In a move that has unsettled hospitals, obstetricians, and public‑health officials across the United States, the Centers for Disease Control and Prevention’s vaccine advisory panel recently reversed decades‑long guidance that had mandated the hepatitis B vaccine for every newborn.
The Decision and Its Immediate Impact
On Friday, the CDC’s vaccine panel advised that only babies born to mothers who test positive for hepatitis B should receive the first dose within 24 hours of delivery. The recommendation removes the universal birth dose that has been in place since the early 1990s and has cut acute hepatitis B infections in children by 99 percent. The panel also suggested that mothers who test negative could decide with their provider whether the infant should receive the birth dose.
The agency’s acting director, Jim O’Neill, had not yet signed off on the recommendation as of Tuesday. While the CDC is not required to follow the panel’s advice, it typically does. The reversal has left clinicians scrambling to decide how to counsel patients and to implement protocols that are now at odds with long‑standing practice.
Voices from the Front Lines
Dr. Brenna Hughes, interim chair of obstetrics and gynecology at Duke University, said the change “creates fear and distrust.” She added, “We don’t really know just yet how individual hospitals and clinicians will handle this.”
In a March of Dimes report released in November, nearly a quarter of pregnant women were not under a doctor’s care during their first trimester, when hepatitis B testing is most often performed. Dr. Steven Fleishman, president of the American College of Obstetricians and Gynecologists, described the newborn vaccine as a safety net. “If there is someone who gets exposed to hepatitis B later in pregnancy, or develops an infection later on,” he said, “the baby is protected by that vaccine.”
Pediatrician Dr. Aaron Milstone of Johns Hopkins Medicine called the fallout “chaos and confusion.” He explained that public‑health experts are struggling to advise clinicians, while doctors in exam rooms face anxious parents. “Many physicians are working across our country in fear that doing the best thing for their patient is now at odds with information coming from what were previously trusted resources,” he said.
The American Academy of Family Physicians’ president, Dr. Sarah Nosal, echoed this sentiment. “If you have to spend 20 minutes explaining that vaccines, yes, in fact, are safe, then we’re not spending 20 minutes making sure the baby’s on the growth curve, that you’re wearing seat belts, that you’re using car seats appropriately,” she said.
Dr. Kevin Schulman, a professor of medicine at Stanford Medicine, highlighted the time lost in vaccine discussions. Meanwhile, Dr. Anna Lok of the University of Michigan Medical School warned that the new guidance “adds barriers for parents, especially in a chaotic delivery room.” She said the change forces parents to “climb to Mount Everest” to get their baby vaccinated.
High‑risk obstetrician Dr. Rashmi Roa of UCLA Health said that, from a medical standpoint, nothing has changed. “Our recommendations will stay the same,” she said.
State‑Level Responses
Some states have chosen to override federal guidance. Dr. Naima Joseph, an OB‑GYN at Beth Israel Deaconess Medical Center, explained that Massachusetts and other states have formed the Northeast Public Health Collaborative to maintain a universal birth dose. “We have already made recommendations regarding universal birth dose hepatitis B vaccine that continues to ensure access to newborns,” she said.
Lawyer Joe Zamboni of the nonprofit American Families for Vaccines noted that the approach would not be uniform nationwide. “I think some states will probably do it better than others,” he said.
Florida’s surgeon general, Joseph Ladapo, has been vocal about eliminating vaccine requirements for school attendance. The Florida Department of Health scheduled a meeting for Friday, Dec. 12, to discuss these requirements. A spokeswoman told NBC News that the meeting would be held in Panama City and would not be available to the public online.
Senator Bill Cassidy, a liver‑disease specialist from Louisiana, explained his support for the CDC guidance that infants should receive the hepatitis B vaccine, citing concerns that the advisory panel might change the recommendation.
The Panel’s Composition and Criticism
The advisory panel was hand‑picked in June by Health Secretary Robert F. Kennedy Jr. Critics say it failed to follow the transparent, evidence‑based process that has historically underpinned CDC recommendations. Dr. Jason Goldman, president of the American College of Physicians, said, “The panel has not followed the standard and transparent process that had made the advisory committee a bastion of good evidence‑based decision making. Their information and decisions cannot be trusted.”
The panel’s vote to hold off the hepatitis B vaccine until at least two months of age for the first dose if it is not given at birth was described by experts as “totally out of line with decades of evidence proving the shot’s safety and effectiveness.”
Key Takeaways
- The CDC panel’s new guidance limits the birth dose of hepatitis B to babies of mothers who test positive, potentially leaving many infants unprotected.
- Hospitals and clinicians are uncertain how to apply the recommendation, causing confusion and fear among patients.
- Several states are maintaining universal birth doses, while Florida’s health officials are moving toward eliminating vaccine requirements for school attendance.
The reversal of a long‑standing public‑health policy has ignited a debate that spans clinical practice, state policy, and the integrity of the CDC’s advisory process. As hospitals and parents grapple with the new guidance, the ripple effects may shape vaccination practices for years to come.
