Pitting national health care systems against one another

by michael_b 2 min read24th Oct 201716 comments


I'm about to have a baby.  Any minute now.  Well, my partner is.  I'm just sitting here not growing a baby wondering what to do with myself.

Maybe I can get a jump on our approach to medical care for the new kiddo.

One thing that sticks out at me is that children in the US get a lot of vaccinations.  At my quick count it's something like 37 shots by the time they're 5.

I grew up in the US in the 80s and I don't remember getting nearly this many.  Is my memory faulty?  I'm pretty sure it was more like 12 back in those days.  Is this all really necessary? Nobody likes getting shots, especially not children.  What changed, anyway?

Now, I'm not an expert on immunology or epidemiology so I expect diving into the literature isn't going to be fruitful; I won't be able to ante up decades of education and experience fast enough.  Presumably this is what we pay people at the US CDC and Department of Health for.

But can you *really* trust them?  Aren't all of these vaccinations really convenient for the pharmaceutical industry?  Aren't there seemingly constant allegations/lawsuits about the over-prescription of drug interventions in the US?

The health care systems in major world countries have access to all of the same literature, and they're presumably staffed by educated, expert people too so they should all come to the same conclusions as the US system right?  Not so!

Here's how many shots each nation's health care system recommends by the time children turn 5.

37 US

25 UK

25 Germany

16 Sweden

16 Denmark

The intersection of vaccines being recommended are TDAP, MMR, Polio, HIB and PCB.

In the US we also recommend: Hep A, Hep B, Rotavirus, Meningococcus, Varicella, and yearly flu shots (for babies and children).

Can we explain the variance?  I can think of a few reasons they would vary.

1. Cultural bias.  This can be big.  A psychiatrist in the UK told me that they're not as pharma heavy as, say, psychiatrists in Germany because of a WW2 era bias: lots of the big pharma companies are German.

2. Cultural and environmental differences.  Some diseases are a bigger deal in some countries than others.  Japan (not included above) recommends immunization against diseases (TB, Japanese encephalitis) that none of the systems above are too concerned with.

3. Undue industry influence.  Run-of-the-mill corruption.

4. Quality of health care systems and social safety nets vary.

When it comes to cultural and environment differences I have a hard time imagining that the orthodoxy varies because Hep A is a much bigger deal in the US.  I presume the calculus changes based on your geographic neighbors, but is it a meaningful difference?  Or is it a counterproductive cultural bias?  For example, in the US we may spend more time thinking about diseases people in central America suffer from than the people in Denmark might, but do the neighbors in this case meaningfully translate to a higher disease risk?  Or are we vaccinating against unfounded fears?

Do the other nations vaccinate less than the US because their health care systems are worse?   Annoyingly (if you're an American) all of their health care outcomes rank better.

Is the US health care system more corruptible by industry influence?

Is the story a lot simpler and less sinister?  That the US vaccinates more than the rest of these countries because the balance of the US's health care system (access to treatment, quality of treatment) is worse?  Or is it because having to stay home with a kid that's sick with chicken pox (varicella) is not so big a deal in, say, Denmark, because the social contract is more forgiving of parents who miss work?

Does the poorer quality of health care in the US (going by international rankings) and the lower tolerance for parents missing work combine poorly with the undue influence of industry and therefore lead to more vaccinations?

On the flip side of this argument: so what if we vaccinate kids against more diseases than other countries?  Well, they're not free.  They cost money to administer, and cost tears because kids hate getting shots.  The health risks from vaccines aren't zero, either.  Vaccines have side-effects, and sometimes they're serious.  Those other nations (presumably) ran cost-benefit analyses too and came to different conclusions.  It would be nice if each country showed their work.  

When it comes to needles to stick my new kiddo with, I'm not really being persuaded to do more than the intersection of vaccinations between similar nations.  The fear that a doctor is about to stick my kid with a needle because there was a meeting in a shady room between a pharma rep and a CDC official is pretty powerful.  It doesn't seem like a strictly irrational concern either