Key Takeaways:
- The U.S. Centers for Disease and Control and Prevention (CDC) has updated its recommended child and adolescent vaccine schedule, reducing the number of universally recommended immunizations from 17 to 11.
- Infectious disease experts in Canada do not expect the country to follow suit, citing different population dynamics, budget restrictions, and public health resources.
- The National Advisory Committee on Immunization (NACI) makes vaccine recommendations in Canada, but provincial and territorial health authorities decide whether to follow them.
- Different regions have different immunization needs, and public health bodies can revise their guidance based on epidemiological trends.
- The CDC’s decision to remove the universal recommendation for the hepatitis B vaccine for infants has been met with criticism, with experts arguing that it was not based on scientific consensus.
Introduction to Vaccine Recommendations
The U.S. Centers for Disease and Control and Prevention (CDC) recently announced updates to its recommended child and adolescent vaccine schedule, reducing the number of universally recommended immunizations from 17 to 11. However, infectious disease experts in Canada do not expect the country to follow suit. According to Dr. Cora Constantinescu, an Alberta pediatrician and infectious diseases specialist, "Just because the CDC has changed their recommendation, I do not see Canada changing their recommendations." This is because public health organizations consider the needs and demographics of their regions, taking into account population dynamics, budget restrictions, and existing public health resources.
Regional Immunization Needs
In Canada, the National Advisory Committee on Immunization (NACI) makes vaccine recommendations, but it’s the provincial and territorial health authorities who decide whether to follow them. Each province and territory considers its own budget, public health resources, and ability to deliver immunizations within a certain time frame. For example, when public health officials in Nova Scotia declared a meningitis outbreak in 2022, the province began offering meningococcal B (Men-B) vaccines to those in post-secondary institutions, despite it not being part of its childhood immunization schedule. This shows how public health bodies can revise their guidance based on epidemiological trends.
Comparison with Other Countries
The U.S. Department of Health and Human Services cited the guidelines of other "peer, developed nations" that offer fewer childhood vaccines, such as Denmark, Japan, and Germany. However, infectious diseases specialist Dr. Caroline Quach-Thanh argues that it doesn’t make sense to change public health recommendations based on countries that deliver healthcare quite differently. Denmark, for instance, has a publicly funded healthcare system, which allows for more comprehensive testing and follow-up for pregnant parents and their children. In contrast, the U.S. has a more complex healthcare system, which may require different vaccination strategies.
Changes to Vaccine Recommendations
The CDC’s decision to remove the universal recommendation for the hepatitis B vaccine for infants has been met with criticism. Dr. Quach-Thanh notes that Denmark recommends testing pregnant parents for hepatitis B and only vaccinating children who are at risk, whereas the U.S. previously recommended universal vaccination due to the lack of follow-up care for pregnant women. The new policy, which will only vaccinate babies within 24 hours of birth if their parents have tested positive for the disease, has been deemed ineffective in preventing the spread of the disease from parent to child.
Expert Opinions
According to Dr. Constantinescu, it’s "not common" for countries to no longer recommend certain vaccines, especially when the corresponding diseases continue to circulate. She points to smallpox as an example of a disease that has been completely eradicated and for which regular vaccination is no longer recommended. Dr. Quach-Thanh also expresses concern about the CDC’s decision, stating that it was not made based on scientific consensus. She emphasizes the importance of evidence-based decision-making in public health, which involves reflection, discussion, debate, and literature review.
Implications for Parents and Travelers
Despite the changes to the CDC’s vaccine recommendations, Dr. Sumon Chakrabarti assures parents that fully vaccinated children will be protected regardless of the recommendations in the U.S. However, he cautions parents with immunocompromised children to follow disease outbreaks before making travel decisions. Dr. Constantinescu hopes to see a "vaccine confidence movement" emerge in Canada, to combat some of the rhetoric emerging from places like the U.S. Ultimately, parents should consult with their healthcare providers to determine the best course of action for their children’s vaccination needs.
