The federal government is ending its recommendation that every infant receive a hepatitis B vaccination at birth, the most substantive change to the childhood immunization schedule yet under US Health Secretary Robert F. Kennedy Jr.
Instead, the Trump administration is leaving the question to “individual decision-making,” according to new guidelines recommended by the US Advisory Committee on Immunization Practices on Friday. If the new guidelines are adopted by the CDC, as expected, most parents will be left to decide on their own in consultation with their doctor. (Mothers who test positive for hepatitis B or whose hep B status is unknown will still be advised to give their baby the shot at birth.)
The new recommendations will suggest, however, that if your child does not receive the birth dose, you should wait until they are at least two months old before giving it to them. At least two members of the committee — Dr. Joseph Hibbeln and Dr. Cody Meissener — argued that there was no scientific basis for the two-month recommendation and that no data had been presented to justify it.
“It’s unconscionable,” Hibblen said Friday shortly before the final vote. Nevertheless, the change was approved as part of a 8-3 vote.
The changes are in keeping with Kennedy’s track record so far on vaccines, seeking to cast doubt on their value and remove official recommendations for them, leaving decisions instead to individual patients. The CDC already walked back the Covid-19 vaccine recommendations to leave it up to individuals and did the same earlier this fall for a rarely used combination measles vaccine.
But the hepatitis B vaccine is a different case.
It has been universally recommended since 1982, and more than 70 percent of newborns have received it within their first three days of life in the US in recent years. It’s also a clear public health win. Before the 1980s, there were about 300,000 new cases of hepatitis B every year. In 2023, there were an estimated 14,000 new cases.
So, why would they do this?
A dubious rationale for changing the childhood vaccine recommendations
During this week’s meeting, the new vaccine committee — whose membership had been completely overhauled by Kennedy Jr. in June to better reflect his own vaccine skepticism — challenged the long-held consensus that every newborn should receive their first dose within days of being born. Presenters argued that the birth dose might not confer long-term protection to patients and that the safety risks of the vaccine hadn’t been appropriately studied. They also asserted that, unless a mother is positive for hepatitis B, the risk to a newborn is low.
But, those arguments were quickly challenged, both by some of the committee members and outside experts watching the meeting. “It calls to mind a magician with a sleight of hand,” Chen told me. “They were picking data, whatever it is that supports their argument.” Meissner pressed the presenters on whether there was any confirmed case of somebody who was otherwise healthy and received the recommended hep B birth dose but later developed an infection. CDC staff later said they were not aware of any such case.
Likewise, the presentation on safety risk was largely limited to appealing to an absence of evidence, arguing that the available data was simply too limited. When Meissner pressed on whether there is any real evidence of harm from the birth dose, the presenter, Mark Blaxill, an anti-vaccine activist who has alleged a connection to autism and is now employed at the CDC, replied, “The safety evidence is very limited. I wouldn’t want to speculate on safety or harm.”
Nevertheless, the committee pressed ahead with changing the guidance.
This shift in policy represents the victory of anti-public health vibes. Over and over again in this week’s meetings, the committee members who wanted to make a change to hep B vaccine guidance acknowledged the limited evidence to justify their decision but argued that, because so many Americans no longer trust public health experts, they had to do something. That something amounts to a piece-by-piece dismantling of decades of scientific consensus.
“I’ve also been a critic of the CDC for many years,” Blaxill said, “so it’s been an honor and a privilege to work on the inside.”
Many of Kennedy’s vaccine committee members were specifically selected because they shared fringe views on vaccines that aligned more with Kennedy’s, who has long pushed the debunked theory that vaccines cause autism, as well as other health problems.
“They are personally motivated by their own internal views, which they voiced for many years,” Chen said. “They now have a soapbox on which they can preach.”And now, they are in a position to actually change government policy.
They aren’t going to waste that opportunity — even if there is not an urgent reason to make these changes. While the Trump administration claims to believe in “gold-standard science,” its vaccine experts are clearly willing to skirt the science if it fits their agenda. More than once during this week’s meetings, committee members and federal health officials — even some of those who were supportive of the changes — acknowledged a lack of data-based justification for the two-month timeline for the first shot or a new recommendation approved by the committee that parents may administer antibody tests to check their child’s immunity before administering later doses.
That is an approach that is likely to further erode trust in vaccines. Many Republicans were already dubious about the government’s health guidance, and now Democrats are losing faith, too. If vaccination rates drop far enough, more people may get sick. One doctor who spoke during the public comment period at the Advisory Committee on Immunization Practices meeting urged panel members to consider the possibility that even a single child could get infected hepatitis B because of this change.
That is the risk they are taking.
