Recent moves by U.S. officials to align the national vaccine schedule with Denmark’s have drawn sharp criticism from public health experts. The CDC advisory panel’s decision to reconsider the universal hepatitis B vaccine at birth, citing Denmark as a model, overlooks fundamental differences in population health, healthcare systems, and disease prevalence. This shift isn’t about scientific improvement; it’s a flawed comparison that ignores real-world context.
The Core Issue: Apples and Oranges
The U.S. and Denmark operate under vastly different conditions. The U.S., with over 340 million people, has a fragmented, largely private healthcare system. Denmark, with a population of just over six million, provides universal, state-funded care. This means that managing public health effectively requires different approaches.
As epidemiologist Katelyn Jetelina points out, “The United States is not Denmark. We should expect country-level policy decisions to vary.” The scale and structure of the two systems simply aren’t comparable.
Disease Prevalence and Screening Rates
The comparison breaks down further when looking at disease rates. In 2023, Denmark recorded 99 new cases of chronic hepatitis B, while the U.S. saw over 17,000. Denmark also maintains nearly 100% screening of pregnant people, with most positive cases receiving treatment—a stark contrast to the U.S., where only around 85% of pregnant people are screened, and many lack access to care.
Hepatitis B is a serious liver infection that, if untreated, can lead to life-threatening conditions. The U.S. approach of limiting vaccination to high-risk groups has proven ineffective in the past: even with targeted screening, cases still spread due to undetected infections within households. Universal vaccination, implemented in 1991, reduced acute hepatitis cases in young people by 99% between 1990 and 2019.
Cost-Effectiveness and Universal Healthcare
Universal healthcare systems like Denmark’s often prioritize cost-effectiveness when making vaccination recommendations. While vaccines are generally cheaper than treating diseases, resource allocation is still a factor. The U.K., for example, prioritizes flu vaccines for older adults because they offer the greatest cost benefit. Denmark may apply similar logic to its hepatitis B policy.
However, this logic doesn’t translate well to the U.S., where healthcare access is uneven. A fragmented system means more people fall through the cracks, making universal vaccination a more effective public health strategy.
Political Undercurrents
The push to alter the U.S. vaccine schedule aligns with a broader trend of prioritizing individual freedoms over collective action. While personal autonomy is important, public health relies on cooperation to protect vulnerable populations. As Jetelina warns, “If we land too much on individualism, diseases are going to come back.”
In essence, comparing the U.S. and Denmark on vaccination policy is a distraction from the real issues: healthcare access, disease prevalence, and the importance of collective public health measures. The Trump administration’s move appears driven by ideology rather than scientific rigor, potentially jeopardizing public health in the long run.
