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 members were all appointed by U.S. Health Secretary Robert F. Kennedy Jr. — a leading anti-vaccine activist before becoming the nation’s top health official this year.
In response, the Illinois Department of Public Health said it would continue to recommend the hepatitis B vaccine for all newborns.
Gov. JB Pritzker signed a law this week 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 are beyond federal recommendations. The new vaccine committee plans to meet Dec. 16 to discuss the new federal guidance.
“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 on 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 six months.
“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 hepatitis B vaccine birth dose.
A patchwork of vaccine guidance and access
But Friday’s vote could result in another patchwork of vaccination recommendations across the country.
And the CDC vote will still have broader implications for vaccines, even in Illinois, said Dr. Emily Landon, an infectious diseases specialist at University of Chicago Medicine. Some parents may start to question vaccine safety while manufacturers could invest less in vaccines. Landon noted Aaron Siri, a lawyer who previously worked with Kennedy and is behind several lawsuits challenging vaccines, was given the most time to speak at Friday’s CDC meeting.
“I am confident that Illinois will do everything they can to try and protect people in Illinois — babies, children, adults,” Landon said. “But I’m concerned that this rhetoric and this meeting is going to have a wider impact. We are not going to be able to make up for everything.”
That’s also a concern for Dr. David Nguyen, who specializes in infectious diseases at Rush Medical College in Chicago. He said the federal recommendations are typically tied to which vaccines are stocked and covered by insurance companies. He’s worried about the long-term implications for hepatitis B vaccine availability.
“It’s the exact opposite of what they say about freedom because they are taking away the access — if that is the end result of having less vaccines available to children,” Nguyen said.
For decades, the government has advised that all babies be vaccinated against the liver infection right after birth. It can become a long-lasting problem that can lead to liver failure, liver cancer and scarring called cirrhosis. The shots are widely considered to be a public health success for preventing thousands of illnesses.
But Kennedy’s Advisory Committee on Immunization Practices decided to recommend the birth dose only for babies whose mothers test positive, and in cases where the mom wasn’t tested.
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 panel recommendation.
For parents of newborns, the change will likely mean the hepatitis B vaccine will become an extra step rather than part of the routine post-birth treatment, Landon said. Nurses were the ones who typically talked to parents about the vaccine, but that discussion will now happen with a doctor.
“Now it’s on the doctor’s shoulders,” Landon said. “They got to come in and talk to you about it, separate, they need to order it, separate, you got to wait for it to come up from the pharmacy, then you got to give it to the baby.”
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.
ACIP 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’s potentially serious long-lasting consequences are why Nguyen, of Rush, said he won’t change how he talks to patients or students about the vaccine.
“In a baby, it’s such a highly consequential event,” he said, noting the problems that come from infection. “… Those are worth preventing with a vaccine.”
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.
It’s more infectious than the HIV virus, said Nguyen and Landon. While some newborns infected with hepatitis B contracted it from their mothers, it remains unclear how it’s transmitted in other newborns, adding that’s one of the reasons why inoculation is considered critical, Nguyen said.