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Panel shifts to case-by-case hepatitis B vaccination for infants
A federal vaccine advisory group voted on Friday to abandon the long-standing policy of routinely immunizing all newborns against hepatitis B, opting instead for decisions based on individual risk.
Vote details and immediate fallout
The Advisory Committee on Immunization Practices (ACIP) approved the change 8-3, recommending that babies born to mothers who test negative for the virus no longer receive the shot at birth. The panel continues to urge vaccination for infants whose mothers test positive.
Within hours, President Donald Trump ordered a sweeping review of all childhood vaccination guidelines. In a White House memo, he directed health officials to compare U.S. recommendations with those of other developed nations and adjust the schedule if foreign practices prove superior.
Trump praised the ACIP decision in a social media post, calling it "very good."
Public health concerns and expert dissent
Critics warn the shift could fuel vaccine hesitancy and increase infections. Hepatitis B, a liver disease spread through bodily fluids, can cause cancer, liver failure, and cirrhosis. Infected individuals may show no symptoms yet still transmit the virus.
"The hepatitis B vaccine recommendation is very well established. We know it's safe and we know it's very effective. To make the changes that are being proposed, we will see more children and adolescents and adults infected with hepatitis B."
Dr. Cody Meissner, ACIP member
Several panel members opposed the new timeline, which delays the first dose until at least two months of age for infants not vaccinated at birth. Dr. Joseph Hibbeln called the voting choices "incredibly problematic," while Dr. Meissner accused colleagues of acting on "baseless skepticism."
Global context and policy rationale
The World Health Organization advises hepatitis B vaccination at birth, one month, and six months. The U.K. recommends doses at eight, twelve, and sixteen weeks unless the mother tests positive.
Supporters of the change argue the U.S. policy was out of step with other nations and that universal vaccination is unnecessary given low transmission risks. They contend vaccines should be tailored to individual patients.
Opponents counter that not all pregnant women have access to reliable testing, and false negatives could leave some infants unprotected. Hepatitis B can spread through shared household items like toothbrushes and razors, not just sexual contact or needle sharing.
Political and administrative backdrop
The vote follows a June overhaul of the ACIP by Health Secretary Robert F. Kennedy Jr., a vocal vaccine skeptic who replaced all panel members with critics of immunization programs. Kennedy's appointment drew criticism from lawmakers, including Republican Senator Bill Cassidy, a physician who voted to confirm him despite reservations.
"As a liver doctor who has treated patients with hepatitis B for decades, this change to the vaccine schedule is a mistake. The hepatitis B vaccine is safe and effective. The birth dose is a recommendation, NOT a mandate."
Senator Bill Cassidy
The CDC's acting director must still approve the new guidance, which is not expected to affect insurance coverage for the vaccine.
State and professional responses
Maryland's health department swiftly issued an advisory urging providers to continue offering the hepatitis B shot at birth, citing guidance from the American Academy of Pediatrics. The state is working to ensure all infants and children retain access to the vaccine.
