President signs a memorandum directing the CDC to align the U.S. childhood vaccination schedule with peer countries; the agency removes coverage for six diseases.

The President, on Friday, issued a presidential memorandum titled Aligning United States Core Childhood Vaccine Recommendations with Best Practices from Peer, Developed Countries. The memorandum directs the Department of Health and Human Services and the Acting Director of the Centers for Disease Control to update the U.S. childhood vaccination schedule to mirror, where superior, the practices of peer nations.

The CDC accepted the directive the same day. Six diseases dropped from the recommended list. The recommended schedule, going forward, covers eleven diseases instead of seventeen.

The memorandum, in support of the action, asserts that Denmark recommends vaccinations against ten diseases, that Japan recommends fourteen, and that Germany recommends fifteen. Three observations are in order.

First, the cited figures count differently than the U.S. count. National schedules group combination vaccines and disease coverage by varying conventions. The European Centre for Disease Prevention and Control’s published catalog, which is the apples-to-apples reference, does not produce the figures the memorandum cites.

Second, the diseases removed include several whose absence from the schedule has, in other countries, produced documented outbreaks. Pediatricians’ associations have spent the afternoon drafting clinical guidance to fill the gap the schedule no longer addresses. The guidance is being distributed by Friday evening through state pediatric societies.

Third, the framing of the memorandum is aligning with peer countries. Alignment, in policy writing, implies a target. The target asserted is the schedule of comparator countries. The schedule of comparator countries, on the actual published documentation, does not match the schedule the memorandum produces. The U.S. schedule, after the action, is more restrictive than the schedules of the countries cited as the model.

There is a smaller observation that bears noting. The memorandum was signed without a press conference. The Acting CDC Director’s decision memorandum, accepting the directive, was published the same afternoon, without a press conference. The pediatric societies’ responses, the children’s hospitals’ guidance documents, and the parents’ phone calls to their pediatricians, started Friday night and have not yet stopped.

A serious country does not adjust the childhood vaccination schedule by memorandum on a Friday afternoon, citing comparators it has misread, while the agency that runs the schedule signs the order under direction.

Calmly documenting the decline.