A federal vaccine advisory committee voted on Friday to end the longstanding recommendation that all U.S. babies get the hepatitis B vaccine on the day they’re born.
A loud chorus of medical and public health leaders decried the actions of the panel, whose current members were all appointed by U.S. Health Secretary Robert F. Kennedy Jr. — a leading anti-vaccine activist before this year becoming the nation’s top health official.
In response, the Illinois Department of Public Health issued a statement saying it would continue to recommend the hepatitis B vaccine for all newborns.
Gov. JB Pritzker signed into law this week a bill that calls for the state to issue its own vaccine guidelines through the newly created Illinois Immunization Advisory Committee. The law also calls for state-regulated health insurance plans to cover the vaccines the state recommends, even if they go beyond federal recommendations. The state’s new vaccine committee plans to meet Dec. 16 to discuss the new federal recommendations.
“As a pediatrician and a parent, I am deeply concerned by this shift away from universal newborn vaccination, particularly in the absence of any new scientific evidence to support such a change,” said Dr. Sameer Vohra, the state agency’s director.
The Illinois-based American Academy of Pediatrics in a statement Friday reaffirmed it will also continue to advise a first dose of the hepatitis B vaccine within the first 24 hours of a birth followed by two other doses by the time the baby is six months old.
“I want to reassure parents and clinicians that there is no new or concerning information about the hepatitis B vaccine that is prompting this change, nor has children’s risk of contracting hepatitis B changed. Instead, this is the result of a deliberate strategy to sow fear and distrust among families,” said Dr. Susan J. Kressly, the group’s president, in a statement.
Several medical societies and other state health departments also said they would continue to recommend the vaccine. While people may have to check their policies, the trade group AHIP, formerly known as America’s Health Insurance Plans, said its members still will cover the birth dose of the hepatitis B vaccine.
But Friday’s vote could result in another patchwork of vaccination recommendations across the country.
For decades, the government has advised that all babies be vaccinated against the liver infection right after birth. The shots are widely considered to be a public health success for preventing thousands of illnesses.
For other babies, it will be up to the parents and their doctors to decide if a birth dose is appropriate. The committee voted 8-3 to suggest that when a family elects to wait, then the vaccination series should begin when the child is 2 months old.
The acting director of the Centers for Disease Control and Prevention, Jim O’Neill, is expected to decide later whether to accept the recommendation from the federal Advisory Committee on Immunization Practices or ACIP.
The decision marks a return to a health strategy abandoned more than three decades ago
Asked why the newly-appointed committee moved quickly to reexamine the recommendation, committee member Vicky Pebsworth on Thursday cited “pressure from stakeholder groups,” without naming them.
Committee members said the risk of infection for most babies is very low and that earlier research that found the shots were safe for infants was inadequate.
They also worried that in many cases, doctors and nurses don’t have full conversations with parents about the pros and cons of the birth-dose vaccination.
The committee members voiced interest in hearing the input from public health and medical professionals, but chose to ignore the experts’ repeated pleas to leave the recommendations alone.
CDC directors almost always adopted the committee’s recommendations, which were widely heeded by doctors and guide vaccination programs. But the agency currently has no director, leaving acting director O’Neill to decide.
In June, Kennedy fired the entire 17-member panel earlier this year and replaced it with a group that includes several anti-vaccine voices.
Hepatitis B and delaying birth doses
Hepatitis B is a serious liver infection that, for most people, lasts less than six months. But for some, especially infants and children, it can become a long-lasting problem that can lead to liver failure, liver cancer and scarring called cirrhosis.
In adults, the virus is spread through sex or through sharing needles during injection drug use. But it can also be passed from an infected mother to a baby.
In 1991, the committee recommended an initial dose of hepatitis B vaccine at birth. Experts say quick immunization is crucial to prevent infection from taking root. And, indeed, cases in children have plummeted.
Still, several members of Kennedy’s committee voiced discomfort with vaccinating all newborns. They argued that past safety studies of the vaccine in newborns were limited and it’s possible that larger, long-term studies could uncover a problem with the birth dose.
But two members said they saw no documented evidence of harm from the birth doses and suggested concern was based on speculation.
Three panel members asked about the scientific basis for saying that the first dose could be delayed for two months for many babies.
“This is unconscionable,” said committee member Dr. Joseph Hibbeln, who repeatedly voiced opposition to the proposal during the sometimes-heated two-day meeting.
The committee’s chair, Dr. Kirk Milhoan, said two months was chosen as a point where infants had matured beyond the neonatal stage. Hibbeln countered that there was no data presented that two months is an appropriate cut-off.
Dr. Cody Meissner also questioned a second proposal — which passed 6-4 — that said parents consider talking to pediatricians about blood tests meant to measure whether hep B shots have created protective antibodies.
Such testing is not standard pediatric practice after vaccination. Proponents said it could be a new way to see if fewer shots are adequate.
A CDC hepatitis expert, Adam Langer, said results could vary from child to child and would be an erratic way to assess if fewer doses work. He also noted there’s no good evidence that three shots pose harm to kids.
Meissner attacked the proposal, saying the language “is kind of making things up.”
Health experts say this could ‘make America sicker’
Health experts have noted Kennedy’s hand-picked committee is focused on the pros and cons of shots for the individual getting vaccinated, and has turned away from seeing vaccinations as a way to stop the spread of preventable diseases among the public.
The second proposal “is right at the center of this paradox,” said committee member Dr. Robert Malone.
Some observers criticized the meeting, noting recent changes in how they are conducted. CDC scientists no longer present vaccine safety and effectiveness data to the committee. Instead, people who have been prominent voices in anti-vaccine circles were given those slots.
The committee “is no longer a legitimate scientific body,” said Elizabeth Jacobs, a member of Defend Public Health, an advocacy group of researchers and others that has opposed Trump administration health policies. She described the meeting this week as “an epidemiological crime scene.”
Republican Sen. Bill Cassidy, a liver doctor who chairs the Senate health committee, called the committee’s vote on the hepatitis B vaccine “a mistake.”
“This makes America sicker,” he said, in a post on social media.