A federal vaccine committee appointed by Health and Human Services Secretary Robert F. Kennedy, Jr., voted Friday to end its recommendation that all newborns be vaccinated immediately against hepatitis B — a serious virus that causes chronic liver disease in more than 90% of infected infants.
Earlier this year, Kennedy — a longtime vaccine skeptic who nevertheless promised during his confirmation hearings not to take actions that “make it difficult or discourages people from taking vaccines” — dismissed all 17 previous members of the Advisory Committee on Immunization Practices (ACIP). He replaced them with members who largely share his views and who mostly have limited backgrounds in vaccine research or clinical care.
According to the New York Times, the newly formed panel postponed a vote three times because of “divisiveness and dysfunction.” On Friday, members finally voted 8–3 that women who test negative for hepatitis B should work with their health care provider to “decide when or if their child will” receive the vaccine. The guidance further suggests that parents and clinicians should “consider vaccine benefits, vaccine risks, and infection risks,” and says the shot should be given “no earlier than 2 months of age.”
The recommendation to vaccinate newborns whose mothers are known to be infected — or whose infection status is unknown — remains unchanged.
Many experts sharply criticized the shift, pointing out that routine hepatitis B shots at birth have nearly wiped out infections in U.S. newborns — and that extensive data show the vaccine is safe.
“We know it’s safe, and we know it’s very effective,” said Dr. Cody Meissner, a professor of pediatrics at Dartmouth Geisel School of Medicine. Under the new approach, he warned, “we will see more children and adolescents and adults infected with hepatitis B.”
Here’s a breakdown of what’s behind the controversy and why many specialists are alarmed.
How did this change gain traction?
Opponents of the current vaccine schedule have long argued that babies receive “too many” shots and that the timing must be harmful, a claim the American Academy of Pediatrics has called “dangerous and inaccurate.” Hepatitis B, in particular, has become a frequent target because of the way the virus is often transmitted.
“Hepatitis B is sexually transmitted, there is no reason to give a baby that is almost just born hepatitis B,” President Trump said in September. “So I would say wait til the baby is 12 years old and formed.”
Critics of newborn vaccination also argue that the likelihood of infection early in life is extremely low. As Retsef Levi, an ACIP panelist and professor of operations management at Massachusetts Institute of Technology, put it on Friday, the “risk of infection throughout your early stage of life, and probably throughout most of your childhood, is extremely low. To quantify how low it is, it’s probably one in several millions.”
Why vaccinate newborns against hepatitis B at all?
Public health experts say this line of reasoning misses key facts.
First, testing for hepatitis B during pregnancy is far from perfect in practice. More than 17,000 infants are born each year in the U.S. to mothers who carry the virus. Yet nearly one in five pregnant women is never tested, and only about one in three who test positive actually receives appropriate follow-up care, according to a report released Tuesday by the Vaccine Integrity Project.
Overall, roughly half of all people living with hepatitis B are unaware they’re infected — meaning many mothers may test negative earlier in pregnancy or never be tested at all, while still passing on the virus.
And even when a mother truly does not have hepatitis B, her baby can still be exposed later. Before the U.S. adopted universal newborn hepatitis B vaccination in 1991, about 18,000 children a year became infected before age 10. Only about half of those infections were traced back to transmission from the mother at birth; the rest occurred in other settings.
“There have been cases of infections in daycare,” Dr. Andrew Pavia, a professor of pediatrics and medicine at the University of Utah and an infectious disease specialist, recently told NPR. “There have been cases of infection on sports teams. There have been documented infections from shared toothbrushes and from shared razors.”
Under the new guidance, those roughly 9,000 children a year who previously would have been protected at birth could be left vulnerable.
The consequences of early infection are severe. When adults contract hepatitis B, only about 5% develop chronic infection. For infants, that number jumps to about 90%. Children who develop chronic hepatitis B face a dramatically higher lifetime risk of cirrhosis, liver failure and liver cancer. About one in four of these children will eventually die from complications of their infection.
That’s why many clinicians and public health authorities argue that even relatively rare infections in childhood are too dangerous to dismiss — and why they are deeply concerned about the long-term impact of the panel’s decision.
