Echoing a longstanding anti-vaccine trope, President Donald Trump falsely claimed that the American vaccine schedule “long required” babies to get “far more” vaccines than are given in “any other” country, and he directed health officials to better “align” practices with those of other countries. The recommended schedule in the U.S. is quite similar to that of other high-income nations, and it isn’t a federal mandate.
Moreover, there are important country-specific differences, such as health care systems, that can explain why vaccine schedules differ around the world. There is no evidence that the existing U.S. vaccine schedule is harmful to children.
Trump’s directive came in a Dec. 5 memo, which told the director of the Centers for Disease Control and Prevention to “review best practices from peer, developed countries” and consider updating the childhood vaccine schedule to “align” it with countries that give fewer vaccinations.
Indeed, multiple news outlets have recently reported that the Department of Health and Human Services is considering changing the U.S. vaccine schedule to match or nearly match that of Denmark, which recommends vaccination against an unusually low number of diseases. Some outlets reported that a canceled Dec. 19 press conference was set to announce this news. (An HHS spokesperson told reporters that the accounts about the topic of the press conference and planned changes were “pure speculation.”)
Explaining the rationale for his directive in a Dec. 5 post on Truth Social, Trump exaggerated the number of vaccines given to American babies.
“The American Childhood Vaccine Schedule long required 72 ‘jabs,’ for perfectly healthy babies, far more than any other Country in the World, and far more than is necessary,” Trump said in the post. In the past, he has incorrectly claimed that babies get “80 different vaccines” all at once.
It is difficult to give a single number for how many shots children receive in the U.S., but babies do not get 72 vaccines. As of early 2025, a child by age 2 was routinely recommended to get around 30 vaccine doses that protected against 15 diseases. Many of the doses are given in combination vaccines, however, so the number of shots given is typically lower. By age 18, the total number of doses could reach into the 70s, but only if including seasonal influenza and COVID-19 vaccines for every year.
“Getting to an exact number is difficult, given the flexibility in how vaccine doses are administered, but by any measure, any number that reaches the 50s or 60s, let alone 70s, invariably includes annual influenza vaccines and COVID-19 vaccines from birth through age 18,” Jason Schwartz, a professor at the Yale School of Public Health with expertise in vaccine policy, told us.
The CDC recommends, but doesn’t require, vaccines on the schedule, which influences what insurance policies and federal vaccination programs will cover. Vaccine mandates for school or day-care attendance are set by states, and there are exemptions.
Trump’s claim is similar to one made in a Food and Drug Administration presentation given earlier on Dec. 5 during the CDC’s Advisory Committee on Immunization Practices’ meeting. Dr. Tracy Beth Høeg, the new chief of the FDA’s drug division and ex-officio ACIP member for the agency, said that as of early 2025, the U.S. was “really an international outlier in giving 72 doses of vaccines.” She contrasted the total with those of four other countries, including Denmark. Høeg’s counting choices, however, served to inflate U.S. numbers while minimizing those of other nations.
Since June, when HHS Secretary Robert F. Kennedy Jr. dismissed all the committee members and installed new ones, ACIP has departed from its normal evidence-based processes and weakened some vaccine recommendations.
Exaggerations notwithstanding, these claims assume that recommending more vaccines for children is a bad thing. In fact, vaccines were added over time to the U.S schedule through an evidence-based process, with the goal of protecting children against more diseases. And even as the schedule has grown, the total number of antigens — the proteins or sugars in vaccines that stimulate an immune response — remains lower today than a century ago.
“More vaccines is actually a good thing,” Dr. Sean O’Leary, a pediatric infectious diseases specialist at the University of Colorado Anschutz, told us, adding that vaccines on the schedule are studied for safety and effectiveness and “the actual number is not an issue.” O’Leary is chair of the American Academy of Pediatrics Committee on Infectious Diseases. The AAP is a nonprofit membership group representing pediatricians. This year, for the first time in decades, the AAP issued different vaccine recommendations than the CDC.
Comparisons Obscure Schedule Similarities
Høeg and Trump are not alone in giving high estimates of U.S. childhood vaccine totals. This is a common strategy long used by anti-vaccine advocates to imply that the U.S. vaccine schedule has grown at an alarming pace.
It is challenging to come up with a single number of vaccines universally recommended in each country, as children can get protection against the same diseases using different combinations of vaccines. The reality, however, is that countries’ vaccine schedules are fairly similar, which becomes more apparent when looking at the number of diseases targeted.
“The core set of diseases for which vaccines are used is very similar across high income countries,” Dr. Andrew Pollard, a pediatrician and director of the Oxford Vaccine Group at the University of Oxford, told us. “However, there is some variation based on differences in disease burden and the way in which the health system works.” For example, he said, some countries place more emphasis on cost-effectiveness than others.
As of early 2025, the U.S. had universal recommendations targeting 17 diseases in childhood and adolescence, including the 15 targeted in early childhood plus meningococcal and human papillomavirus vaccines recommended at older ages. Again, there is some ambiguity in counting how many diseases a vaccine schedule targets and in deciding which nations are “peer, developed countries.” But looking at data on the 31 nations that are both members of the Organization for Economic Cooperation and Development and classified by the International Monetary Fund as “advanced economies,” 17 is just a few more diseases targeted than the median of 14, according to our analysis. (We did not count infant immunizations with antibody products that protect against respiratory syncytial virus, or RSV, in our totals, as these are not vaccines. Countries vary in whether they have adopted maternal vaccination, infant immunization or — as in the case of the U.S. — flexibility in choosing either.)
In recent months, the U.S. has walked back universal recommendations for hepatitis B and COVID-19 vaccination for children. That brings the current U.S. total down to 15.
Trump’s memo and Høeg’s presentation did include comparisons of the number of diseases targeted by Japan, Denmark, Germany and, in Høeg’s case, the U.K. But they did not place these countries in a larger context of high-income nations.
“The U.S. has a robust set of vaccine recommendations, and that reflects the priority on using the tools that are available to prevent illness and death, particularly in children, but the differences between the U.S. and peer countries have been overstated,” Schwartz said.
“The real outlier in this conversation appears to be Denmark,” he added.
Denmark is one of just three OECD advanced economy nations to not universally recommend the hepatitis B vaccine. It is also in the minority in not recommending vaccines against rotavirus, meningococcal disease or chickenpox. The U.S., on the other hand, is one of the few high-income nations to recommend vaccination against hepatitis A or to continue recommending universal COVID-19 vaccination until recently.
Seasonal Vaccines Lead to High Dose Counts
There is some truth to the idea that the U.S. vaccine schedule recommends a relatively high number of doses. However, anti-vaccine advocates often justify dramatically high numbers of doses compared with other countries by using misleading methods of counting.
In reality, a person could complete the U.S. childhood and adolescent vaccine schedule as of early 2025 while receiving less than two dozen shots and oral vaccines, not including flu and COVID-19 vaccines.
Høeg acknowledged during her presentation that in arriving at a count of 72 doses, she had counted “the yearly influenza vaccine,” but she omitted context on other countries’ flu vaccine recommendations.
The U.S. does stand out somewhat in having a longstanding universal recommendation for seasonal flu shots, including for children age 6 months and older. The universal childhood flu vaccine recommendations were progressively adopted in the U.S. in the 2000s, expanding to cover kids up through age 18 before the 2008-2009 flu season.
However, the U.S. is not alone in recommending childhood flu vaccination. In Europe, for example, flu vaccination recommendations for children have become more common in recent years, according to a November 2025 report from the European Center for Disease Prevention and Control. During last year’s flu season, six of the 30 European countries analyzed had universal recommendations throughout childhood beginning at 6 months, and another 13 countries had universal recommendations for certain age groups. (The remaining countries — including Denmark and Germany — recommended the vaccines to children with certain risk factors.) In our analysis of OECD countries with advanced economies, 21 out of 31 nations recommended universal flu vaccination for at least some portion of childhood.
In her dose comparisons, Høeg did not highlight vaccine recommendations from any countries that universally recommend these annual vaccines throughout childhood. Examples of these countries include Austria, New Zealand and Canada.
In her dose count for the U.K., which she reported as 17, Høeg appeared to omit annual flu vaccines, which are recommended every year from age 2 until around age 15.
The conclusion that the U.S. vaccine schedule ever included 72 doses also relies on counting yearly COVID-19 vaccines through age 18. But this relies on a counterfactual scenario in which annual shots were recommended for kids over an entire childhood. In the end, the annual doses were universally recommended starting at age 6 months for just over three years.
The U.S. was relatively slow among nations to drop its universal recommendation for COVID-19 vaccination in children. But even before Kennedy reconstituted the CDC’s vaccine advisory committee, the group had been moving toward a risk- and age-based approach to COVID-19 vaccinations.
This year, the AAP adopted recommendations similar to what the former advisory committee had been considering, urging kids under 2 to get vaccinated but backing away from a universal recommendation for all children. Under Kennedy, the CDC decided to recommend COVID-19 vaccination for all Americans 6 months and older under shared clinical decision-making. This means that people can discuss whether they need the vaccines with health care providers and get coverage for them if desired, but the vaccines are no longer universally advised.
Misleading Combination Vaccine Math
Another way anti-vaccine advocates inflate U.S. dose counts is by individually counting vaccines commonly given as a combination shot. The relative flexibility of the U.S. schedule and the availability of a variety of vaccines allows people to construct theoretical scenarios involving high numbers of doses.
In arriving at her count of 72 vaccine doses in the U.S. schedule, Høeg said on a slide in her ACIP presentation that she had counted vaccines against polio, hepatitis B, Haemophilus influenzae type b (Hib), and diphtheria, tetanus, and pertussis (DTaP) separately. These individual vaccines are available, but most babies get some doses in combination shots, experts told us.
“It would be highly unusual, if not unheard of, for a child to receive each vaccine separately,” Dr. Michelle Fiscus, a pediatrician and chief medical officer of the Association of Immunization Managers, told us, referring to the combination vaccines.
Meanwhile, countries like Denmark and the U.K. have less flexible schedules that include specific combination shots. In calculating her low totals of 11 and 17 doses in these countries, respectively, Høeg appeared to count combination shots as only single doses, despite not always doing this in the U.S. tally.
She justified this by saying that “part of the difference” between the U.S. and other countries is that the U.S. can give individual vaccines, “whereas Europe tends to give combination vaccines in those circumstances.”
The FDA did not reply to a request for more information on how Høeg calculated her figures.
Decision-Making in Denmark
Trump’s directive to consider emulating vaccine schedules from other nations also glosses over major differences between countries that shape their recommendations.
Countries are, of course, more likely to recommend vaccinations against diseases if they are common in the area. For example, the U.S. does not vaccinate routinely against “tuberculosis, typhoid, yellow fever, malaria, meningococcal disease (for infants), or dengue, while these are routinely recommended in other countries,” an AAP fact sheet said.
Other factors include those related to a country’s health system, such as availability of specific vaccines or combination vaccines, the timing of routine health visits and cost-effectiveness analyses, the fact sheet said.
“We’re the most well resourced country in the world, and so sometimes we adopt things earlier, because some other countries are more cost-conscious,” O’Leary said. “But it’s not that they’re concerned about safety issues.”
In some cases, the difference between the U.S. and other countries is not in whether vaccination is recommended at all, but in whether it is recommended universally.
For example, as we have previously written, Denmark takes a risk-based approach to hepatitis B vaccination that relies on testing pregnant women for the disease and tracking at-risk babies. ACIP members cited policies in other countries to justify recently changing the U.S. approach to a risk-based one, despite objections from experts who said that the U.S. had an inferior rate of screening and follow-up.
“What we know, at least in the U.S., is that risk-based approaches don’t work,” O’Leary said. “That’s been shown over and over again.” These risk-based approaches might work better in countries with universal health care systems and electronic health records that track people across their entire course of life, he said.
Høeg did mention cost and other practical considerations as a factor on some slides, but she also held up Denmark’s evidence-based practices as an example while sharing safety concerns about vaccines.
Denmark has a “research culture where they really rely on randomized control trials, extensive documentation about the decision-making, about which vaccines they do and don’t recommend,” she said. But experts rejected the implication that the U.S. recommendations vary from those in Denmark due to differences in transparency and rigor of decision-making.
“Certainly in the U.S., we have decades of evidence of careful deliberation regarding how to use our vaccines optimally, very transparent advisory committee processes that have functioned for decades, the very active vaccine surveillance programs that have existed for decades designed to respond to rare adverse events,” Schwartz said.
“Their decision-making is not any higher quality than ours,” O’Leary said of Denmark. It is only recently, with the appointment of Kennedy and the new ACIP panel, that the vaccine decision-making process has departed from the “normal process that has been built over decades in the U.S.,” he added.
“We consider the vaccines that are used in the US but not in Denmark to be safe and effective,” Anders Hviid, who studies vaccination and epidemiology at the Statens Serum Institut in Denmark, told us in an email. “Every country is different, and every country’s national responsible authorities must make their own decisions based on a careful evaluation of national epidemiology, cost, logistics, ethics etc.”
Vaccine Schedule Does Not ‘Require’ Shots
Trump also was incorrect in claiming that the vaccine schedule “required” 72 shots for “babies.” There are no national vaccine mandates in the U.S., unlike in some other countries, including in Europe, although the U.S. does rely on school vaccine requirements that are set by states.
The vaccine schedule is made up of CDC recommendations on how vaccines should be used at the population level, guided by the recommendations of ACIP. “While the ACIP recommendations are closely watched, they’re influential, they’re important in how we think and talk about vaccines in the United States, nothing ACIP does directly connects to whether a vaccine is required for a particular child,” Schwartz said.
States set vaccine requirements children must meet to attend schools and licensed day care, he said. Discussions about these requirements “often begin with ACIP recommendations as a starting point for whether to consider a particular vaccine requirement, but those decisions by no means derive automatically from ACIP’s action,” he added.
For example, while a few states recommend yearly flu shots for young children in day care, states do not recommend annual flu shots for school-age children, even though these are on the vaccine schedule. No states currently require COVID-19 vaccines in schools.
“The U.S. has certainly featured vaccine requirements more prominently than many of our peer countries,” Schwartz said, referring to the state-level school requirements favored in the U.S. to reach high vaccination rates. But that “has been changing in recent years, precisely because of declining vaccination rates, in western Europe in particular,” he added.
For example, Germany — highlighted as a peer nation by Trump and Høeg — in 2020 passed the Measles Protection Act, a national measles vaccine requirement for people being cared for in certain communal facilities, such as schools or day care, as well as those working in these and other facilities, such as hospitals. Since 2018, France has required childhood vaccination against a total of 11 diseases, an increase from a previous requirement for just the DTaP vaccine. The law is also enforced by barring children who have not met the requirements from attending schools or other settings where children gather.
One 2024 analysis of vaccination policy in Europe and the U.S. found that 12 out of 32 countries had at least one nationally required vaccine. A 2020 paper analyzing mandatory vaccination policies in Europe found that mandates were associated with a greater rate of people getting vaccinated and a lower rate of measles in countries that adopted them.
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