Most American babies receive a hepatitis B vaccine just before their first bath, in the series of pokes, prods and photographs that come with giving birth in a 21st-century hospital.
But starting this week, thousands of U.S. newborns will no longer receive the initial hepatitis B shot, the first in a series of childhood shots and the best protection against one of the world's deadliest cancers.
Dec. 5, Centers for Disease Control and Prevention's powerful vaccine advisory panel voted for refusal birth dose recommendation developed decades ago.
The change was spearheaded by Health and Human Services Secretary Robert F. Kennedy Jr. and his Make America Healthy Again movement, which has long sought to rewrite the CDC childhood immunization schedule and eliminate state immunization requirements for kindergarten.
California officials have vowed to keep the state's current guidelines in place, but federal changes could jeopardize vaccine coverage by some insurers and public benefit programs and cause broader impacts.
“This is the gateway,” said Jessica Malaty Rivera, an infectious disease epidemiologist in Los Angeles. “It’s not just hepatitis B—it’s disrupting the whole schedule.”
Democratic-led states and major insurance companies have worked hard to ensure access. California joined Hawaii, Oregon and Washington in forming the West Coast Health Alliance to maintain a unified state vaccine policy in the face of official “misinformation and disinformation.”
“Universal hepatitis B vaccination at birth saves lives, and abandoning this science is reckless,” California Gov. Gavin Newsom said in a statement. “The Trump administration’s ideological policies continue to impose ever-higher costs—for parents, newborns, and our entire public health system.”
The issue is also already being considered in court.
The Supreme Court on Tuesday sent a case over New York's vaccination rules back to the 2nd U.S. Circuit Court of Appeals for review, signaling skepticism about strict school vaccination requirements first introduced in California. Florida public health officials on Friday appeared poised to eliminate hepatitis B immunization requirements in their schools, as well as vaccinations against chickenpox, a dozen strains of bacterial pneumonia and a longtime leading cause of deadly meningitis.
Supporters of the hepatitis B changes said they would replace impersonal mandates with “shared clinical decision-making” about whether and how to vaccinate, while maintaining stricter recommendations for children of infected mothers and those whose status is unknown.
Critics say families have always had the right to refuse the vaccine. 20% did it nationwide in 2020, according to data published by the CDC. This is the only vaccine on the list that children on Medicaid receive at the same rate as children with private insurance.
Critics say that rather than improving informed consent, the CDC committee's decision and the tumultuous public fight that led to it have led to declining vaccination rates, even among children of infected mothers.
“Hepatitis B is the weakest vaccine on the list,” said Dr. Chari Cohen, president of the Hepatitis B Foundation. “The message we're hearing from pediatricians and gynecologists is that parents are making it clear that they don't want their child to receive the dose at birth, they don't want their child to receive the vaccine.”
Much of this vulnerability is related to timing: the first dose is given within hours of birth, while symptoms may not appear for decades.
“Everything that happened with the first day is really annoying people,” Rivera said. “They think, 'This is my perfect fresh baby and I don't want to put anything in it.' »
US Surgeon General nominee Casey Means called the universal birth dose recommendation “absolute madness,” saying in a post on X last year that it should “make every American think and question the mandates of the health care system.”
“The disease is transmitted exclusively through needles and sexual contact,” she said. “There is no benefit to the child or the general population from receiving this vaccine unless they are at risk of sexual or intravenous transmission. There is only risk.”
In fact, at least half of transmission occurs from mother to child, usually at birth. A smaller percentage of children become infected with the disease if they share food, nail clippers or other household items with their fathers, grandparents or daycare teachers. Because infections are often asymptomatic, most do not know they have the virus, and at least 15% of pregnant women in the U.S. are not tested for the disease, experts say.
Infants infected with hepatitis B overwhelmingly develop chronic hepatitis, leading to liver cancer or cirrhosis in middle age. On the contrary, the vaccine much less likely than flu or chickenpox medications to cause even minor reactions such as fever.
“We've administered 50 billion doses of hepatitis B vaccine and haven't seen any signals that give us any cause for concern,” said Dr. Su Wang, medical director of the viral hepatitis programs and the Center for Asian Health at Cooperman Barnabas Medical Center in New Jersey, who lives with the disease.
Still, “sex and drugs” remain a popular topic of conversation not only among Kennedy's allies in Washington and Atlanta, but also among many prominent Los Angeles pediatricians.
“It creates a mentality on day one of, 'I don't necessarily agree with this, so what else do I disagree with?' said Dr. Joel Warsh, a Studio City pediatrician and MAHA luminary whose recent book, “Between the Vaccine and a Hard Place,” addresses vaccine-hesitant families.
Hepatitis B also disproportionately affects immigrant communities, further stigmatizing a disease that first entered the public consciousness as an early sign of HIV infection in the 1980s before it was fully understood.
At a committee meeting last week, committee member Dr. Evelyn Griffin called illegal immigration “the elephant in the room” in the birth dose debate.
The move comes as a post-pandemic wellness culture has increased vaccine hesitancy, expanding objections from the long-debunked link between the measles, mumps and rubella vaccine to the more general and equally false belief that “healthy” children who eat whole foods and play outside are unlikely to get vaccine-preventable diseases and, if they do, can be treated with “natural” treatments. products such as beef tallow and fish oil.
“It's about your quality of life, it's about what you put into your body, it's about your health — we've debunked that before,” Rivera said. “This is eugenics.”
Across Southern California, pediatricians, preschool teachers and public health experts are seeing a rise in families seeking to eliminate certain vaccinations from their schedules, and many are postponing others based on “individualized risk.” The trend has spawned a cottage industry of e-books, Zoom seminars run by “vaccine-friendly” doctors offering alternative schedules, personalized vaccinations and post-vaccine detox regimens.
Data from the Centers for Disease Control and Prevention (CDC) shows that vaccine exemptions in kindergartens have risen sharply since the height of the COVID-19 pandemic, with about 5% of schoolchildren in Georgia, Florida and Ohio, more than 6% in Pennsylvania and nearly 7% in Michigan opting out last year.
In Alaska and Arizona, these figures exceeded 9%. In Idaho, one in six childcare centers are exempt.
California is one of four states (along with New York, Connecticut and Maine) that do not have religious or personal belief exemptions for school vaccines.
It is also among at least 20 states that have pledged to preserve doses of hepatitis B vaccine for infants through public insurance, which covers about half of American children. It is unclear whether the revised recommendation will affect state vaccine coverage in other states.
Experts warn that the success of eliminating the birth dose, despite almost universal opposition from the medical establishment, jeopardizes the entire childhood vaccination schedule and threatens the school policies that enforce it.
Experts say ongoing measles outbreaks in Texas and elsewhere that have killed three and sickened nearly 2,000 highlight the risks of lifting the requirements.
Hepatitis is not as contagious as measles, which can linger in the air for about two hours. But experts say it's still fairly easy to get infected, and it's devastating for those who become infected.
“These decisions made today will have terrible residual consequences later,” said Rivera, the Los Angeles epidemiologist. “I can’t imagine a new mother having to deal with this.”
