When it comes to vaccine policy, the U.S. government is holding up Denmark as a role model. Major changes in the schedule of recommended vaccines for children, announced on Monday by the U.S. Department of Health and Human Services (HHS), were based on a comparison of 20 “peer, developed nations,” according to the agency—but it highlighted Denmark in particular. The Scandinavian nation of 6 million gives children far fewer vaccines than the United States has done.

The new U.S. schedule follows Denmark’s example. It no longer recommends that all children get vaccinated for half a dozen diseases: hepatitis A and B, rotavirus, meningococcal disease, influenza, and COVID-19. Instead, administering these shots should be “based on shared clinical decision-making” between parents and doctors, HHS says.

The move elicited widespread criticism from doctors and public health experts—but it also drew attention to Denmark’s minimalist vaccination program. Demetre Daskalakis, a former top official at the U.S. Centers for Disease Control and Prevention (CDC), somewhat dismissively likened the Danish schedule to a “toy plane” compared with the “jet engine” that, until now, was the U.S. program.

But why does Denmark recommend fewer childhood vaccines than many other developed countries? Science spoke to Jens Lundgren, an infectious disease specialist at the Copenhagen University Hospital and a member of the advisory board that makes recommendations to the Danish Health Authority about which shots to include in the country’s vaccine program, which means the shots are paid for by the government. Lundgren stressed that the U.S. and Denmark are very different countries and vaccine schedules should be tailored to each population’s needs. One reason Denmark has held off on endorsing several childhood vaccines, he explained, is to avoid “vaccine fatigue” in parents.

Questions and answers have been edited for brevity and clarity.

Q: President Donald Trump’s administration says it has modeled its new recommendations on Denmark’s policies. There are six vaccines that Denmark does not recommend that were, until last week, recommended in the U.S. What is behind those differences?

A: This really needs a vaccine-by-vaccine discussion. If I can start with hepatitis B: We do not recommend it for all newborns, and that is due to the fact that we have very low rates of undiagnosed hepatitis B and a very effective prenatal screening program. A baby receives a vaccine if the mother tests positive or if there’s hepatitis B in [other close contacts]. Because infection rates in Denmark are so low, you would need to vaccinate an extraordinary number of kids to prevent one infection. [Editor’s note: CDC estimates roughly 640,000 adults in the U.S. are infected with hepatitis B, and only about half of those are aware that they are infected.]

Q: So it wouldn’t be cost-effective?

A: Cost-effectiveness is one aspect, but we also want to be sure that the vaccines that are being recommended are actually used. There is a balance between how many vaccines you add in on top of each other and vaccine acceptance rates.

After the COVID-19 pandemic, we introduced influenza vaccines for children from 2 to 6 years old. We thought uptake would be high, but we found that it wasn’t. We then removed it again, because we wanted to make sure parents didn’t get vaccine fatigue.

Vaccines for measles, diphtheria, pertussis, and tetanus are critical. If some parents start to make choices between less important vaccines and more important ones, that could lead to serious problems. It’s a delicate balance and something you need to constantly monitor.

Q: What about rotavirus, a common cause of diarrhea in infants and young children that leads to hospitalizations every winter? A majority of European countries vaccinate babies against it.

A: The rotavirus vaccine is not currently recommended in Denmark, but it is being discussed. There are legitimate reasons on either side. Rotavirus is not trivial, but it’s usually not a terribly serious condition. And the vaccine obviously provides some benefits, but it’s actually not a very great vaccine, and there are others that we have prioritized. But it is one of those that is still on the table.

Q: What about meningococcal disease, where bacteria infect the bloodstream, the lining of the brain, or the spinal cord?

A: That’s not really a public health problem in Denmark. We feel that there are other vaccines that should be higher on the list at the moment, at least in the Danish context. The incidence of meningococcus is actually dropping. [Editor’s note: There were 26 cases of meningococcal disease in Denmark in 2024, 11 of them among children ages 0 to 18. In the U.S., CDC recorded 503 cases in 2024.]

If something new comes into the vaccination program, many parents want to know why, and we need to be able to give a very comprehensive answer. It would be very hard for me to go on national television and argue for adding a meningococcus vaccine at the moment. If we had a meningococcal problem, we would reassess.

Q: How does the Danish situation differ from the U.S. for these diseases?

A: In general, you want to design your vaccine program so that it is tailored to the population you are responsible for. You can’t just say “we want to be like them,” because it doesn’t address the population you are dealing with.

The U.S. is much more diverse, and access to health care is much more varied. That inequality is not present in Denmark. That should influence your choice of vaccines. Vaccines are an excellent way to protect the population if you don’t have consistent access to health care. If I were in the U.S., where I know that a significant number of women get inadequate prenatal care, my opinion around the hepatitis B vaccine would be very different. In that context, compared to the situation we have in our country, broad vaccination can make sense.

Q: So the U.S. shouldn’t necessarily model its recommendations on Denmark’s?

A: That’s where common sense is important. How are you getting the most public health value out of the money that is being invested, and how good are you at communicating the benefits of the vaccination program? I’ve been listening to the communication that has been happening in the U.S., and I can see why parents would be uncertain about whether to get their kids vaccinated.

The idea that you should leave the decision to the parents is fundamentally correct. But they need to have guidance, by health care professionals who actually have expertise in this area. And it should be those experts who say what is sensible or not sensible, not the politicians. Politicians sometimes have to weigh in in crisis situations. But they need to be well educated before they weigh in, because bad information can very quickly erode trust.

Q: You mentioned “vaccine fatigue.” Can you explain what that is?

A: Adherence to vaccines is related to what I call the vaccine saturation effect: If you put too many vaccines into the schedule, at least if you do that too quickly, you could see a situation where parents start to pick and choose between them. And then parents tend to lose perspective on which ones are most important. They will turn to Facebook and other unreliable sources to decide which vaccines to give their babies.

Vaccination fatigue among parents is a real issue that you need to take seriously, and it’s on us as experts to prioritize with that in mind. We can’t just put more vaccines into the program.

Why does Denmark recommend so few childhood vaccines? A Danish scientist explains

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