On Dec. 5, President Trump issued a memorandum directing the CDC to compare the United States childhood vaccine schedule with those used in peer nations. Other developed nations vaccinate successfully, achieve high uptake, and maintain stronger trust, yet their schedules often look meaningfully different from ours. The difference is not that they are “anti-vaccine.” It is that most peer nations organize their childhood programs around three straightforward questions:

• Is the disease common in childhood?

• Is it serious in childhood?

ª Does vaccination meaningfully reduce community-level spread?

Only when the answer to all three is yes do most countries include a vaccine in the universal childhood schedule. These criteria are not ideological. They reflect a simple commitment to ensuring that universal childhood recommendations are justified by childhood disease burden and by clear, population-level benefit. The United States does not consistently apply these filters, and understanding that divergence is key to understanding why our schedule is larger, earlier, and more complex than those in many peer nations.

The first question—is the disease common in childhood?—reflects a basic principle of proportionality.

Universal vaccination is typically reserved for infections that children routinely encounter in the course of normal life. Peer countries hesitate to place low-prevalence or age-skewed conditions into their childhood schedules unless there is an overriding public-health rationale. The goal is alignment: recommending universal vaccination only when........

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