In a controversial decision, the CDC’s vaccine advisory panel voted to narrow a decades-old U.S. recommendation to give the hepatitis B vaccine at birth. The Advisory Committee on Immunization Practices (ACIP) voted 8–3 to advise that the birth dose be given only to infants born to mothers who test positive for hepatitis B or whose infection status is unknown. For infants whose mothers test negative, the committee’s updated guidance recommends a discussion between parents and the child’s clinician rather than an automatic birth dose.
The committee also voted, 6–4 with one abstention, to recommend checking infants’ antibody levels after each hepatitis B shot to determine whether additional doses are needed. Because the licensed infant series was studied as three doses (birth, 1–3 months, and 6–15 months), critics warned that relying on post-vaccination antibody testing could leave some children with only one or two doses, an approach not validated by the original trials. CDC official Dr. Adam Langer cautioned that licensed vaccines were evaluated using a three-dose regimen and that omitting doses based on antibody testing assumes effectiveness that current data do not support.
The votes exposed sharp divisions within ACIP. A subgroup that reviewed the policy, led by Vicky Pebsworth, pushed the change; several members who supported it have histories of questioning vaccine safety. Retsef Levi described the shift as a “fundamental change” likely to prompt parents to weigh risks and potentially delay vaccination, while ACIP vice chair Robert Malone framed the debate as unresolved questions about possible harms. Liaisons from the medical community strongly objected, arguing the universal birth dose has been a major factor in dramatically reducing hepatitis B–related liver disease among U.S. children.
Opponents warned the change could lead to more infections. Pediatrician Dr. Cody Meissner, the only current member with prior ACIP service, emphasized the vaccine’s established safety and effectiveness and said changing the recommendation risks harm. Other clinicians argued that risk-based approaches fail in practice because prenatal screening and identification sometimes miss infected mothers; newborns can be exposed through tiny amounts of blood or routine care and cannot control caregivers’ infection status. State health officials also warned that language encouraging “shared decision-making” could create a perception of uncertainty that deters providers from administering the vaccine.
The committee’s composition and leadership have drawn scrutiny: critics noted the panel was appointed by Health Secretary Robert F. Kennedy Jr., who has a history of vaccine skepticism. The votes follow an attempted change in September that was postponed after a chaotic meeting. This week’s discussion included testimony from outside figures who question mainstream vaccine science; some prominent vaccine scientists reportedly declined invitations to attend.
Public health agencies maintain that cumulative evidence does not support claimed links between newborn hepatitis B vaccination and later health problems. Officials say insurance coverage, including Medicaid and CHIP, would continue under the proposed language. Still, many clinicians worry that weakening the universal birth-dose recommendation could reduce uptake and leave vulnerable infants less protected against a virus that can cause cirrhosis and liver cancer, whereas infant immunization provides long-lasting protection.
The change must be approved by the CDC acting director to take effect. In the meantime, public-health experts urge families to follow guidance from medical providers and professional organizations such as the American Academy of Pediatrics and the American Medical Association for evidence-based advice.