CDC Advisers Vote to Drop Universal Newborn Hepatitis B Shots, Drawing Warnings of Harm

On Friday, a CDC advisory panel handpicked this year by Health and Human Services Secretary Robert F. Kennedy Jr. voted to end the universal recommendation that every newborn in the United States receive a hepatitis B vaccine. The vote ends a policy that has stood since 1991, and public health experts say it will lead to more illness.

The Advisory Committee on Immunization Practices, known as ACIP, voted 8-3 to recommend what it calls shared decision-making between providers and mothers who test negative for the virus. Under that approach, families would decide with a clinician whether and when to vaccinate, including at birth. If the shot is not given at birth, the panel suggests waiting until the child is at least 2 months old. Members also voted 6-4 to encourage testing children for immunity when deciding whether later doses are needed, and approved 8-0 a resolution aligning the recommendations with the federal Vaccines for Children program.

The current schedule calls for a first dose at birth, a second at 1 or 2 months, and a third between 6 and 15 months. Since universal infant vaccination began, infections in children have fallen from an estimated 18,000 a year to about 20. Hepatitis B is a highly infectious liver virus spread through blood or genital fluids. It can pass from mother to child during vaginal delivery or C-section, and through bites or scratches. Many adults clear it, but about 90% of infected infants and 30% of infected children aged 1 to 5 develop chronic disease, which raises the risk of liver cancer, organ failure and cirrhosis. People with chronic infection are 70% to 85% more likely to die early.

Kennedy, a longtime anti-vaccine activist, removed the previous 17 advisers before naming the current members. Many have voiced anti-vaccine views, but not all backed the change. Dr. Cody Meissner, a Dartmouth pediatrician, voted against the first two measures and said the panel was doing harm by changing the wording. Psychiatrist Dr. Joseph Hibbeln said the change had great potential to cause harm and hoped the committee would accept responsibility if it did. Dr. Retsef Levi, an MIT management professor, said the aim is to give parents more choice, and that many might wait far longer than two months, perhaps years or even until adulthood.

The votes do not change access. Insurers and officials said that even if the recommendations are adopted, parents who want the vaccine will still get it at no cost. The concern is confusion. Dr. Demetre Daskalakis, former director of the CDC's National Center for Immunization and Respiratory Diseases, said the wording signals risk in a vaccine shown over decades to be exquisitely low risk, and that confusion often leads to the wrong medical decision. He urged providers to follow the American Academy of Pediatrics and the Infectious Diseases Society of America, both of which still recommend universal birth doses. AAP President Dr. Susan J. Kressly called the guidance irresponsible and purposely misleading, saying nothing new about the vaccine or children's risk prompted it. The American Medical Association urged rejection, with trustee Dr. Sandra Fryhofer calling the vote reckless. Sen. Bill Cassidy, a Republican physician who chairs the Senate health committee and cast a pivotal vote to confirm Kennedy, wrote that as a liver doctor he considered the change a mistake and that acting CDC Director Jim O'Neill should not sign it.

The agenda also included a presentation from Aaron Siri, managing partner of a law firm that sues agencies and states over vaccine policy and represents people claiming vaccine injuries. A close friend of Kennedy's who worked on his presidential campaign, Siri criticized the childhood schedule's clinical trials and safety data. Meissner called it a terrible distortion of the facts, said association is not causation, and said he did not think Siri should have been invited. Siri replied that he accepts his own bias, shaped by the injured patients he sees, and warned that failing to recognize them will feed vaccine hesitancy.

O'Neill now decides whether to approve the recommendations, and the agency typically follows its advisers. President Trump praised the vote on Truth Social and said he had signed a memorandum directing HHS to fast-track a comparison of vaccine schedules in other countries. Dr. Tracy Beth Hoeg, newly named acting director of the FDA's drug center, pointed to Denmark's simpler schedule and its lower aluminum exposure. Aluminum is a long-used adjuvant, and Kennedy has linked it to allergies despite broad evidence of its safety. The rest of the childhood schedule appears to be next.