The federal government's recent decision to decrease the number of recommended childhood vaccines from 17 to 11-and fall more in line with other high-income countries-is raising questions and concerns among families, health care providers, schools and state public health leaders.
University of Michigan experts in epidemiology and health policy, discuss the potential implications and other issues related to the decision.
Abram Wagner, assistant professor of epidemiology and global public health at the School of Public Health, investigates vaccination programs, including analyzing vaccine effectiveness studies and vaccine hesitancy. He also studies how infection spreads among groups of people by testing blood for immune markers.
"For generations, Republican and Democratic administrations alike have been united in supporting American scientists and physicians to make evidence-based decisions about what is best for American children," he said. "This announcement from the Department of Health and Human Services effectively outsources vaccine recommendations to other countries, despite clear differences in epidemiology, disease susceptibility, demographics, and healthcare systems.
"I would prefer that decisions about the health of American children continue to be made by American experts, using American data and within American ethical and legal frameworks."
Anand Parekh, chief health policy officer at the School of Public Health and a former deputy assistant secretary for health at the Department of Health and Human Services, says the basis for the change is not the science of childhood illness but political preferences.
"The science underlying the childhood vaccine schedule-the epidemiology of childhood infectious diseases, the safety and effectiveness of the vaccines-has not changed nor has our nation's commitment to procuring and purchasing childhood vaccines," said Parekh, a board-certified internal medicine physician. "There has been no new data, evidence or study leading to this decision. All that has elicited the change is the personal preference of current policymakers who wish to see children receiving fewer vaccines in this country.
"It is always prudent to review and update the science behind vaccine safety and effectiveness. Unfortunately, no serious research study or transparent dialogue with pediatricians or infectious disease experts was undertaken in this decision."
Parekh says it's surprising to see the change as measles outbreaks spread and the U.S. is weathering an era of record childhood flu deaths.
"It is particularly ironic that flu shots are no longer being recommended when we are in the midst of a significant flu season and the current vaccine is over 70% effective against emergency department visits and hospitalizations for children and adolescents. This also comes on the heels of a record number of children dying from the flu last year," said Parekh, who has led national efforts on public health emergency preparedness related to pandemic influenza and bioterrorism and developed and implemented national initiatives on prevention, wellness and care management.
"From an institutional perspective, I do not believe that healthcare entities-physicians, hospitals, insurance companies-will change their current practice and adopt the new schedule. I also believe that most state legislatures will refrain from adopting the new schedule and changing kindergarten entry requirements in public schools."
Amy Thompson, a clinical professor at the College of Pharmacy and director of Community Health and Engagement at Michigan Medicine, says there's flawed-and risky-logic in changing vaccine recommendations for U.S. children based on other countries' approaches.
"While the rationale of the changes is to better align the U.S. with other developed countries, promote shared decision-making and increase public trust, these changes were made with limited expert review," she said. "My concern is that this will lead to more confusion for both parents and health care providers and actually weaken confidence in routine childhood vaccination-leading to reduced vaccination rates and increased disease outbreaks. We are already seeing this outcome with the recent measles outbreaks.
"Important factors such as population size, access to health care and disease burden are all considered when vaccine recommendations are made. These recommendations are not meant to be copied and pasted from one country to another, and what works well in one country will not necessarily work well in the U.S. Additionally, we have seen the impact of a change in the vaccine schedule in the U.S. before. In 1999, the CDC changed the hepatitis B vaccine schedule from all infants receiving the first dose, to only infants born to infected mothers receiving the first dose at birth. This led to lower overall vaccination rates and the CDC eventually reversed that guidance, recognizing that protecting all newborns was the safest approach."
And with the U.S. seeing decreasing vaccine rates for children and preventable, contagious, potentially deadly diseases reemerging, Thompson fears the proven approach of prevention will fall out of favor.
"My main concern is that parents may choose to decline vaccines without fully understanding and discussing the risks versus benefits with a clinician," she said. "Supporters of this change believe the approach could open the door for more shared decision-making between parents and health care providers and allow for more individualized decisions. However, I feel that preventative care works best when expectations and messaging are consistent across the board.
"The real concern with reducing universal recommendations is that fewer children may get the vaccines they need. Research has consistently shown that the recommended childhood vaccine schedule is safe, and we know that when vaccination rates drop, the risk of preventable diseases goes up, not just for individual children, but for whole communities."
