On Dec. 5, President Trump issued a memorandum directing the CDC to compare the United States childhood vaccine schedule with those used in peer nations. Other developed nations vaccinate successfully, achieve high uptake, and maintain stronger trust, yet their schedules often look meaningfully different from ours. The difference is not that they are “anti-vaccine.” It is that most peer nations organize their childhood programs around three straightforward questions:
• Is the disease common in childhood?
• Is it serious in childhood?
ª Does vaccination meaningfully reduce community-level spread?
Only when the answer to all three is yes do most countries include a vaccine in the universal childhood schedule. These criteria are not ideological. They reflect a simple commitment to ensuring that universal childhood recommendations are justified by childhood disease burden and by clear, population-level benefit. The United States does not consistently apply these filters, and understanding that divergence is key to understanding why our schedule is larger, earlier, and more complex than those in many peer nations.
The first question—is the disease common in childhood?—reflects a basic principle of proportionality.
Universal vaccination is typically reserved for infections that children routinely encounter in the course of normal life. Peer countries hesitate to place low-prevalence or age-skewed conditions into their childhood schedules unless there is an overriding public-health rationale. The goal is alignment: recommending universal vaccination only when the likelihood of exposure in childhood is substantial enough to warrant it. Measles and pertussis meet this criterion and are routinely part of international schedules. Hepatitis B does not meet this criterion based on its limited prevalence in most pregnant women in peer nations (transmission in childbirth is the most common way the disease is acquired in infants), and, as such, is less commonly part of universal schedules.
The second question—is the disease serious in childhood?—ensures that childhood vaccination addresses true pediatric burden.
Many infections are common but mild. Others are severe but rare. Childhood schedules in most developed nations reflect a balance: they prioritize diseases that can cause hospitalization, long-term complications, or death in children themselves. This keeps universal programs focused on conditions where the benefit to the child is direct and clear. It also prevents the schedule from expanding indefinitely to cover every infection for which a vaccine exists, regardless of pediatric impact. Again, measles and pertussis easily cross this threshold. Varicella, while meeting the first standard—it is common—is generally a mild disease in childhood, and, again, is less often seen internationally on universal schedules.
The third question—does vaccination meaningfully reduce community spread?—is where most countries exercise the greatest restraint.
Universal vaccination is justified when wide uptake produces measurable community protection. But not all vaccines function this way. Some protect the individual without altering transmission dynamics. Peer nations preserve universal recommendations for situations where vaccination changes the broader pattern of disease in a way that benefits the entire community. This distinction matters because universal programs impose obligations on millions of children; those obligations should correspond to clear, achievable population-level goals. Again, measles and pertussis both meet this threshold. Their vaccines can achieve herd immunity when there is uptake in most of the population. In contrast, several of the vaccines in the U.S. schedule are effective at the individual level, but do not provide the same breaks in transmission.
These three questions shape vaccination policy across most developed nations. They create coherence: children are vaccinated universally when disease is common, serious, and addressed by a vaccine that improves community outcomes. When any of those criteria are not met, vaccines may still be recommended, but not universally, and not necessarily in infancy. The result is schedules that are focused, comprehensible, and easier for the public to trust.
The United States, by contrast, has accumulated recommendations over decades for reasons that are not always tied to pediatric disease burden or community-level benefit. Some decisions were driven by convenience, some by historical momentum, and some by challenges reaching adults in our fragmented healthcare system. A careful international comparison may affirm the wisdom of certain choices and call others into question. Either outcome is useful. The point is not to copy another country’s schedule, but to ask whether our own reflects the principles we claim to value.
Vaccination has delivered enormous public-health gains. That point should never be lost. But if the past several years taught anything, it is that public trust erodes when institutions overstate certainty and treat long-standing policy as immune to reevaluation. A willingness to look outward—to understand why peer nations vaccinate the way they do—is not a retreat from science. It is a return to it. Even if the ultimate result is no change at all, we will have taken the essential step: ensuring that our childhood vaccine schedule is grounded in clear reasoning, transparent goals, and a commitment to serving children as well as possible.
Monique Yohanan, MD, MPH, is a senior fellow for health policy at Independent Women.
The views and opinions expressed in this commentary are those of the author and do not reflect the official position of the Daily Caller News Foundation.
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