A seismic shift in the nation’s approach to public health occurred Friday, one that was foreseen the moment Health Secretary Robert F. Kennedy Jr. replaced the Centers for Disease Control and Prevention’s vaccine advisory committee with vaccine skeptics. The panel voted to end the universal birth-dose recommendation for hepatitis B, a bedrock of the childhood immunization schedule for more than 30 years. Though the vaccine will still be available to parents who request it, the change will have many negative effects and might be even more alarming than it initially seems.
The biggest shift is that the vaccine is no longer recommended for all babies. Instead, the committee says that for infants born to mothers who test negative for hepatitis B, parents and clinicians should decide on their own whether to give the birth dose — and, if they skip it, to wait until at least two months of age to begin vaccination.
On the bright side, the policy doesn’t change care for the babies at highest risk: Infants born to mothers known to have hepatitis B will still receive the vaccine, along with a preventive immunoglobulin, to reduce the risk of perinatal transmission. And families who want their newborns to receive the hepatitis B shot can still choose it and have it be covered by insurance.
But this new approach attempts to solve an issue that doesn’t exist. There is no evidence that the birth dose is unsafe, and no evidence that waiting until two months offers any advantage to safety or efficacy. What ending the universal recommendation does do is inject complexity into a system that already struggles to reach every infant, especially those whose families lack a regular pediatrician or whose mothers’ hepatitis B status is recorded late or inaccurately. It also implies that the birth dose carries some risk that warrants hesitation, when no such risk has been shown.
Plus, transmission doesn’t just happen mother-to-baby. Hepatitis B can spread through casual contact, including shared household items, small amounts of blood or saliva on toys and surfaces. Everyday interactions such as sharing spoons or cups, handling a baby with microscopic cuts on one’s hands or even inadvertently mixing up toothbrushes can be enough to transmit the virus. A study cited by CDC staff concluded that as many as 1 in 10 children with hepatitis B acquire it through such exposures.
Several committee members suggested that parents could try to identify whom around their newborn might pose a risk, but that is simply not practical. Families cannot be expected to screen every relative, friend or child care provider for hepatitis B, particularly when many adults don’t know their own status.
And the stakes for infants are high: About 90 percent of infected babies go on to develop chronic hepatitis B, a lifelong incurable disease that can silently damage the liver for decades before it manifests as liver failure. Many will develop liver cancer, which has a five-year survival rate of less than 20 percent.
Universal newborn vaccination has helped drive childhood hepatitis B infections down from 18,000 cases in 1991 to just about 20. Why change a policy that has been so effective?
That’s not all. The hepatitis B vaccine is currently given as a three-dose series, and all three doses are needed to be considered fully protected. The advisers voted to change this process. Now, after just one dose, parents are supposed to ask their clinician about doing a blood test to check antibody levels. If the antibodies meet a threshold of 10 milli–international units per milliliter, then presumably no further shots are needed.
That might sound reasonable: If someone is already immune after one shot, why not forgo the others? Except no evidence supports this approach. Even proponents of the change could produce no data, despite repeated requests, demonstrating that a single dose provides reliable protection or that, after one shot, the new antibody threshold is an appropriate marker of lasting immunity. This guidance is not only baseless but dangerous, as it gives families false assurance that their children are protected when they might not be.
Taken together, the changes point to a disturbing and consequential shift: Health policy decisions are no longer being rooted in solid science, but in speculation and suspicion. Listening to the proceedings, it was as if data no longer mattered; the only thing guiding these appointees are their deeply held belief that vaccines are the source of harm rather than the lifesaving tools they are.
The advisers ended their meeting with an outline for even broader changes they plan to make to the childhood immunization schedule. That leaves the public with two terrible questions: Which long-accepted vaccine will be next to be cut? And which once-controlled disease will be first to return?
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