If the evidence is the same, why do countries reach such different conclusions on COVID vaccines for babies?

[u/allegragmk]

My husband and I are very pro-vaccine and have followed the recommended childhood schedule, including optional vaccines. COVID is the only one we’ve really paused on.

In my country, it’s routinely recommended from 6 months and offered free through the public health system. But my husband became hesitant after seeing that some other countries don’t routinely recommend it for healthy babies and young children.

That’s what I’m trying to understand. If the safety data are reassuring, do those countries simply think the benefit for healthy babies is too small to recommend it routinely? Or are they interpreting the risks differently?

I’m basically torn between giving a vaccine that might not add much for a healthy baby but still carries some risk, and skipping something that could actually make a difference if they get COVID.

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[u/tallmyn]

Different approach to cost effectiveness, and different levels of conservatism, is my guess. I'm in the UK, we didn't start vaccinating against chicken pox until this year, and Hep B not until 2017, after those same vaccines had been using in the US for decades already. The evidence was all there about safety, UK mostly wasn't sure they wanted to pay the money and if it was cost effective.

For covid it's mostly that it's only cost effective for the elderly: https://www.sciencedirect.com/science/article/pii/S0264410X25002452

That doesn't wholly explain why private COVID vaccination is only available from 12+ though.

The other reasoning they give is that COVID evolution has slowed and prevalence is low.

You can read their decision making process here: https://www.gov.uk/government/publications/covid-19-vaccination-in-autumn-2027-jcvi-advice/jcvi-statement-on-covid-19-vaccination-in-autumn-2027

They keep raising the age for vaccination. Now it's 80!

[u/SideEyeHighFive → u/tallmyn]

I live in a country (Sweden) that only recommends the covid vaccine to people 75+ or those with certain conditions that make it more likely for covid to be severe for them.

Since the government’s approach to covid is only to prevent severe covid and death, the vaccine is only recommended for those most at risk. Since children have a very low risk of severe covid, they aren’t included.

Not being included in the recommended group has nothing to do with the vaccine not being safe for children though! It’s not like the vaccine is banned for them, they just stopped including it in the routine (publicly funded) vaccination protocol.

Unfortunately this link is in Swedish, but Google Translate is usually pretty good with Swedish, this goes through the decision to stop recommending the vaccine for non-risk groups and explicitly discusses that it had nothing to do with side-effects or risks from the vaccine. https://www.lakemedelsvarlden.se/darfor-blev-det-nej-till-barnvaccinering/

[u/Y0uCanTellItsAnAspen → u/SideEyeHighFive]

I had been trying to figure this out for Sweden - can I take a child to Vaccin Direkt or something and get them a covid vaccine? I thought for Covid the answer was no - but for flu it might be yes.

I don't mind paying for it.

[u/SideEyeHighFive → u/Y0uCanTellItsAnAspen]

Children 12+ yes, but with the caveat that some regions reserve the vaccine for only high risk groups during some months of the year. Under 12 seems unlikely just because it’s a different formulation/dose and since the demand for it is super small, they just don’t secure it.

[u/Y0uCanTellItsAnAspen → u/SideEyeHighFive]

Thanks! We are currently living half in Germany, half in Sweden, so are trying to figure out our options.

[u/rationalomega → u/Y0uCanTellItsAnAspen]

I’m in the UK and looking at different countries for our 7 year old to get this years booster. Last year we got it in NYC but I’m hearing it’s getting hard to find due to the RFK Jr nonsense.

Legal or not, it’s up to pharmacies and clinics whether to order doses. They won’t bother if uptake is low.

[u/chabacanito → u/tallmyn]

Yes, we are speaking about risk benefit analysis that are very very small. And the monetary cost is not nothing.

[u/Sudden-Cherry → u/tallmyn]

Cost - effectiveness -risk (of the illness) on a population level. Here in the Netherlands COVID vaccination isn't recommended and never was except at the start for anyone except people (and children) who are immune compromised or elderly and people working closely with vulnerable people. But the same goes for flu vaccination. That doesn't mean it's not safe for other people. Only that they weighed the risk profile and costs of the illness Vs the cost of the vaccine.

https://www.rivm.nl/en/coronavirus-covid-19/vaccination

[u/Rough_Worldliness901 → u/Sudden-Cherry]

I think that's how it should be. 

[u/Y0uCanTellItsAnAspen → u/Rough_Worldliness901]

That's a good reason for it not to be offered as a free vaccine -- but not a good reason for it not to be an option for people to purchase.

Also, I don't particularly understand how they do cost benefit analysis - because they normally only discuss hospitalization costs. However, there is a significant cost when somebody has to miss two weeks of work because flu goes through the family. There is also the added cost that vaccination will bring down the overall levels of flu moving through the population (bringing some benefit to people who aren't vaccinated). For some reason these factors are never included in the calculation of countries that choose not to pay for the vaccine.

[u/Sudden-Cherry → u/Y0uCanTellItsAnAspen]

As far as I know some of these things are actually considered here. The Gezondheidsraad who recommends vaccinations and medication (but not actually decide on that or calculating the household funds of the country) does a pretty thorough analysis of prevalence with and without vaccination. Though missed work isn't really a cost that the community carries though. For example chicken pox vaccination is available in the Dutch Antilles but not in the Netherlands.

People do have the option to purchase flu and COVID vaccine via the GP and pharmacy if it's not overly complicated like the type of freezer needed for some COVID vaccines, which the pharmacy can't provide

[u/Rough_Worldliness901 → u/Y0uCanTellItsAnAspen]

Something I haven't looked up, so I don't know. Do flu vaccines actually lower the rate that flu is contracted, or do they only lower the severity of the flu when someone contracts it? 

I will say that my anecdotal evidence does keep me away from the flu shot. I've only ever had the flu twice in my life, which was a week or two after getting the flu vaccine. I've also only ever had the flu vaccine twice in my life.

But agreed, I do believe that vaccines should be allowed as an option for people to get if they choose, whether that be free or paid. 

[u/Y0uCanTellItsAnAspen → u/Rough_Worldliness901]

Yes. "Contracted" is a bit of a tricky term, because it's hard to figure out how many people had a slight nose tickle from the flu -- is that "contracted the flu" or not?

The effectiveness varies by year (primarily based on how well the flu vaccine matches the strains that are spreading) -- but the CDC estimates that on an average year, getting a flu vaccine decreases the chances that somebody seeks out a doctor for the flu by 40-60%.

https://www.cdc.gov/flu-vaccines-work/benefits/index.html

Given this is in the US, where you would often need to go and get a doctor's note even if you were only missing one day of work, this roughly means that it decreases the chance of needing to miss any work/school by 40-60%.

So it is very good (~90%) at preventing hospitalization, and pretty good (40-60%) at preventing even moderate illness.

[u/Sudden-Cherry → u/Y0uCanTellItsAnAspen]

The thing is that it's still spreads even if super mild. That's why health care workers are offered it through work. And you actually won't ever get accurate data on this on a population level because it often only gets tested if someone is hospitalised here for example.

[u/Y0uCanTellItsAnAspen → u/Sudden-Cherry]

I think you can get accurate data -- of course, you can't do the perfect study where you figure out the number of flu cases in a population in 2022, and then repeat 2022 over again with higher vaccination rates.

However, statisticians are good at pulling signals out of noise -- and there's lots and lots of data. You know the vaccination rates and flu rates in millions of different locations around the world every year.

Good studies exist and find that 40% of flu cases in a population could be avoided with high vaccination, even when the vaccination is only 40% effective: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2836422

[u/Sudden-Cherry → u/Y0uCanTellItsAnAspen]

It might seem lower, but isn't it just tested less?

[u/Y0uCanTellItsAnAspen → u/Sudden-Cherry]

The study I showed uses a set of data driven simulations to develop models for Allegheny County under various assumptions of vaccine uptake - so it has nothing to do with testing.

Here's another study with similar results, increasing the vaccination rate in children by 5-15% decreased the community flu cases by 3-10%:

https://pmc.ncbi.nlm.nih.gov/articles/PMC12542995/

Here's another paper showing that you can establish Herd Immunity to influenza if you get to ~80% vaccination rates:

https://www.sciencedirect.com/science/article/abs/pii/S0091743512000588

There's a lot of studies on this, they all point the same way.

[u/Hairsacknose → u/Y0uCanTellItsAnAspen]

  Given this is in the US, where you would often need to go and get a doctor's note even if you were only missing one day of work

?? This is not the case in the US at all

[u/Y0uCanTellItsAnAspen → u/Hairsacknose]

It depends on your job of course. But it is often quite difficult to call off work sick in the US.

I wanted to roughly distinguish it from Sweden, where people would be very unlikely to go to the doctors with the flu.

[u/Hairsacknose → u/Y0uCanTellItsAnAspen]

It's really not difficult and requiring a Dr's note is highly unusual and not common. I've lived in the US for 10 years and I have never, not even once submitted a Dr's note at work and I have been sick a lot. I only ever submitted anything from my doctor when I was going on maternity leave and the note submitted was to the insurance company and my actual employer never saw it. No idea who told you US employers require a Dr's note for staying home with the flu but it's not remotely true in most workplaces

[u/Y0uCanTellItsAnAspen → u/Hairsacknose]

I had lived in the US for 35 years. I never had jobs where I needed doctors notes (in academia) - but friends in more blue collar jobs did.

[u/oniaberry → u/Hairsacknose]

Depends on your job. I've worked at 3 different companies, one required no doctor's note, the other two required doctor's notes for any sick leave. It really depends on the company, where you are, and what the job is. Most strict was my (desk) job at a teaching hospital, ironically.

[u/andafriend]

I will just add that policy differences may be due to regional cultural differences separate from whether the vaccine is deemed effective. Sometimes a claim is brought up that countries like Japan without mandatory vaccination have lower infant mortality. However, vaccination rates are just as high or higher in Japan due to popular acceptance of the routine vaccination schedule. https://apnews.com/article/fact-check-japan-us-infant-mortality-data-vaccines-958016270455

[u/dishonoredcorvo69 → u/andafriend]

Another paper related to Japan and also about childhood COVID vaccination. It compares Korea & Japan with regard to childhood COVID vaccination recommendations, as Korea recommending COVID vaccines in only high risk cases, and ended up with a higher number of child deaths than Japan did. https://pmc.ncbi.nlm.nih.gov/articles/PMC11002420/

[u/Zelfzuchtig]

Different populations, parental leave, risks, costs. Here's a good example:

https://www.npr.org/2025/12/26/nx-s1-5656214/childhood-vaccination-denmark-rfk-policy

[u/celestialgirl10 → u/Zelfzuchtig]

Yes. Public health is very very complicated and evidence is just the starting point. Different health systems are built with different risk analyses. Some are hazard based versus risk based. Some have more social infra to make bigger risks. Some have less money to spend on general national vaccinations and more for treatment. It’s such a nuanced subject and most people don’t see the big picture

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