“We need to follow what our peer countries are doing and have universal health care,” Jernigan said.

Most importantly, the United States has a population of 330 million (Denmark’s 6 million) and a highly fragmented healthcare system that covers a huge geography and a very diverse population. There are deep health disparities in America; almost third A large portion of the population does not have access to primary healthcare. Lack of access to healthcare or paid sick leave means diseases spread further before Americans receive treatment.

Rural areas where access to health care is very limited, as well as dense urban centers and a lot of travel across state and international borders, mean “the disease progresses differently” in the U.S., Scott said. Jernigan said that going from a small town to a big city (for example, going to a large university where tens of thousands of students live together) can expose young people to new threats of diseases such as meningitis: “It’s like traveling from your home country to a new country.”

In other countries with more comprehensive health systems, it may be easier to access vaccines that are recommended only for high-risk groups rather than all children. For example, children of pregnant women with hepatitis B are at risk of becoming very ill; But they are the group least likely to have access to hepatitis B vaccines in the U.S. because they often cannot go to doctors for testing or follow-up care.

HHS spokesman Andrew Nixon noted declining confidence in public health but did not provide evidence of how changing the vaccination schedule would affect public confidence.

Even other countries with universal healthcare are recommending similar vaccines, as the United States once did.

“I’ve never seen anything like what other countries are doing. [given] It carries the same weight as scientific evidence,” Jernigan said, comparing this to recommending that all drivers in the U.S. move to the left side of the road because other countries do so.

Scott said the recommendations “are not really about aligning with peer countries, they’re about finding a justification for this predetermined conclusion that they want to eliminate vaccines.”

Jernigan said officials also overturned established scientific process in making the decision, with no public comment, no discussion from the Advisory Committee on Immunization Practices (ACIP) and no feedback from outside scientists or professional groups such as the American Academy of Pediatrics (AAP).

“We have a comprehensive health policy with no public participation,” he said, noting that a process for making transparent decisions about vaccines was established long ago, but “this administration refuses to use that process.”

Scott echoed this concern, calling it “very concerning” and “very concerning” that these “amendments have not been voted on,” “have not been discussed publicly,” and “have not been subjected to the evidence-to-recommendation framework that ACIP uses.”

Instead, the administration issued a statement. 33 page report From Tracy Beth Høeg, a frequent vaccine skeptic who is now the top drug regulator at the U.S. Food and Drug Administration (FDA), and biostatistician Martin Kulldorff, who was briefly an advisor to ACIP appointed To HHS.

“It lists two authors, which is very strange; two authors are listed on a comprehensive document that led to significant policy change,” Jernigan said. “You end up with something that is truly an opinion piece.”

There was no transparency in the announcement. A small group of journalists was selected by HHS to hear about the changes on Monday; The Guardian was not invited.

Jernigan noted that even the president’s order to reexamine the program was unusual: “I’m trying to imagine a president saying, ‘Atvorstatin for lowering cholesterol, I think that should be changed.'”

Authorities are constantly monitoring the vaccines for potential safety signals, and no new evidence of potential harm has been made public.

“The science hasn’t changed. The only thing that has changed is who is making the decisions and what conclusions they want to achieve,” Scott said.

Jernigan said such unscientific changes would cause tremendous harm, adding: “We can’t let this be the new normal of what the government does, because the government is basically saying, ‘from now on, stop listening to me.’ It’s really unfortunate.”

He hopes patients will continue to seek vaccines and providers will continue to recommend them: “You don’t want to be the parent of a child like that.” [goes] They attend a university where they experience an outbreak of meningitis and end up losing a limb or dying.