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

The U.S. Centers for Disease and verify and bar (CDC) in betimes jan proclaimed updates to its recommended child and adolescent vaccine schedule, reducing the number of universally recommended immunizations from 17 to 11 — but infectious disease experts here say they don’t expect Canada to follow suit.

"Just because the CDC has changed their recommendation, I do not see Canada changing their recommendations,” said Alberta pediatrician and infectious diseases specialist Dr. Cora Constantinescu. There’s “no new evidence having come out in our populations.”

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

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

Each considers what’s in “their own budget, their own public health resources and think about, ‘How can we purchase the immunization, and do we have the ability to deliver the immunizations?’ and within what time frame.”

And as disease patterns shift, so does the guidance. 

For example, when public health officials in Nova Scotia declared a meningitis outbreak in 2022 at Dalhousie University in Halifax, the province began offering meningococcal B (Men-B) vaccines to those in post-secondary institutions — something it continues to do. 

Though the Men-B vaccine isn’t part of its childhood immunization schedule, the province’s response shows how public health bodies can revise their guidance based on epidemiological trends. 

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"You kind of have to make a decision budgetarily based on what is the risk of our population being exposed to the disease," said Constantinescu. 

She adds that provinces and territories also differ when it comes to vaccine access and uptake. 

“Places like Ontario may have more of a concern about vaccine access,” said Constantinescu.

“Whereas places like Alberta may actually have pretty good vaccine access but more concerns around confidence [in vaccine safety].”

In announcing its revisions to the pediatric immunization schedule, the U.S. Department of Health and Human Services issued a fact sheet suggesting it was influenced by the guidelines of other "peer, developed nations" that offer fewer childhood vaccines.

Those include places like Denmark, Japan and Germany — all countries with vastly different populations than the U.S., whose citizens, for the most part, have better access to the health-care system.  

Infectious diseases specialist Dr. Caroline Quach-Thanh said it doesn't make sense to change public health recommendations based on countries who deliver health care quite differently than the U.S. 

"Denmark has a publicly funded health-care system like Canada, which the U.S. Doesn't," said Quach-Thanh, who is also Quebec's director of public health, in an interview with The Dose host Dr. Brian Goldman.

Denmark recommends that children receive roughly 10 immunizations, excluding shots like the hepatitis B vaccine. 

In the case of that immunization, Quach-Thanh says the Danish health-care system tests pregnant parents for hepatitis B, follows the parent throughout pregnancy and determines if a child might need a hepatitis B vaccine at birth.

Previously, in the U.S., “given the greater proportion of women who did not have a followup of their pregnancy, then they thought it was safer to give a birth dose of hepatitis B to everybody," said Quach-Thanh. 

But as of December 2025, U.S. Babies will only be vaccinated for hepatitis B within 24 hours of birth if their parents have tested positive for the disease — a policy the country used in the 1980s that was considered ineffective at preventing the spread from parent to child, which is why the universal vaccine was adopted.  

According to Constatinescu, it's "not common" for countries to no longer recommend certain vaccines, especially when the corresponding diseases continue to circulate. 

"You have to have no threat of that disease to your population," she said. 

"As long as that disease exists somewhere else in the world, you'd have to have a very careful risk analysis on whether your population is going to be re-exposed to that disease."

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

She adds that different vaccines exist for varying reasons — like preventing severe infection, hospitalization and even death.

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"All this to say that when people introduce these vaccination programs, a lot of thoughts, economic analyses, go into coming up with a schedule like that," said Constantinescu. 

Despite the change in guidelines, the CDC still suggests that "high-risk" groups receive all previously recommended vaccines. Additionally, families won't have to pay out of pocket if they choose to get all of the previous vaccines, regardless of their children's risk status. 

Nonetheless, Quach-Thanh says the vaccine recommendation changes in the U.S. Are concerning because the decision wasn't made based on scientific consensus. 

"When we make recommendations and when we make decisions, it takes reflection," she said. 

"It takes discussion. It takes debate. You do a literature review. All those steps that we still do in Canada and that we'll keep on doing to make sure that the decisions that we take are evidence-based."

Constatinescu says she hopes to see a “vaccine confidence movement” emerge in Canada, to combat some of the rhetoric emerging from places like the U.S. 

As for parents concerned about travelling to the U.S., infectious diseases specialist Dr. Sumon Chakrabarti says that fully vaccinated children will be protected regardless of the recommendations in the U.S.

Still, he cautions parents with immunocompromised children to follow disease outbreaks before making travel decisions. 

“If you went to Texas at a certain point last year, you're at risk contracting measles, but that's why we have our vaccinations,” said Chakrabarti. 

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

Associate Producer

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