Last week, MedPage Today published a piece I wrote titled “Parents Are Confused. I’m Worried for My Pediatric Patients.” I wrote it after a recent series of conversations in clinic that felt meaningfully different from the questions I usually hear about vaccines.

These conversations weren’t driven by misinformation. The parents were disoriented.

One parent summed it up well with this question: “What vaccines are recommended now? I’m so confused.”

I’ve heard some version of that question several times this week, including from families who previously made confident, routine decisions to vaccinate.

That confusion is the predictable outcome of an overnight rewriting of the U.S. childhood vaccine schedule, justified as an effort to “restore” or “rebuild” trust.

This rationale deserves far more scrutiny than it has received.

The argument appears to go like this: the United States is a negative “outlier” compared to peer nations; routine childhood vaccination is facing a crisis of trust; and recommending fewer routine vaccines will lead parents to trust clinicians more.

As someone who studies vaccine delivery and communication, and who sits with families every day, I can say plainly: each of those assumptions is backwards.

This week, I want to examine the assumption underlying all of them: that the U.S. being an outlier in childhood vaccination is inherently a problem.

Is Being an “Outlier” a Problem?

One of the most common justifications for the schedule overhaul is that the U.S. was an “outlier” compared to peer nations, often citing countries like Denmark.

Many responses have focused on whether that claim is even accurate, noting correctly that the U.S. schedule is not dramatically different from those of many peer countries and that Denmark is itself an outlier.

While these points matter, they skip over the more revealing assumption embedded in the argument: being an outlier is evidence of a problem.

Being ahead of peer nations in preventing life-threatening disease, using one of humanity’s greatest achievements, is only a liability if you assume routine vaccination is a problem and we should do less of it. That conclusion is being treated as self-evident without ever being defended.

The U.S. has been an outlier in plenty of other domains where “different from peers” is rarely invoked as a warning sign. We have been an outlier in landing humans on the moon, building the internet, and sequencing the human genome. In none of these cases is outlier status taken as evidence that we should pull back to align with peer nations.

Difference, on its own, tells us nothing about whether a policy is good or bad. What matters is evidence of harm, risk, or unintended consequences that outweigh the benefits.

And this is where the justification falls apart.

We’ve been offered no new evidence that broader protection against vaccine-preventable diseases has become a liability rather than a strength. Instead, the vaccine schedule is being rewritten as if that conclusion were already established.

I joined the ScienceVs podcast this week to talk through these issues, and one point I tried to make there was this:

The fact that we have vaccine coverage for more diseases is not evidence of a problem. That's backward. It's not a competition to see how few diseases we can prevent.

Why “Peer Nation” Comparisons Fall Short

Setting aside the unexamined assumption that more vaccines are inherently problematic, the fact that another high-income country does not routinely recommend vaccines reflects different policy trade-offs, not a lack of evidence.

Vaccine schedules are shaped by national context, including disease epidemiology, health-system capacity, financing, equity, and the reliability of follow-up care. Those factors matter enormously.

Denmark has a smaller population, far less inequality, and universal health coverage. In that setting, policymakers can reasonably assume timely access to care, consistent follow-up, and fewer structural barriers. The U.S. operates under very different conditions.

Here, the childhood vaccine schedule must compensate for gaps in access, delayed diagnosis, inconsistent follow-up, and wide variation in healthcare delivery. It functions, in part, as a proactive clinical safety net, one designed to protect children despite those system-level weaknesses.

That difference is often overlooked.

I recently spoke with a pediatrician who practiced for many years in Denmark before moving to the U.S. He had many positive things to say about the Danish healthcare system, much of which we should aspire to replicate. Yet he viewed Denmark’s more limited vaccine schedule as a weakness, not a strength, particularly given how well the U.S. program has prevented disease across a far more complex system.

Calling the U.S. schedule an “outlier” was never evidence that it was wrong. In many cases, it meant we were setting the pace.

In fact, peer nations often move toward the U.S. over time. The United Kingdom’s recent adoption of routine varicella (aka chickenpox) vaccination is one example. And even Denmark recently added the RSV vaccine during pregnancy, following the U.S. lead.

Here’s the irony that isn’t being widely acknowledged: The U.S. is now becoming an outlier in the opposite direction, and we are narrowing protections while other countries expand them.

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