The Advisory Committee on Immunization Practices (ACIP), a panel within the Centers for Disease Control and Prevention (CDC), has voted 8-3 to discontinue the longstanding recommendation that all newborns receive the hepatitis B vaccine at birth. This decision, made on December 5, 2023, marks a significant shift in public health policy regarding hepatitis B vaccination, influenced by Health Secretary Robert F. Kennedy Jr.

Historically, the hepatitis B vaccine has been administered in a three-dose series and is recognized for its effectiveness in preventing the disease, with a strong safety profile. The universal recommendation for vaccination at birth was established in 1991 after previous risk-based strategies failed to reduce infection rates. Since then, hepatitis B cases in children have decreased by 99%.

Under the new guidelines, the birth dose will now be limited to infants born to mothers who are known to be infected with hepatitis B or whose infection status is unknown. For infants born to mothers who test negative, the decision to vaccinate at birth will be left to individual discretion, potentially exposing newborns to the virus during a critical early period. Public health experts have expressed concern that this change could lead to increased infections among infants, resulting in higher rates of chronic liver disease, liver cancer, and premature death.

Pediatrician Cody Meissner, a voting member of ACIP, emphasized the moral imperative of 'do no harm' in his opposition to the vote, stating that the change could indeed cause harm. Concerns were also raised by committee member Joseph Hibbeln regarding the lack of data supporting the proposed delay of vaccination until one month of age, questioning the rationale behind selecting this time frame without evidence comparing the risks and benefits of administering the vaccine at birth versus later.

The rationale for the two-month delay was not clearly articulated by committee members, with some suggesting that parents should have the option to delay vaccination, potentially leading to significant gaps in immunization. Critics, including Sandra Adamson Fryhofer of the American Medical Association, condemned the votes as reckless, arguing that they undermine public confidence in a proven vaccine and create confusion for parents regarding the best practices for protecting their newborns.

Additionally, the committee approved a recommendation for testing a child's antibody levels after each dose of the hepatitis B vaccine series, despite the absence of supporting data. Medical experts criticized this decision, stating that vaccine efficacy is based on the complete three-dose series, and antibody levels alone cannot ensure lifelong protection.

The composition of the ACIP has also faced scrutiny, as many current members were appointed by Health and Human Services Secretary Robert F. Kennedy Jr. and lack traditional qualifications in vaccinology and pediatrics. Presentations during the meeting were not conducted by career CDC staff, which deviates from standard practice.

Internationally, the U.S. is considered an outlier in its universal vaccination policy, with many countries opting for selective vaccination strategies. However, experts noted that the U.S. has achieved its low hepatitis B rates through comprehensive public health measures, including the universal birth dose. The implications of this policy change may extend beyond immediate health concerns, reflecting broader issues of public trust in vaccination and the influence of varying perspectives on health policy.