In a historic vote, the Centers for Disease Control and Prevention’s vaccine advisory panel recommended narrowing the agency’s long-standing guidance to start hepatitis B vaccination at birth. If the CDC acting director approves the change, it would roll back a universal birth-dose recommendation used in the U.S. for more than 30 years that has been credited with dramatically reducing liver disease caused by hepatitis B.
The Advisory Committee on Immunization Practices (ACIP) voted 8-3 to recommend giving the hepatitis B vaccine at birth only to infants born to women who test positive for hepatitis B or whose status is unknown. For infants of mothers who test negative, the panel’s updated guidance says parents should discuss vaccination with their child’s doctor.
The committee also voted 6-4, with one abstention, to recommend checking infants’ antibody levels after each hepatitis B dose to decide whether additional shots are necessary. Because the standard infant series is three doses (at birth, 1–3 months, and 6–15 months), antibody testing could result in some children receiving only one or two doses rather than the three used in clinical trials. Dr. Adam Langer, a CDC official, warned that licensed vaccines were studied using a three-dose regimen and that stopping earlier based on antibody testing assumes efficacy not supported by existing data.
The votes reflected sharply divergent views among ACIP members. Members of a subgroup that reviewed the policy led the changes, while liaisons from the medical community strongly objected, arguing the universal birth dose has been a key factor in reducing hepatitis B among U.S. children. Dr. Grant Paulsen, representing the Pediatric Infectious Diseases Society, questioned why a working policy with demonstrated benefits would be changed over what he described as possibly theoretical safety concerns.
Several members who voted for the change have histories of questioning vaccine safety. Retsef Levi, a voting member and MIT professor, described the shift as “a fundamental change” that would prompt parents to weigh risks and potentially delay vaccination. ACIP vice chair Robert Malone framed the debate as unresolved questions about evidence of harm. The subgroup reviewing the policy was led by Vicky Pebsworth, a nurse and board member of the National Vaccine Information Center, an advocacy group critical of vaccines.
Opponents warned the change could increase infections. Dr. Cody Meissner, a pediatrician and the only current member with prior ACIP service, argued the hepatitis B vaccine is well established as safe and effective and warned that changing the recommendation risks more infections among children, adolescents and adults. He said “Do no harm is a moral imperative. We are doing harm by changing this wording.”
Those favoring preservation of the universal birth dose emphasized that risk-based approaches fail in practice because screening and identification systems miss cases. Dr. Su Wang, an internist and hepatitis B researcher, said babies can be exposed through microscopic blood and everyday exposures, and newborns cannot control who cares for them or others’ hepatitis B status. Dr. Natasha Bagdasarian, representing state and territorial health officials, said ambiguous language around shared decision-making could create a false perception of uncertainty and deter providers from administering the vaccine.
Critics also noted the committee voting this week was hand-picked by Health Secretary Robert F. Kennedy Jr., who has a long history of questioning vaccines. Kennedy’s tenure has included other changes narrowing access or modifying recommendations for vaccines, and the CDC is reviewing the broader childhood vaccine schedule.
Friday’s votes followed a failed attempt in September to change the universal recommendation. The earlier meeting became chaotic and was postponed. The vaccine-safety debate at this week’s meeting included testimony from figures outside mainstream vaccinology. Aaron Siri, a trial attorney who frequently litigates vaccine cases and has worked with Kennedy, spoke at length questioning established science on the childhood vaccine schedule and advocating for post-licensure safety studies and an end to vaccine mandates. ACIP member Meissner objected to Siri’s invitation, calling his presentation a distortion of the facts. Two prominent vaccine scientists, Dr. Peter Hotez and Dr. Paul Offit, were reportedly invited but declined to attend; Hotez said he declined because he believed ACIP had shifted away from evidence-based medicine.
Those arguing for change have suggested possible links between newborn hepatitis B vaccination and later health problems or autoimmune disease, but public health experts say cumulative evidence does not support such claims. Andrew Johnson, a Centers for Medicare and Medicaid Services policy analyst, said the vaccine would remain covered by insurance, including Medicaid and CHIP, and that the agency did not see coverage gaps in the proposed language.
Public health experts urged people to follow guidance from medical providers and professional organizations such as the American Academy of Pediatrics and the American Medical Association for science-based advice. The immediate public-health impact of narrowing the recommendation is uncertain, but many clinicians worry that weakening guidance could reduce vaccination uptake and leave vulnerable infants less protected against a virus that can cause liver cancer and cirrhosis and that infant immunization can provide long-lasting protection.