An influential federal vaccine advisory panel on Friday voted to lift the long-standing recommendation that all U.S. newborns receive a vaccination against hepatitis B (HBV) shortly after birth. The decision marks the most significant change to the nation’s childhood immunization schedule in decades and has sparked fierce condemnation from major medical and public health organizations.
The Advisory Committee on Immunization Practices (ACIP), which provides guidance to the Centers for Disease Control and Prevention (CDC), voted 8-3 to eliminate the universal recommendation for a birth dose, which has been standard practice since 1991. The move signals a major shift in public health strategy under the current administration.
The Rollback of Universal Protection
The ACIP’s new guidance creates two distinct paths for newborns, abandoning the previous “universal” approach:
- High-Risk Infants: The recommendation for newborns whose mothers test positive for HBV remains unchanged; these infants must still receive the vaccine at birth to prevent a potentially fatal, chronic infection.
- Low-Risk Infants (New Guidance): For babies born to mothers who have tested negative for the virus, the panel now recommends “individual-based decision-making” in consultation with a healthcare provider. For infants who skip the birth dose, ACIP suggests delaying the first dose until the child is at least two months old.
Proponents of the change argued that the universal recommendation was overly broad since most babies born to HBV-negative mothers have a very low risk of infection. They claimed the revised guidance would minimize the number of doses a baby receives and empower parents’ informed choice.
The Backlash: ‘Unconscionable’ and ‘Dangerous’
The vote immediately triggered a wave of criticism from infectious disease experts and public health advocates who warn the change is unscientific, politically motivated, and will inevitably lead to an increase in preventable illnesses and deaths.
- Erosion of Success: Before the universal birth dose was recommended, an estimated 20,000 newborns per year were infected with HBV. Since the 1991 policy, infections among infants have plummeted to fewer than 20 cases per year, a 99% reduction that experts hail as a monumental public health success.
- Safety Net Removed: Medical groups, including the American Academy of Pediatrics (AAP), opposed the change, arguing the universal dose acts as a crucial safety net. They cite scenarios where a mother’s HBV status is unknown, where a false-negative test occurs, or where the mother becomes infected late in pregnancy.
- Increased Risk: According to a recent public health model, delaying the shot from birth to two months could lead to at least 1,400 additional infections, 300 cases of liver cancer, and 480 deaths every year.
One dissenting ACIP panel member reportedly called the revised guidance “unconscionable,” while another criticized the lack of scientific data presented to support the change, stating, “no rational science has been presented” to justify altering the well-established protocol.
What Happens Next?
The ACIP’s recommendation is a non-binding guideline and must now be reviewed by the Acting Director of the CDC, Jim O’Neill, who will decide whether to accept the panel’s vote and officially alter the U.S. vaccination policy.
While the new recommendation does not restrict access—insurance is still expected to cover the vaccine—medical experts worry that introducing “shared clinical decision-making” for this routine vaccine will confuse parents and providers, creating a dangerous barrier to timely vaccination, especially for vulnerable or low-income families.