The Buzz This Week
Last week, the Center for Disease Control & Prevention’s (CDC’s) Advisory Committee on Immunization Practices (ACIP) changed their recommendation for vaccinating babies against hepatitis B, overturning a 30-year-old policy that has contributed to reducing chronic hepatitis B infections in children and adolescents by 99%.
Following the ACIP announcement, President Trump issued a presidential memo directing US Secretary of Health and Human Services Kennedy to review the full childhood vaccine schedule and compare to “best practices of peer, developed countries.” According to the American Academy of Pediatrics, “while vaccine guidance is largely similar across developed countries, it may differ by country due to different disease threats, population demographics, health systems, costs, government structures, vaccine availability, and programs for vaccine delivery.”
An ACIP working group is already reviewing the entire schedule, though it’s unknown what additional changes to the childhood vaccine schedule the committee may consider.
The new recommendation states that instead of vaccinating all newborns at birth, parents should discuss with their doctors whether to give the hepatitis B vaccine (HBV) at birth, or at all. It also states that those who choose to do so should wait to begin the vaccine series until their baby is at least 2 months old.
The committee also recommended that parents consult with healthcare providers to decide whether to conduct a post-vaccination serology test when weighing the need for subsequent HBV doses. The traditional HBV vaccine schedule consists of a three-dose series given within the first 6 months of life.
The revised recommendations apply to mothers who test negative for hepatitis B during their pregnancy. Babies born to mothers who test positive for hepatitis B during pregnancy or whose hepatitis B status is unknown would be advised to vaccinate.
Why It Matters
The HBV recommendations are the latest, and possibly most significant, in a series of recommendations from the newly rebuilt ACIP. Committee members were handpicked by Kennedy, whom the medical community has repeatedly criticized for his vaccine stances that often lack supporting evidence. The HBV recommendations are also the most recent step in the Trump Administration’s plans to review the childhood vaccine schedule.
Since 1991, the universal HBV birth dose has prevented more than 500,000 childhood infections and prevented an estimated 90,100 childhood deaths, according to a joint statement by the American Public Health Association and 72 public health experts in response to the ACIP call for public comment.
A 2022 study found that children in the US who received the vaccines as newborns were 22% less likely to die from any cause. According to a recent report, delaying the birth dose could lead to at least 1,400 preventable hepatitis B infections among children, 300 additional cases of liver cancer, 480 preventable deaths, and more than $222 million in excess healthcare costs for each year the revised recommendation is in place.
In addition to the serious health implications, the recommendation, if adopted, would likely worsen the fracturing in US vaccine recommendations.
Since being rebuilt, the ACIP has made several decisions that upset major medical groups. These decisions include recommending that the preservative thimerosal be removed from doses of flu vaccine (without evidence of harm); recommending new restrictions on a combination shot that protects against chickenpox as well as measles, mumps, and rubella; and not recommending COVID-19 vaccinations, even for high-risk populations like seniors.
These decisions prompted many states to begin delivering their own recommendations and even resulted in several states coming together to form their own health and vaccine coalitions.
Following the HBV decision, Illinois announced it will conduct its own review, the American Academy of Pediatrics said the organization will continue to recommend the vaccine, and New York State’s Department of Health said that it would continue to tell medical practitioners to offer the birth dose. The incongruence between federal and state recommendations has the potential to create confusion for both providers and patients.
For the time being, the votes will not affect insurance coverage for HBV including under Medicaid and the Children’s Health Insurance Program, or through the Vaccines for Children program. Likewise, the Blue Cross Blue Shield Association and AHIP reassured members that they will continue to cover all vaccines recommended by the committee as of earlier this year, with no cost-sharing, through 2026.
Though many physicians have spoken about their intentions to continue recommending at birth, the expectation is that the ACIP decision will further erode trust in vaccines. Should the committee continue to examine the rest of the schedule, as the Trump Administration has directed, that erosion is likely to continue.
RELATED LINKS
CNN:
Insurance coverage of hepatitis B vaccine won’t change, industry and officials say
Politico:
Trump asks RFK Jr. to ‘fast track’ vaccine schedule review
STAT:
Childhood vaccines facing scrutiny by Kennedy's ACIP panel
