Advisers to the Centers for Disease Control and Prevention abruptly postponed votes on a proposed change to the long-standing recommendation that all newborns receive the hepatitis B vaccine. The Advisory Committee on Immunization Practices (ACIP) moved the decisions to Friday after members said the proposed ballot language had been revised repeatedly and they needed time to review it.
Committee members described the meeting as unusually contentious. Dr. Joseph Hibbeln, a voting member, said the questions had been reworked several times in a short span and that ACIP members had not been adequately consulted in drafting the language. Multiple revisions posted between Friday morning and early afternoon prompted some advisers to request the chance to study the wording in writing before voting.
At issue is whether to abandon the long-held policy of giving the hepatitis B shot to all healthy newborns regardless of the mother’s infection status. The universal birth dose was adopted to ensure that infants at risk are not missed and to provide early, long-lasting protection against hepatitis B—a virus that can cause chronic liver disease, cirrhosis and liver cancer. Hepatitis B can be transmitted sexually and through injection drug use, but transmission from mother to infant at birth and in early childhood carries a particularly high risk of chronic infection. There is no cure for chronic hepatitis B.
The meeting exposed a sharp split among advisers. Dr. Tracy Beth Høeg, representing the Food and Drug Administration at the meeting, questioned the benefit of a routine birth dose for infants without identifiable risk factors, noting that many higher-income countries do not administer the vaccine at birth. In contrast, Dr. Cody Meissner of Dartmouth defended the existing strategy, saying the decline in disease in the United States reflects the success of current immunization policies.
Nonvoting liaisons from medical organizations criticized ACIP’s process. Dr. Jason Goldman, a liaison for the American College of Physicians, warned the committee was departing from usual practice and urged members to weigh the full balance of risks, benefits and equity. He expressed concern that decisions were being advanced without sufficient data.
The postponement leaves ACIP with a crowded agenda on Friday. In addition to the hepatitis B proposal, the committee will review how the U.S. immunization schedule compares with other countries and examine possible links between aluminum-containing vaccine adjuvants and asthma—an area where most medical experts say there is no convincing evidence of harm.
Public health observers warned the deliberations could affect vaccine access. ACIP recommendations strongly influence clinical practice and insurance coverage, and some say the committee’s credibility has been strained since new leadership replaced members in June with a slate selected by Kennedy. ACIP has also reduced longstanding collaborations with groups such as the American Academy of Pediatrics and is making less use of CDC staff expertise, according to participants and observers.