Advisers to the Centers for Disease Control and Prevention voted to narrow the agency’s long-standing recommendation for hepatitis B vaccination at birth. The Advisory Committee on Immunization Practices (ACIP) approved, by an 8–3 vote, advising a birth dose only for infants whose mothers test positive for hepatitis B or whose maternal status is unknown. For infants of mothers who test negative, ACIP recommended that parents discuss vaccination with their child’s clinician rather than follow a universal, birth‑time mandate. The change still requires approval from the CDC acting director before taking effect.
If adopted, the policy would roll back more than 30 years of guidance credited with sharply reducing hepatitis B infections and related liver disease among U.S. children. Hepatitis B can be transmitted during childbirth and via contact with infected body fluids; infant immunization has been shown to provide long-lasting protection against outcomes such as cirrhosis and liver cancer.
ACIP also voted on post‑vaccination antibody testing and the standard dosing schedule. Traditionally, infant immunization comprises three doses: at birth, at one to three months, and at six to 15 months. The committee voted 6–4 with one abstention to recommend measuring children’s hepatitis B antibody levels after each shot to determine whether further doses are needed. That approach could result in some children receiving only one or two doses instead of the three used in original vaccine trials. Dr. Adam Langer, a CDC official overseeing hepatitis prevention, warned that authorized vaccines were studied using a three‑dose regimen and that stopping early based on antibody results assumes effectiveness not established in the existing clinical trials.
The votes exposed sharp divisions within ACIP. A subgroup that reviewed hepatitis B policy and recommended the changes was led by Vicky Pebsworth, who serves on the board of the National Vaccine Information Center, an organization that questions vaccine safety. ACIP’s roster for this vote was selected by Health Secretary Robert F. Kennedy Jr., who has publicly questioned widely used vaccines; several voting members have previously raised vaccine safety concerns. MIT professor and ACIP member Retsef Levi described the action as a “fundamental change” that would prompt parents to weigh risks and potentially delay vaccination.
Many medical organizations and clinicians strongly objected. Representatives of professional societies stressed that the prior universal newborn recommendation protected infants who might otherwise be missed because prenatal screening is imperfect. Dr. Grant Paulsen, speaking for the Pediatric Infectious Diseases Society, questioned altering a policy “that has been working.” Dr. Cody Meissner, a pediatrician and former ACIP member, warned the change could lead to more hepatitis B infections across age groups and urged adherence to the established, safe three‑dose schedule. Other clinicians pointed out that newborns cannot control exposures or the hepatitis B status of caregivers, and that low levels of blood exposure can transmit infection.
Supporters of the new guidance argued that improved prenatal screening can identify mothers who need intervention and that shared decision‑making with parents is appropriate. Some raised concerns about potential harms from vaccinating newborns—claims that public health authorities and most scientific evidence do not support.
The meeting included presentations from nonmedical and legal speakers critical of current vaccination policy; attorney Aaron Siri, who works on vaccine litigation and has collaborated with Secretary Kennedy, urged further post‑licensure safety studies and fewer mandates. Several prominent vaccine scientists invited to present declined; some said they felt ACIP had shifted away from science‑based deliberation.
Officials representing medical groups and state health departments questioned the committee’s portrayal of vaccine harms as unresolved and warned that language favoring shared decision‑making could create a false impression of scientific uncertainty and reduce uptake.
Federal officials said insurance coverage for the hepatitis B vaccine is not expected to change. A policy analyst at the Centers for Medicare and Medicaid Services said the vaccine would remain covered, including under Medicaid and the Children’s Health Insurance Program.
The immediate public health impact of the potential policy change is uncertain. Public health experts urged families to consult their clinicians and respected medical organizations—such as the American Academy of Pediatrics and the American Medical Association—for guidance on preventing hepatitis B and other vaccine‑preventable diseases.