In a historic vote, advisers to the Centers for Disease Control and Prevention recommended narrowing the agency’s long-standing guidance that has called for hepatitis B vaccination at birth. The Advisory Committee on Immunization Practices (ACIP) voted 8–3 to recommend the birth dose only for infants born to mothers who test positive for hepatitis B or whose status is unknown. For infants of mothers who test negative, the committee said parents should discuss vaccination with their child’s clinician rather than follow a universal mandate.
The change, which still requires approval from the CDC’s acting director to take effect, would roll back a more than 30-year policy credited with sharply reducing hepatitis B and related liver disease in U.S. children. Hepatitis B can be transmitted during childbirth and through contact with infected body fluids; infant immunization has been shown to provide long-lasting protection against serious outcomes such as liver cancer and cirrhosis.
ACIP also voted on post-vaccination testing and the number of doses. Full infant immunization has traditionally consisted of three doses: one at birth, a second at one to three months, and a third at six to 15 months. The committee voted 6–4 with one abstention to recommend measuring children’s antibody levels after each hepatitis B shot to determine whether additional doses are required. That approach could lead some children to receive only one or two doses instead of the standard three. Dr. Adam Langer, a CDC official overseeing hepatitis prevention, warned that approved vaccines were studied using a three-dose regimen, and stopping early based on antibody tests would assume efficacy not demonstrated in existing trials.
The votes revealed sharp divisions within ACIP. Members who led a subgroup reviewing hepatitis B policy supported the change. The committee roster for this vote was selected by Health Secretary Robert F. Kennedy Jr., who has questioned widely used vaccines; several voting members have previously expressed vaccine safety concerns. Retsef Levi, an MIT professor and ACIP voting member, described the action as a “fundamental change” that would prompt parents to weigh risks and possibly delay vaccination.
Medical liaisons and many physicians objected strongly. Dr. Grant Paulsen, representing the Pediatric Infectious Diseases Society, asked why the committee was altering a policy “that has been working” and cited safety concerns he said were largely theoretical. Dr. Cody Meissner, a pediatrician at Dartmouth who has previously served on ACIP, warned the change would lead to more hepatitis B infections among children, adolescents and adults, saying the vaccine is “very well established,” safe and effective. When casting his “no” vote, Meissner said, “Do no harm is a moral imperative. We are doing harm by changing this wording.”
Opponents argued the prior universal recommendation ensured at-risk infants wouldn’t be missed, noting screening of pregnant women is imperfect and infections can be transmitted through tiny amounts of blood in everyday exposures. Dr. Su Wang, an internist and hepatitis B researcher, said risk-based recommendations fail in practice because newborns cannot control who cares for them or whether adults around them know their hepatitis B status.
Supporters of the change contended that enhanced prenatal screening could identify mothers who need intervention and that shared decision-making with parents is appropriate. Those in favor also raised concerns about potential harms from administering hepatitis B vaccine to newborns—claims that public health authorities and most scientific evidence do not support.
Some members and medical groups argued the decision reflects broader shifts under Secretary Kennedy, who has pushed to overhaul federal vaccination policy and has narrowed recommendations for other vaccines. Dr. Rochelle Walensky, a former CDC director, said the votes represented another “chisel” undermining the nation’s vaccine infrastructure.
The ACIP subgroup reviewing hepatitis B policy was led by Vicky Pebsworth, a nurse who serves on the board of the National Vaccine Information Center, an advocacy organization that questions vaccine safety. Pebsworth said stakeholders had pressured for the policy to be revisited.
ACIP members also heard a lengthy presentation from attorney Aaron Siri, who specializes in vaccine litigation and has worked with Kennedy. Siri, who has no medical training, criticized the science behind the childhood vaccine schedule and called for post-licensure safety studies and an end to mandates. Several scientists who have been vocal vaccine defenders were invited but declined to present; Dr. Peter Hotez said he declined because he believes ACIP has shifted away from science and evidence-based medicine. Dr. Paul Offit said he was not explicitly invited and would have declined.
Representatives of professional medical groups at the meeting disputed the committee’s characterization that harms from the vaccine are unresolved. Dr. Flor Munoz of the Infectious Diseases Society of America asked how the committee could remove a “well established, successful and safe prevention strategy” when measures to identify at-risk infants are not fully in place. Dr. Natasha Bagdasarian, representing state and territorial health officials, warned that ambiguous language about shared decision-making creates a false impression of scientific uncertainty and could reduce uptake by signaling that a vaccine is controversial.
Officials said insurance coverage is not expected to change. Andrew Johnson, a policy analyst at the Centers for Medicare and Medicaid Services, said the vaccine would remain covered, including by Medicaid and the Children’s Health Insurance Program.
The immediate public health impact of the policy shift is uncertain. Public health experts urged families to consult their clinicians and professional medical organizations—such as the American Academy of Pediatrics and the American Medical Association—for science-based guidance on preventing disease.