Changes to US public health guidance are raising questions for Canadian physicians and patients. An updated childhood vaccine schedule by the US Centers for Disease Control and Prevention (CDC) omits several vaccines that had been recommended for all children. Vaccines now fall into the following three categories: those recommended for all children, those recommended for children based on risk factors, and those for physicians and parents to jointly decide on. Vaccines for hepatitis A and B, meningococcus, rotavirus, respiratory syncytial virus, influenza, and COVID are no longer universally recommended.

“Canada, the provinces, the National Advisory Committee for Immunization [NACI] — we have very long-standing and well-thought-out processes that we follow,” Marina Salvadori, MD, senior medical advisor at the Public Health Agency of Canada and NACI, told Medscape News Canada. “We make all our own decisions and do not mirror any country, including the US. So, this should have no effect at all on our current recommendations or immunization schedule.” 

The World Health Organization (WHO) has set the gold standard for vaccine advisory programs or National Immunization Technical Advisory Groups (NITAGs), Salvadori explained. NACI, the NITAG in Canada, is well respected worldwide and has multidisciplinary members who are world leaders in vaccine science, she said. NACI considers many factors (like the burden and severity of illness, long-term consequences of disease, characteristics and safety of the vaccine, potential benefits and side effects, and cost effectiveness) before making recommendations. 

In Canada, vaccines undergo several layers of scrutiny. After approval by Health Canada, they are reviewed by NACI, which makes recommendations. From there, each province, often with its own immunization committee, reviews and incorporates the recommendations into provincial vaccine schedules.

In contrast, the NITAG in the US (the CDC’s Advisory Committee on Immunization Practices) was recently disbanded and reconstituted without following best NITAG practices or disclosing conflicts of interest.

Misleading Comparisons

In December 2025, the CDC made the controversial decision to end universal hepatitis B immunization for infants born to women who test negative for the virus. A month later, a graphic circulated by US President Donald Trump erroneously implied that European children receive 11 vaccinations, while US children receive 72.

The CDC’s message and the president’s graphic were misleading, Christos Karatzios, MDCM, pediatric infectious disease specialist at Montreal Children’s Hospital, told Medscape News Canada. The numbers of vaccines on the childhood vaccine schedules in Canada and European countries like Denmark were comparable with the number of vaccines in the US before the CDC’s update.

The discrepancies may result in part from the counting of combination vaccines as multiple separate vaccines and the inclusion of vaccines up to age 18 years. Still, Karatzios was unable to calculate how the alleged total of 72 vaccines was reached.

“Denmark has a different healthcare system. They have an excellent and robust public health reporting system and disease surveillance system. People have access to universal healthcare. So, the screening strategies for diseases are much more robust in Denmark than they are even in Canada,” said Karatzios. “What makes sense for Denmark does not make sense for the US and definitely doesn’t make sense for Canada.”

Too Soon to See Effects of Change

Without universal vaccination for diseases such as hepatitis B in the US and, to a lesser extent, in Canada, patients who are not screened because they lack access to healthcare or are uninsured will fall through the cracks, Karatzios explained. A CDC study demonstrated that vaccination alone prevented 6 million hepatitis B infections, hospitalizations, and deaths over 30 years.

“The recent events certainly raised concerns over the potential of seeing a further increase in vaccine hesitancy among Canadians, but I think it’s really, really too soon to know what, if any, impact that will have,” Julie Bettinger, PhD, professor of pediatrics at the University of British Columbia in Vancouver and researcher at the Vaccine Evaluation Centre within the BC Children’s Hospital Research Institute, told Medscape News Canada.

Anyone can be or become vaccine-hesitant, regardless of religion, age group, or province of residence, Bettinger emphasized. The key in communicating with the 17% of Canadian parents who are vaccine-hesitant is by answering questions directly and addressing specific concerns. Family doctors on the front lines can make a big difference by actively recommending vaccination and engaging in those difficult conversations, she added.

To counsel any parents with doubts resulting from the changes in the US, Karatzios said, “We are not the US. We are more conservative when it comes to vaccination because we want to target all our population, and that’s a good public health policy.”

“Canadian parents should be reassured that we’ve had long-standing processes that are robust, scientifically based, and constantly under scrutiny to continue to deliver what we all want, which is the best and healthiest childhood for all the children who live in Canada,” Salvadori added. 

Salvadori, Karatzios, and Bettinger reported having no relevant financial relationships.

Allen Chang, MDCM, is a journalist and geriatric medicine subspecialist at Nova Scotia Health Authority and an assistant professor at Dalhousie University in Halifax.