Demetre C. Daskalakis is former director of the Centers for Disease Control’s National Center for Immunization and Respiratory Diseases.
Imagine a jet engine — an intricate, high-stakes machine powering millions of passengers through the sky. Now imagine that someone suggests tossing out the engineering manual for that engine and replacing it with the instructions for a plastic toy airplane. “They’re both planes,” they say. “How different could the instructions really be?”
That is the level of logic behind the idea of replacing the U.S. childhood and adolescent vaccine schedule with that of Denmark.
Federal health officials might soon announce exactly this kind of swap, sources familiar with the matter told The Post. If true, the consequences would be profound: destabilized vaccine access, supply chain disruptions, increased litigation and a public health landscape thrust into chaos.
Both schedules contain familiar immunizations: DTaP, MMR, HPV, pneumococcal vaccines. But the resemblance ends there. The U.S. schedule is a jet engine manual — complex because the system it supports is complex. Denmark’s is a toy-plane pamphlet — perfectly adequate for a small, controlled environment but catastrophically insufficient for a machine operating at the scale, speed and, most important, higher risk context of the United States.
To be clear, we aren’t a jet because we are better than Denmark. We are a jet because we must use complex networks to compensate for a fragmented health care system.
Denmark is a nation of about 6 million people — smaller than the Atlanta metro area It has universal health care, national patient registries and a highly homogeneous population with low rates of vaccine-preventable diseases. Its immunization program is designed for a system where every child is tracked, every parent has access to care and every gap is quickly closed.
The United States is a nation of 340 million featuring enormous geographic, socioeconomic and demographic diversity. Millions are uninsured, with more probably coming soon. Many lack consistent prenatal care. Children enter daycare earlier because of restrictive parental leave policies. Disease burdens differ dramatically. Public health infrastructure is heterogeneous, sometimes varying county by county.
The Danish schedule omits several vaccines that are essential in the U.S. context, including those for varicella (chickenpox), rotavirus, hepatitis A, meningococcal disease, covid-19 and the RSV monoclonal antibody for infants. Denmark can omit these vaccines because its disease burden is different.
But these aren’t “extras” in the U.S. schedule. They’re protections against diseases that circulate more widely, cause more severe outcomes or disproportionately affect vulnerable populations.
Chickenpox, often dismissed as “mild,” can cause pneumonia, hepatitis and death. Rotavirus was once responsible for hundreds of thousands of ER visits annually. Hepatitis A outbreaks continue to sweep through U.S. communities. Meningococcal disease, while rare, is devastating when it strikes.
Hepatitis B offers a case study in differences between the systems. Denmark vaccinates only high-risk infants for the disease. That works because Denmark has near-universal prenatal screening and reliable follow-up. The U.S. does not. Here, the universal birth dose is a safety net that prevents newborn infections when prenatal care is inconsistent or screening results are delayed. Removing it would be like removing a jet engine’s backup hydraulic system because a toy plane doesn’t need one.
Changing the U.S. vaccine schedule would immediately put vulnerable children at risk. The Vaccines for Children program, which provides immunizations for uninsured, Medicaid-enrolled and Native American/Alaska Native children, may no longer cover vaccines removed from the official schedule. Millions of children could lose access to essential vaccines overnight, widening existing health disparities.
Private insurance plans usually follow the Advisory Committee on Immunization Practices recommendations, so insured children would continue receiving all vaccines recommended by ACIP as of Sept. 1, 2025. Those without insurance, however, could lose coverage, deepening inequities in access to crucial immunizations. The divide between insured and uninsured children would widen further.
Removing vaccines from the schedule would also mean they are no longer covered by the National Vaccine Injury Compensation Program, established during the Reagan administration to provide a process for individuals to seek compensation if they experience rare but serious side effects from vaccines. Without the no-fault compensation system, manufacturers could face a torrent of litigation, which might prompt them to exit the market, destabilizing vaccine supply and our preparedness for everyday and emergent disease threats.
Lastly, vaccine supply chains would be disrupted. Many vaccines are produced in fixed combinations specific to the U.S. schedule, and sudden changes would leave these combinations unusable. Manufacturers cannot quickly adjust production lines, which could lead to shortages lasting up to 18 months.
A new schedule contradicting the recommendations of major medical organizations will result in chaos. Pediatricians will be forced to choose between federal guidance and established clinical standards. Parents will be left to navigate conflicting messages amplified by social media ecosystems primed to exploit confusion. Decision-makers responsible for such a change must show the modeling and policy analysis they have done to conclude that it is justified.
The U.S. schedule is not a historical accident or the result of bureaucratic overreach. It is the product of decades of rigorous, U.S.-specific epidemiology, modeling and real-world data. It is designed to prevent severe outcomes, reduce disparities and protect children in a system where universal access is not guaranteed.
Replacing it with Denmark’s schedule is not simplification. It is negligence. When a jet engine fails at 30,000 feet, it’s not the manual writer who pays the price. It’s the passengers — in this case, America’s children.
The post The U.S. vaccine schedule is a jet engine. Denmark’s is a toy plane. appeared first on Washington Post.
