MW CDC panel compares the U.S. hepatitis B child vaccine schedule to Denmark's - but omits crucial context

By MARIE MAZUR

A CDC panel decided to end the universal birth dose of a hepatitis B vaccine for newborns, with some officials pointing to Denmark's policies as a model

During a recent ACIP meeting, several officials compared the hepatitis B policy in the U.S. to the one in Denmark, where healthy infants do not receive a birth dose.

The CDC's Advisory Committee on Immunization Practices meeting last week marked an abrupt shift in hepatitis B policy in the U.S., with implications that reach far beyond a single line on the childhood vaccination schedule.

Until now, the U.S. recommended a simple universal birth dose of a hepatitis B vaccine for every newborn precisely because prenatal care, insurance coverage and medical records are so variable in our fragmented system.

A birth-dose safety net is cheaper than betting every pregnant woman will be screened, every result will be acted on and every at-risk baby will reliably return for a perfectly timed follow-up appointment. During the ACIP meeting, several speakers repeatedly compared the longstanding approach in the U.S. with the pediatric schedule in Denmark, where healthy infants do not receive a birth dose and hepatitis B vaccination is largely reserved for defined risk situations.

Denmark's program can look like proof that "less vaccine" equals good outcomes, but the resemblance is misleading. Denmark has a tax-funded universal health system, high coverage of prenatal care, far less income inequality and a much smaller reservoir of chronic hepatitis B infection than the U.S. In that context, Denmark's policy still captures almost everyone at risk.

But in the U.S., the same interpretation would reliably miss children at the edges of the system. Hepatitis B cases can reappear years later as cirrhosis, liver cancer and cause liver transplants that can approach $1 million per case when surgery, hospitalization and follow-up care are included.

Importantly, hepatitis B is not the only place where copy-pasting Denmark's policies would worsen the long-term cost profile of American healthcare.

Other vaccines that Denmark uses more selectively - such as hepatitis A, rotavirus, varicella, meningococcal vaccines, routine influenza vaccination for all children and broad RSV prevention in infancy - are precisely the ones needed to compensate for America's structural weaknesses. Those weaknesses include higher child poverty, more crowded housing and daycares, uneven access to primary care and a larger reservoir of chronic viral and bacterial infection.

In a Nordic system with universal access and a structured primary-care system, lean childhood vaccine schedules can still deliver low hospitalization rates. In the fragmented U.S. system, removing these "extra" layers of protection would predictably translate into more outbreaks, more ICU stays and a higher lifetime of treatment costs, especially in communities that already bear the heaviest infectious-disease burden.

Danish officials did not design their schedule to signal that vaccines are overused. Their choices sit on top of near-universal enrollment with a primary care doctor, strong social protection and a coordinated public health infrastructure that can find a child quickly when there is a problem.

By contrast, U.S. clinicians and health plans have long used universal childhood vaccines as a backstop against all the places the system fails: missed wellness baby visits, gaps in insurance, families moving between states and the reality that some children's first real contact with the health system is in an emergency room.

Stripping away universal recommendations without first repairing those structural gaps does not replicate Danish outcomes, but externalizes more risk onto children and families who already have the least margin for error.

Weaker pediatric vaccination is not just a clinical issue. It is an economic risk that unfolds over decades.

Fewer birth-dose hepatitis B shots will mean more chronic infections, which will then lead to higher spending on liver disease, including expensive antiviral therapy, hospitalizations and a subset of patients who will need transplantation.

It's a similar story for other common childhood diseases such as rotavirus, RSV and influenza. Early prevention means more avoidable hospital admissions, which strain capacity and increase volatility in healthcare utilization. A recent model of a delayed hepatitis B birth dose already projects hundreds of extra pediatric infections per affected birth cohort and tens of millions of dollars in additional direct medical costs each year, rising into the low billions over a decade if the policy is sustained.

In a heavily fragmented health system like that of the U.S., the question is not whether Denmark's schedule is "wrong," but whether decision makers are being honest about the very different starting point.

Denmark's lean schedule is a dividend from decades of investing in universal access and social protection. The U.S. pediatric schedule is part of the minimum infrastructure needed to keep a more fragile system functioning.

Public health choices and financial choices are inseparable. The decisions we make on childhood vaccination today will shape medical spending, budget and economic resilience for years to come. Oversimplifying those decisions through inappropriate one-to-one comparisons between wildly different countries does not just blur the science; it systematically raises the mid- to long-term financial risk profile for the U.S.

Abraham Lincoln once said: "We must plan for the future because people who stay in the present will remain in the past."

We have a responsibility to press for policies that strengthen, rather than erode, the preventive foundations that American households, health systems, and life sciences investors rely on.

Marie Mazur is a strategic adviser to life sciences companies. She has more than 25 years of leadership in global vaccine development, manufacturing and pandemic response at top-tier organizations and drugmakers. She is recognized for her work supporting innovation at the intersection of science, policy and markets. She serves on the strategic advisory group of the Partnership for International Vaccine Initiatives and on the board of Mid-Atlantic Diamond Ventures.

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December 09, 2025 08:58 ET (13:58 GMT)

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