A key government advisory committee will vote Wednesday on whether to recommend delaying the first hepatitis B vaccine shot, currently given to babies at birth, by at least one month.
Experts fear delaying the shot would lead to more children developing chronic liver infections and complications, setting back decades of public health work that has almost eliminated infant hepatitis B cases in the U.S.
The recommendation to vaccinate newborns came after vaccines had been available for nearly a decade for high risk people, but had yet to decrease the infection rates. Following the recommendation in 1991, cases in children and teens dropped 99%.
Giving newborns their first dose of the hepatitis B vaccine almost immediately helps ensure that they don’t contract the disease from their mothers. While pregnant people are recommended to be screened for hepatitis B, some people don’t receive prenatal care, and some people may get hepatitis B after being screened.
If the first shot is pushed back, “we’re going to miss babies, we’re going to miss moms, we’re going to miss those who are most vulnerable,” Chari Cohen, president of the Hepatitis B Foundation, said in an interview. “We’re removing the safety net essentially.”
Once babies leave the hospital, they’re also at risk of contracting the disease from people they come into contact with, as the pathogen is highly contagious and can be passed on through small specks of blood.
There is no cure for hepatitis B, and if an infant is exposed to the virus and develops a chronic liver infection, that could then lead to liver cancer or the need for a transplant.
Recommendations from the Advisory Committee on Immunizations Practices influence how physicians practice and help determine health insurance coverage.
The country’s main association of health insurers announced on Tuesday that its members will still cover all vaccines that were recommended before this week’s ACIP meeting, even if those recommendations change, through next year. But even then, a vote to delay the first dose of the hepatitis B vaccine could create a confusing landscape for physicians and for parents seeking information on vaccinating their children.
ACIP’s current recommendation on the hepatitis B vaccine has been questioned in recent months. At the previous meeting in June, the newly appointed chair, Martin Kulldorff, questioned the necessity of the birth dose if the baby’s mother does not have hepatitis B. Health secretary Robert F. Kennedy Jr. fired the panel’s previous members earlier this year and replaced them with his own picks.
Sen. Rand Paul (R-Ky.) echoed that sentiment on X, writing, “No medical reason to give newborns Hep B vaccine if mother is not infected.”
The comment quickly drew the ire of Sen. Bill Cassidy (R-La.), a physician who specialized in treating liver diseases such as hepatitis B. He wrote in a response, “Empirically, this is not true.”
Following a Wednesday Senate hearing with the ousted director of the Centers for Disease Control and Prevention, which convenes ACIP, Cassidy told reporters that if the committee recommended changes to the childhood vaccination schedule, that guidance should not be trusted.
In advance of the vote, the CDC posted a review of the evidence on the effects of the vaccine, which included eight studies and largely found a low risk of side effects.
Aside from the health risks of pushing back the first shot, there would also be logistical challenges. There are no other childhood vaccines only recommended at one month, and it could be an added burden for pediatricians’ offices to add vaccination appointments and stock the vaccine, said Su Wang, a doctor at Cooperman Barnabas Medical Center in New Jersey and an advisor to the Hepatitis B Foundation.
