Advisers to the Centers for Disease Control and Prevention unexpectedly postponed votes Thursday on proposed changes to the recommendation for universally vaccinating newborns against hepatitis B. The Advisory Committee on Immunization Practices (ACIP) pushed the contested votes to Friday after members said the wording of the proposals kept changing and required more time for review.
“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 measure under consideration would roll back a long-standing recommendation to give the hepatitis B vaccine at birth to all healthy newborns, regardless of maternal infection status. Committee members said the language of the ballot altered between postings on Friday morning and afternoon, prompting some to ask for written materials and more time to evaluate the changes.
Supporters of the current policy emphasize it aims to prevent missed cases of at-risk infants and to provide lifelong protection against hepatitis B, which can cause severe liver disease, including cirrhosis and liver cancer. Hepatitis B spreads through sexual contact, injection drug use, mother-to-infant transmission at birth, and exposure to infected body fluids in infancy. Chronic infection is more likely and more severe when acquired as an infant, and there is no cure.
The discussion exposed a sharp split among participants. Dr. Tracy Beth Høeg, speaking for 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,” she 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?”
Others defended continuing universal newborn vaccination. Dr. Cody Meissner, a pediatrics professor at Dartmouth’s Geisel School of Medicine, credited the current immunization program with reducing disease in the United States. When another adviser asked him to frame the remark as opinion, Meissner replied, “These are facts, Robert.”
Nonvoting liaisons from medical societies criticized how the process was handled. Dr. Jason Goldman, a liaison for the American College of Physicians, accused the committee of abandoning norms and said, “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. 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.”
The delayed vote made for a crowded Friday agenda. ACIP also plans to compare the U.S. vaccine schedule with other countries and examine alleged links between aluminum adjuvants used in many vaccines and asthma, a connection most medical professionals say lacks convincing evidence. Public health experts warned that recent moves could be part of broader efforts to restrict vaccine access in the U.S.; ACIP’s recommendations influence clinical practice and insurance coverage. Some mainstream medical groups say the committee has lost trust since Kennedy replaced its members in June with his own slate and that ACIP has reduced collaboration with organizations like the American Academy of Pediatrics and CDC experts.