Last week the Advisory Committee on Immunization Practices voted to change a policy that has protected newborns for 30 years. ACIP is the group that advises the CDC on vaccines, and its decisions shape what shots are covered by the Vaccines for Children program, Medicaid, and private insurance… so they have a hardwire into vaccine policy and reimbursement.
Arizona reacts to RFK Jr. panel’s decision on Hep B vaccine
The new recommendation says that parents of babies born to mothers who test negative for hepatitis B should talk with their doctor about whether to delay the first dose of the hepatitis B vaccine. If they choose to delay, ACIP says the baby should wait until at least 2 months of age to start the vaccine series.
This is a big shift in policy (which wasn’t supported by evidence). The birth dose has helped cut hepatitis B infections in babies by more than 90% over the last few decades.
At least the committee recommended that if a mom hasn’t been tested for Hep B (or if she tests positive for hepatitis B) the old rules stay in place… that the babies should still get the vaccine within 12 hours of birth, plus hepatitis B immune globulin.
Because of the way ACIP wrote the new recommendation, coverage rules don’t change. VFC and private plans must still cover the birth dose.
But here’s the concerning part: ACIP didn’t present new safety or effectiveness issues to support this change. Instead, committee members said they revisited the policy because:
- Some parents have concerns about the birth dose
- Some European countries wait a few months to start the vaccine
- It has been a long time since ACIP last reviewed this topic
Those reasons may sound reasonable at first glance, but they ignore real-world risks in the U.S. health system. All pregnant women should be tested for hepatitis B, but testing does not always happen.
Even when it does, about 2% of results are false negatives. And some women become infected later in pregnancy, after they’ve already been tested. The birth dose is the safety net that protects babies in these situations.
A new modeling study (not yet peer-reviewed) estimates that delaying the vaccine until 2 months could lead to:
- 1,400 more babies becoming chronically infected in the first year
- 304 future liver cancer cases
- 482 deaths related to hepatitis B
Hepatitis B in infants is extremely serious. About 90% of babies infected at birth become chronically infected, and about one-quarter of those children will die early from liver disease.
An Odd Second Recommendation
ACIP also advised that parents who choose to vaccinate their kid for Hep B ask for a blood test after the first dose to see if more doses are needed. This suggestion wasn’t backed by evidence either. It’s also impractical and won’t be covered by VFC or insurance because it’s not a vaccine—it’s a lab test.
The Bigger Picture
Last week’s changes won’t cause sweeping harm right away because they apply only to infants whose moms known to be negative for hepatitis B. But the signal is clear.
I think this these decisions are just the lowest hanging fruit and the start of what will be a years-long effort by CDC leadership and Kennedy to make wholesale changes to the kids and adult vaccine schedules. Basically, that last week’s “small” changes are warm-up for much larger steps in 2026, 2027 and 2028.
In a nutshell:
- The decisions at ACIP are now mainly driven by politics & ideology rather than hard evidence, undermining trust in public-health guidance.
- This politicization decreases vaccination uptake, risking preventable disease outbreaks and long-term public health harm.
- That greatly weakened institutional expertise at the CDC and their consent to the ACIP recommendations harms both domestic and global health infrastructure — which historically relied on robust, evidence-based vaccine programs out of the ACIP & CDC.
Since last week’s changes weren’t driven by evidence – the future changes probably won’t be either.
