President Trump signed an executive order yesterday in the Oval Office calling for a reshaping of the childhood vaccine schedule. Speaking at the event, Trump repeated debunked claims linking autism to vaccines and made other false statements about the fluid content of vaccines as well as the numbers of vaccinations children receive in the United States. He also controversially urged a splitting up of the measles, mumps and rubella vaccine into separate shots.
STAT News reported that the President and top health officials such as Health and Human Services Secretary Kennedy have made “extraordinary claims without evidence to support the remade federal agenda.”
Conspicuous in her absence was Dr. Schwartz, the newly confirmed director of the Centers for Disease Control and Prevention. Under normal circumstances, the director would be the face of policy changes related to vaccines as the CDC is the responsible agency.
In fact-checking the event, the New York Times pointed to several incorrect claims Trump made about the volume of liquid contained in vaccines as being close to “the size of a bottle of soda,” even mentioning “gallons” and “vats of vaccine.” In reality, they’re a fraction of a teaspoon.
Trump and Kennedy also said that American children get 72 shots. However, children receive less than half that number of injections by age five. even if one includes vaccinations that are recommended and not required by most states, such as a yearly flu jab.
This raises the question why Press Secretary Leavitt posted a misleading image depicting a happy-looking baby with “11 injections” in “a European country” versus a miserable-looking infant with “72 injections” in the U.S.
Trump connected false dots to one another when he indicated there’s a need to split up combination jabs, as spacing out shots would “let time elapse between visits so the body can handle this massive amount of fluid being pumped in.”
Adding yet another untrue claim to the mix, Trump stated that separating out shots would have a “huge impact on autism,” falsely implying that there is a link between the MMR vaccine and autism.
No peer nation splits the MMR immunizations into three separate jabs, as there is no clinical rationale for doing so. Nor would it logistically be a simple matter, as individual shots for the three diseases aren’t available in the U.S.
Misleading Comparisons
It’s problematic to compare U.S. vaccine policies to those of other wealthy nations without including an appropriate context. Yet, this is what Trump and his team at HHS embarked upon after a presidential memorandum was issued in January of this year to reconsider the entire U.S. childhood vaccine schedule by reviewing “best practices” in peer countries. This culminated in yesterday’s executive order which asserts that based on the administration’s “scientific assessment” the U.S. “currently recommends more childhood vaccines than any peer nation, including more than twice as many vaccine doses as some European nations.”
The document doesn’t provide evidence to back up the “twice as many” claim.
The differences between childhood vaccine schedules in the U.S. and its peers tend to be relatively minor, with the most notable exceptions being the inclusion in prior American guidance of COVID-19 and influenza vaccines. These are not found on most European guidelines unless individuals are at high risk of complications.
But, contrary to the president’s remarks singling out the hepatitis B vaccine as one which shouldn’t be universally recommended, the vast majority of European peers do recommend it as part of their childhood vaccine schedules.
The administration’s apparently preferred option, the slimmed down Danish schedule, doesn’t, however. Here, though, it’s important to account for this discrepancy by examining how the healthcare systems differ. The Trump administration changed hepatitis B vaccine guidance last December in part to align with Denmark. But there are evidence-based reasons why the prior U.S. schedule differed from Denmark’s, primarily having to do with major screening, treatment and outcome gaps in the American healthcare system. Adopting a strategy that would only give hepatitis B vaccines at birth to those deemed at high risk sidesteps the problem of the U.S. healthcare system not doing an adequate job at timely identification of those at risk.
Moreover, most other European childhood vaccine schedules aren’t as narrow as the one Denmark deploys. They’re more similar than different to what has been the prevailing U.S. schedule. The Netherlands’ schedule, for example targets 15 diseases, three fewer than contained in the traditional U.S. set of recommendations: Specifically, varicella (chicken pox), influenza and COVID-19, which are still offered to those with underlying health conditions.
Parental Choice Versus Vaccine Mandates
The Trump administration has consistently maintained that it wants there to be “parental choice” and a process in which healthcare providers and parents are involved in shared decision-making regarding vaccinations. In so doing, it wants to abolish vaccine mandates. The executive order continues with this theme. However, it ignores the fact that informed consent and numerous religious and medical exemptions are already an integral component of vaccine policy in the U.S.
The order goes on to state that the administration’s “scientific assessment also found that, instead of implementing vaccination mandates, most peer nations maintain high childhood vaccination rates through public trust and education.” By contrast, “individual States set mandatory vaccination requirements that children must meet to attend school.”
While it’s true that individual states set vaccine schedules that include mandatory shots for attendance in (public) schools, the U.S. policies on public trust and education have historically been remarkably similar to their peers. After being informed by scientific advisory committees, the CDC provides guidance on which vaccines to include or exclude and why. And these sets of recommendations are subsequently disseminated throughout the country to state and local authorities. Doctors and other healthcare providers are then encouraged to follow guidance but also educate their patients. European and other peer public health agencies follow an analogous pathway in creating guidance and informing the public. However, among peer nations the centralized agencies have typically granted much less leeway to local or provincial authorities.
And while technically, in a legal sense, some European systems like the Dutch rely on voluntary cooperation rather than vaccine mandates, their protocols are geared to achieve compliance with public health guidelines.
Allow me to briefly describe my experience, having lived in the Netherlands and had children born and raised there. We received summons notices from the public health authority instructing us to get our children immunized at a vaccination center a few blocks from our home. The notice included a description of all the vaccines our children would receive along with a timetable with suggested appointment times. The notices were sent almost immediately after each child’s birth, with periodic reminders every month or so for upcoming follow-up shots. Once at the center, vaccines were administered with assembly line efficiency to the many infants waiting in line with their parents or guardians. In the end, there’s no getting around the government’s repeated summons to go to the local vaccination center and have your child jabbed almost the same number of times as in America.
