How Vaccine Policy Changes Fuel Misinformation, Whether Intended or Not

A recent consequential change to the US childhood immunization schedule has sparked intense debate among clinicians and public health experts. Under the newly announced revisions, influenza vaccination for children will no longer be universally recommended; it will instead fall under shared clinical decision-making.

In a wide-ranging conversation with Infection Control Today^® (ICT^®), Robert H. Hopkins, Jr, MD, medical director of the National Foundation for Infectious Diseases, explains why aligning US policy with Denmark’s approach overlooks critical differences in health systems, surveillance, and access, and why reducing routine influenza vaccination risks sending the wrong message to families about the importance of prevention.

ICT: The HHS just announced revisions to the US childhood immunization schedule that will align closely with Denmark's recommendations. I want to ask about one major change: Influenza vaccination will move from a universal recommendation to shared clinical decision-making. This means flu shots for kids will no longer be routinely recommended for all children.

What is your initial reaction to this news?

Robert H. Hopkins, Jr, MD: My initial reaction is, Oh, my goodness. It wasn't entirely unexpected. This was telegraphed just before the holidays. Let's think about the context. Denmark, a small country about the size of Maryland, if I'm not mistaken, has about 20 million people in Denmark, if I'm not mistaken again, universal health care, guaranteed parental leave when they have new children, guaranteed leave when your children are sick, very good, robust surveillance systems for disease, for tracking. All of the things that are important to us in clinical care and infection prevention. Which of those do we have in the United States? Zero. We have a large country. We have a much, much larger population. We have areas of health care, deserts across our country. We have no universal health care. There's no guaranteed parental leave for either the care of a sick family member, or for postpartum leave.

If you look at other industrialized countries, Denmark is at the low end of the spectrum in the number of vaccines they recommend. The US was at the high end, at 18, but we recommended less than many other countries. We recommend more than many other countries, but our vaccine schedule was based on the risks for our children and trying to minimize the risk to the children in the United States. We've now gone away from that.

ICT: Do you have any idea why they chose Denmark?

RHH: Not directly. Based on comments Tracy Beth Hoag [MD, PhD] made at the last [Advisory Committee on Immunization Practices] meeting, Denmark has very good health outcomes. She has some direct knowledge about the health care system in Denmark, as certain others do. And I think they chose the country of the developed countries in their list that had the smallest list and use that as their starting point. That's the best answer I can give you.

ICT: Last night, I went online…to Facebook. I reviewed some of the articles other media outlets posted, and the reactions both appalled and terrified me. I wanted to ask you about some of the comments I read. I'll read you some of the nicer ones. Someone said, “This vaccine doesn't work for this strain. So why take it?” “People will end up sick and sometimes in the hospital. So why take it?” Before I go on, what would you answer to those [comments]?

RHH: If you don't take the influenza vaccine, you can contract influenza with no protection. If you take the influenza vaccine, even if the mismatch is imperfect, as we know, the H3N2 is this year, you get some degree of protection. We don't know what that degree is yet. We're going to get that data over time, but some protection is better than zero, isn't it?

So why go into influenza season with a fatalistic attitude-"I'm going to get it if I get sick, and I end up in the hospital"? I'd much rather go into it with the opposite and say I'm going to do everything I can to minimize my risk.

I'm traveling at this point. I wore a mask on public transportation. I'll do it when I head back home today. I got my flu vaccine. All my family members got their flu vaccine, including my children, my parents, if my grandchild was old enough, he'd have gotten his too. But, why go into it with the attitude of, “I'm just going to roll the dice.” Why not hedge the bet in your favor? Particularly when the risk is near zero.

ICT: Would you please explain why you get or how you get the protection [from the vaccine for the flu], even if it's not an exact match?

RHH: The H3N2 strain of influenza has a number of different antigens on its surface. There are a number of changes in this new subclade k variant from the H3N2 that circulated, and that we chose to put in our flu vaccine this year. So, you're going to have antigens there that are present on the subclade K. It's not going to be an exact match to all of them, but you're going to get some of those antigens that your immune system has been presented with in the vaccine.

You'll have some degree of protection, though it's not optimal. We would have loved to have the opportunity to have a perfect match. Again, having some protection is better than none. And, you know, we can go into other pieces. But I think it's also important to recognize that some of the other actions of our HHS-affiliated agencies make us less safe.

We've taken away investment in mRNA technology. MRNA vaccines can be modified much more rapidly than our traditional influenza vaccine. So, if we'd had that tool in our tool belt, potentially when we identified this subplate K of H3N2, we could have revised the vaccine that was being made for the country and responded more effectively, so multiple actions that have been made that put us more at risk.

ICT: The next comment was: "We have an immune system. Eat healthy, exercise. I'm in good health. Why should I worry about it? Why should I get the flu shot?” How do you respond to people like that?

HHR: I agree, but I disagree with you. I absolutely agree that it's important to eat healthy. I absolutely agree that it's important to get good sleep. I absolutely encourage everybody to exercise every day. You know, at least to a modest degree, there's evidence that all of those have health benefits. But healthy people are hospitalized every day with influenza. Healthy People die from influenza, not just elderly, healthy people. You all may have heard of the 16-year-old young lady that passed away over the weekend. I believe it was in Ohio. She was a healthy, active teenager and died from the flu. That's a catastrophe that we can prevent.

ICT: The next question was whether this is fear-mongering.

HHR: I cannot guarantee to anybody whether they will get sick or whether they will not get sick with flu, with RSV [respiratory syncytial virus], with COVID-19. I want everyone to stay as healthy as possible, but I can say that in 2024-2025, we had a severe influenza season. We had more pediatric deaths from influenza than we've had since the H1N1 swine flu in 2009.

Why take a chance? I certainly understand if you don't want to think about adverse outcomes. I certainly understand if you don't want to think about bad things happening. But isn't it better for us to prepare than to play ostrich?

ICT: Absolutely. The next one is, and this was my favorite: “They wouldn't know what strain it is unless they are making it.”

HHR: Interesting. The H3 the subplate K, H3N2, was detected initially in Europe in the summer. We did not know this would be the predominant strain when the vaccines were chosen. I don't know that there is anyone who would be sick enough, right, that they would create a virus that's causing this much death and disability. I just have a hard time conceiving of that conspiracy.

ICT: What about “It's a money grab from pharma.”

HHR: If you think about money grab, is it more expensive for your health insurer to pay $20 for your flu vaccine or $10,000 for an ICU stay? If you want to do a money grab, you eliminate vaccines, and you put more people in the hospital who require more expensive drugs that require ventilatory support. You're going to pay for more funerals. Yes, the money grab would be: Let's not protect our population.

ICT: It said something about meningitis not being covered or not being recommended. Of course, this was almost 30 years ago. One of my dearest friends died from meningitis, and I can't believe that they're going to say that it's not recommended anymore. What would you say to that?

HHR: Meningococcal infections are very uncommon, but they're devastating when they happen. And you know, we've had a number of outbreaks of meningococcal infections, meningococcal meningitis, many of them on college campuses. And the Meningococcal vaccine that we routinely recommend, the tumeningococcal vaccines that we routinely recommend are reduce that risk of a devastating infection. Yes, I'll agree, it's uncommon, but one teen, one young adult dying of an infection that we can prevent with vaccine, ignoring that possibility of prevention just seems nonsensical to me.

ICT: If you could say anything to the CDC right now, what would you say?

HHR: I would say first that all of my support, all of my love, all of my hope, is for those dedicated professionals who are still holding out and doing what they can within the CDC. I know there are many.

But to those who have come into leadership who are removing our tools to monitor and to protect the health of Americans, you should be ashamed of yourselves. And it does not make any sense at all to take away or to minimize access, to create fear, to stoke distrust; that's going to put lives at risk, lives of children at risk. That doesn't make any sense to me.

I'm very much agree that we need to preserve universal vaccination with MMR, universal vaccination with DTaP, universal vaccination against polio, Hemophilus influenza, B, pneumococcal, HPV, varicella, but as we mentioned earlier, meningococcal infections are devastating. Why remove that as a universal recommendation and open up gaps in our prevention to increase the likelihood that young people are going to die from meningococcal disease?

Why back off on hepatitis B neonatal vaccination, which has gotten us to a point of almost no newborns with Hepatitis B from a failed strategy? That was a targeted strategy before we've proven that our universal strategy works. Why remove hepatitis A vaccine protection from all children in the United States?

If you look at the [epidemiological] data. Now, most hepatitis A in the US is in folks above 30 years old. Guess when we started doing universal hepatitis A vaccine? Just a little over 30 years ago? Why remove the RSV monoclonal antibody from newborns, which has reduced the hospitalization rate of children in the first complete season that we used the vaccine by 28 to 43%; that's in 1 year. And why put more children at risk from influenza and COVID-19? Because families are now hearing well, this must not be important. If it's not routine, we're putting children at risk, and that means we're putting all families at risk by undertaking this reduction in vaccine recommendations.

ICT: Do you have anything else you'd like to add?

HHR: I think it's important that we all recognize what our audience knows. You know we are in health care. Our goal is to reduce the risk of loss of good quality of life for our patients and families. I really have a hard time understanding how these recommendations that have come out from CDC, driven by HHS, are done with that same goal in mind; these seem to be biased recommendations that are made from a position of not wanting to protect the health of people, rather than for our desire for improved health.

I think we need to continue having mutually respectful conversations with patients. I hate to hear some of the comments you received on your blog, but if we can't sit down and have conversations with people, we can't help them understand that our motivation is very much like most of these people's. It's a healthy life, and we must have those conversations one-on-one. We have to be advocates for the health of our patients, and that's where all of our efforts need to be aligned.

(This transcript has been edited for clarity and length.)