The vaccine advisory panel for the Centers for Disease Control and Prevention is poised to recommend that the federal government drop guidance that all children be vaccinated for hepatitis B at birth.
The action would be a notable break with precedent. Since 1991, the CDC has recommended a universal hepatitis B vaccination for all newborns within the first 24 hours of birth. The Advisory Committee on Immunization Practices, the expert panel that advises the agency on vaccines, is slated to recommend “individual-based decision-making, in consultation with a healthcare provider,” for parents to decide to give the birth dose of the vaccine for hepatitis B-negative mothers. A vote was scheduled for Thursday, but was later delayed to Friday.
Hepatitis B is a serious liver infection that, in adults, often lasts less than six months. However, for some, particularly infants and children, it can become a chronic condition that leads to severe liver problems, including cancer.
The vaccine has come under scrutiny from anti-vaccine advocates within the “Make America Healthy Again” movement, in part because hepatitis B among adults is spread through sexual contact or intravenous drug use. However, infants and children can be exposed to the virus both through birth to hepatitis B-positive mothers or through close contact with an infected caregiver.
Infants born to those mothers who are unknowingly hepatitis B-positive are 90% more likely to go on to develop chronic hepatitis B and eventually die from liver cancer or liver disease.
Giving newborns the first dose of the hepatitis B vaccine in their first 24 hours of life was recommended by the CDC after the more targeted approach of only vaccinating known-positive mothers failed to reduce infection rates significantly. The agency originally recommended testing each mother before making the decision to vaccinate, but the body eventually switched to a universal vaccine policy to prevent patients from falling through the cracks.
The draft language does not explicitly recommend against a dose of the vaccine given to an infant within the first 24 hours of life, but recommends that parents who choose against the initial birth dose get their children vaccinated “no earlier than 2 months of age.”
“Parents should consult with health care providers and decide when or if their child will begin the HBV vaccine series. Parents and health care providers should consider vaccine benefits, vaccine risks, and infection risks,” says the draft vote language posted on the CDC website as of Wednesday.
Internal conflict over recommendation language
During the meeting, Dr. Robert Malone, interim committee chairman and a vocal critic of COVID-19 vaccines, announced that an update was made to the language posted on the CDC website on Wednesday, specifically affirming the “current standard of care” to give the vaccine to infants whose mothers’ hepatitis B status is unknown.
Although the vote was originally scheduled for Thursday afternoon, the committee members decided to postpone the vote on the amended recommendations to Friday morning after intense discussions about the precise language of the recommendations.
Dr. Joseph Hibblen, an ACIP member, protested after Malone read the voting language that committee members who were not part of the childhood vaccine schedule working group did not have enough time to review the text.
“This is the third version of the questions that most of the [ACIP] received in 72 hours,” Hibblen said in a dramatic moment during the full-day session. “We’re trying to evaluate a moving target.”
ACIP was supposed to vote on the birth dose of hepatitis B during its September meeting, but the discussion leading up to the original vote turned heated following missing evidence, including the risk of infection for infants born to hepatitis B-negative mothers.
Malone said during the start of Thursday’s meeting that the September vote rescheduled for the December meeting was “not about hesitation or reluctance, it was about standards.”
“When gaps in the evidence emerge, the responsible action is not to push forward. It’s to pause review, ensure that we fully understand what the data can and cannot support, and then formulate independent advice to the CDC director,” Malone said.
President Donald Trump weighed in on the controversy following the September meeting, saying he believes there is “no reason to give a baby” the hepatitis B vaccine and recommended that parents “wait ‘til the baby is 12.”
The matter has caused friction within the GOP, particularly among physician members of Congress.
Sen. Bill Cassidy (R-LA), a physician who ran a hepatitis B clinic in Louisiana before his political career, has been a staunch proponent of the universal perinatal dose of the vaccine as a safety net for underprivileged mothers and infants who do not receive appropriate prenatal care.
On Thursday morning, Cassidy highlighted on X that Aaron Siri, a high-profile litigator against vaccine manufacturers, will provide testimony on Friday regarding vaccine ingredients. He said Siri’s slated testimony undermines the credibility of the ACIP.
Vicky Pebsworth, leader of the ACIP’s hepatitis B working group, said during the meeting that the CDC’s recommendation needs “to address stakeholder and parent dissatisfaction.”
TRUMP PARDONS AND COMMUTATIONS: NOTABLE ACTS OF CLEMENCY IN HIS SECOND TERM
Pebsworth is affiliated with the anti-vaccine group the National Vaccine Information Center, which provides legal support for parents who believe that vaccines caused their children’s autism or other adverse health conditions.
Positive effects of universal vaccination
Several presenters and panel members argued that the universal vaccination policy has not been helpful in lowering hepatitis B infection rates, instead attributing the decline since the 1980s to other, more targeted public health measures.
Dr. Cynthia Nevison, who is affiliated with the anti-vaccine group Children’s Health Defense, argued that universal vaccination has had less of an effect on lowering hepatitis B infections than needle exchange programs, safe sex practices, and improved testing of expectant mothers, all of which were implemented around the same time as the vaccine.
The researchers also noted that immigrant populations from southeast Asia and Africa have higher risks than “the average American child.”
Dr. Cody Meissner, an ACIP member and professor of pediatrics at Dartmouth University, strongly disagreed with their interpretation of the data.
“This disease has gone down in the United States thanks to the effectiveness of our current immunization program,” said Meissner, who was also a member of ACIP in the early 2000s, after the universal hepatitis B vaccine policy was established.
Some of the panelists opposed to universal vaccination noted that most western European countries only recommend the vaccine for high-risk populations. They noted that Denmark, in particular, has had success with this policy in keeping their rates low.
DEMOCRATS NEED TO TEMPER THEIR EXPECTATIONS OF A 2026 BLUE WAVE, DATA SHOW
Dr. Su Wang, a nonmember participant and physician who has chronic hepatitis B contracted in infancy, commented that it is not prudent to compare U.S. hepatitis B rates to Denmark because “they are not us.”
“They have a universal healthcare system, and have less than 20 acute Hep B cases a year. The U.S. is more than 50 times their size, and a population much more diverse, and we have a complex, not coordinated healthcare system,” Wang said. “We also have more than 14,000 acute Hep B cases a year.”
