Despite having a strong healthcare system, vaccine hesitancy and mixed messages from government have curtailed some immunization efforts.Credit: Carl Court/Getty
When US officials announced earlier this month that they were shrinking the country’s roster of recommended childhood immunizations, physicians and scientists alike wondered what to expect. How much would infectious disease rates rise? Who would be most affected?
Half a world away, specialists in Japan say they have some hard-won wisdom to offer. They watched flu and pneumonia deaths spike after the Japanese government stopped pushing parents to have their children vaccinated against influenza. They witnessed rubella outbreaks driven by shifting vaccine guidance that left a segment of the population vulnerable. And they saw an unfounded media scare turn the public away from immunizations against human papillomavirus (HPV), which is responsible for nearly all cases of cervical cancer.
From that perspective, the US decision to pull back from vaccines is bewildering, several researchers told Nature. “It was shocking,” says Akihiko Saitoh, a paediatrician at Niigata University Graduate School of Medical and Dental Sciences in Japan. “The US had been leading immunization policy around the world. Now, it’s a completely different story.”
Changing schedules
The new US childhood vaccine roster, announced on 5 January, no longer recommends that all children should receive vaccines against rotavirus, COVID-19, influenza, meningococcal disease, hepatitis A and hepatitis B. That does not mean the vaccines will be out of reach: several remain recommended for certain high-risk groups, and all of the vaccines will still be covered by federal health-insurance programmes. Parents can still make their own decisions about whether their children receive the vaccines, at least for now.
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Even so, the abrupt shift in guidance and rhetoric from the US government could affect vaccination rates by fueling vaccine hesitancy, which was already rising in some pockets of the country. And the absence of government backing for vaccines could create a legal risk for physicians who provide them, ultimately discouraging paediatricians from offering or encouraging immunization.
“There’s uncertainty about what might happen,” says Lauren Meyers, a computational epidemiologist at the University of Texas at Austin, “both in terms of how it will impact people’s behaviour, and what public-health and health-care impacts it will have.”
But some researchers in Japan say there are a few broad lessons to be learnt from their country’s troubled history with vaccines. Although Japan is a wealthy country with a strong health-care system, it has experienced several cases in which vaccine hesitancy and reduced government recommendations led to a decline in immunizations. In some cases, this was then followed by a scramble to catch up on missed vaccines when recommendations were reinstated.
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