Why do childhood vaccine recommendations differ in Canada and around the world?

In early January the US Centers for Disease Control and Prevention (CDC) announced updates to its recommended child and adolescent vaccination schedule, reducing the number of universally recommended vaccinations. from 17 to 11 – But infectious disease experts here say they don’t expect Canada to do the same.

“Just because the CDC changed its recommendations, I don’t think Canada will change its recommendations,” said Dr. Cora Constantinescu, a pediatrician and infectious disease specialist in Alberta. “No new evidence has emerged in our population.”

Public health organizations consider the needs and demographics of their areas when making vaccination recommendations, taking into account population dynamics, budget restrictions, and existing public health resources, among other things.

Vaccination requirements differ in different regions

In Canada, the National Advisory Committee on Immunization (NACI) makes vaccine recommendations in Canada — but according to Constantinescu, it is provincial and territorial health officials who decide whether to follow them.

Everyone considers “what they have in their own budget, their own public health resources, and they think about, ‘How can we purchase vaccinations, and do we have the capacity to deliver vaccinations?’ And within what time frame.”

And as disease patterns change, so does the guidance.

For example, when public health officials in Nova Scotia Meningitis outbreak declared in 2022 at Dalhousie University in Halifax, The province started offering Meningococcal B (Men-B) vaccines are given to those in post-secondary institutions – something that continues to be done.

Although the Men-B vaccine is not part of its childhood vaccination program, the province’s response shows how public health bodies can modify their guidance based on epidemiological trends.

Look US to stop offering universal hepatitis B vaccine to infants:

“You have to make decisions budgetaryly based on the risk of our population being exposed to the disease,” Constantinescu said.

She says provinces and territories also vary when it comes to vaccine access and uptake.

“There may be more concern about vaccine access in places like Ontario,” Constantinescu said.

“While places like Alberta may actually have great access to the vaccine, there are more concerns about confidence (in vaccine safety).”

‘Peer nation’ comparisons don’t always make sense

U.S. Department of Health and Human Services, Announcing Amendments to the Pediatric Immunization Schedule released a fact sheet suggesting that it was influenced by guidelines from other “equivalent, developed countries” that provide fewer childhood vaccines.

These include places like Denmark, Japan, and Germany – all countries with very different populations than the US, whose majority of citizens have better access to health care systems.

Infectious disease expert Dr. Caroline Quach-Thanh said it doesn’t make sense to change public health recommendations based on countries that provide health care significantly differently than the US.

“Denmark has a publicly funded health care system, like Canada, which the U.S. doesn’t have,” Quach-Thanh, Quebec’s public health director, said in an interview. diet Host Dr. Brian Goldman.

Denmark recommends that children receive about 10 vaccinations, excluding shots such as hepatitis B vaccine.

In the case of that vaccination, Quach-Than says the Danish health care system tests expectant parents for hepatitis B, follows the parents during pregnancy and determines whether the baby may need the hepatitis B vaccine at birth.

Previously, in the US, “given the large proportion of women who did not have their pregnancies followed up, they thought it was safe to give everyone a birth dose of hepatitis B,” Quach-Thanh said.

but like December 2025American infants will be vaccinated against hepatitis B within 24 hours of birth if their parents have tested positive for the disease – a policy used in the country in the 1980s. deemed ineffective To prevent spread from parent to child, That’s why universal vaccination was adopted.

Skipping vaccine recommendations is ‘not common’, expert says

According to Constantinescu, it is “not common” for countries to no longer recommend certain vaccines, especially as related diseases continue to spread.

“You shouldn’t have any risk of that disease in your population,” he said.

“As long as that disease exists elsewhere in the world, you have to do a very careful risk analysis on whether your population is going to be re-exposed to that disease.”

Constantinescu points to smallpox as an example of a disease that has been completely eradicated and for which routine vaccination is no longer recommended.

She adds that different vaccines exist for different reasons – such as preventing serious infections, hospitalizations and even death.

“All this is to say that when people start these vaccination programs, there are a lot of considerations, economic analysis, that come with this kind of program,” Constantinescu said.

Despite the change in guidelines, the CDC still recommends that “high-risk” groups receive all previously recommended vaccines. Additionally, if families choose to get all previous vaccinations regardless of their children’s risk status, they will not have to pay out-of-pocket.

Nonetheless, Quach-Than says the change in vaccine recommendations in the US is worrying because the decision was not made based on scientific consensus.

“When we make recommendations and when we make decisions, that’s taken into consideration,” he said.

“It requires discussion. It requires debate. You do a literature review. All those steps we still do in Canada and we will continue to do to make sure the decisions we make are evidence-based.”

Constantinescu says he hopes a “vaccine confidence movement” will emerge in Canada to counter some of the rhetoric emerging from places like the US.

As for parents worried about traveling to the US, infectious disease expert Dr. Sumon Chakraborty says fully vaccinated children will be protected in the US regardless of the recommendations.

Still, he cautions parents with immunocompromised children to keep an eye on disease outbreaks before making travel decisions.

“If you went to Texas at a certain time last year, you’re at risk for getting measles, but that’s why we have vaccinations,” Chakraborty said.

“It’s a case-by-case basis, but the general thing is if you as an individual are up to date on your vaccinations, I don’t think traveling to the States would be (a cause for concern).”