Vaccine advisers to the Centers for Disease Control and Prevention unexpectedly postponed controversial votes Thursday on changes to the recommendation of universally immunizing newborns against hepatitis B. Confusion and disagreement over the wording of the votes led the Advisory Committee on Immunization Practices (ACIP) to push them to Friday.
“This is the third version of the questions that we have received in 72 hours, and we’re trying to evaluate a moving target,” said Dr. Joseph Hibbeln, a psychiatrist and voting member of the committee. “I protest the description that the ACIP members have been consulted in developing these questions.”
The planned vote would have focused on ending a longstanding recommendation to vaccinate all healthy newborns against hepatitis B, regardless of whether the mother tests positive. The language of the vote changed between its posting Friday morning and early afternoon, and some members wanted more time to review it in writing.
The current policy aims to ensure no at‑risk infant is missed and to provide lifelong protection against hepatitis B, a virus that can cause severe liver disease, including cirrhosis and liver cancer. Hepatitis B can be transmitted sexually, through drug use, from mother to infant during childbirth, and in infancy via contact with infected body fluids. Chronic infection is more likely and more dangerous when acquired in infancy; there is no cure.
The day’s discussion revealed a pronounced split among attendees. Dr. Tracy Beth Høeg, representing the Food and Drug Administration, questioned the need for a universal birth dose. “Babies who are born without high risk factors, without a mother who is antigen positive, without a family member who has hepatitis B – for these babies, the potential for benefit is so low,” Høeg said. “Why are we stating that it is absolutely necessary to give this dose at birth, when high income nations throughout the world are not?”
Dr. Cody Meissner, a pediatrics professor at Dartmouth’s Geisel School of Medicine, defended the policy. “This disease has gone down in the United States, thanks to the effectiveness of our current immunization program,” he said. When challenged by adviser Robert Malone to frame the comment as opinion, Meissner replied: “These are facts, Robert.”
Nonvoting liaisons from medical societies criticized the process as departing from ACIP norms. “As physicians, your ethical obligation is to ‘first, do no harm’ and you are failing in that by promoting this anti‑vaccine agenda without the data and evidence necessary to make those informed decisions,” said Dr. Jason Goldman, a liaison for the American College of Physicians. “Your job as a committee is to look at the totality of the risks and benefits, the harms, the equity, which you have not done.”
Postponing the vote created a crowded Friday agenda. In addition to the hepatitis B decision, ACIP plans to review how the U.S. vaccine schedule compares with other countries and examine alleged links between aluminum adjuvants—used in many vaccines to boost effectiveness—and asthma. Most medical professionals say there is no good evidence that aluminum adjuvants are unsafe.
Public health experts expressed concern that this week’s moves are part of efforts to undermine vaccine access in the U.S. ACIP wields significant influence because its recommendations shape clinical practice and insurance coverage. The committee has lost the trust of many mainstream medical groups since Kennedy replaced its members in June with his own slate, and it has scaled back longstanding collaborations with organizations like the American Academy of Pediatrics and the CDC’s internal experts.