Jumping Without a Net
Robert F. Kennedy Jr.’s new CDC advisory board continues to try and fix things that aren’t broken. Next up: the hepatitis B vaccine birth dose.
On September 19, 2025, the CDC’s Advisory Committee on Immunization Practices (ACIP) considered the possibility of delaying the birth dose of hepatitis B vaccine. Secretary of Health and Human Services, Robert F. Kennedy Jr., explained why: “Today we are prioritizing the restoration of public trust above any specific pro- or anti-vaccine agenda. A clean sweep is necessary to reestablish public confidence in vaccines.” According to RFK Jr., the best way to restore public trust is to disrupt vaccine programs with long records of safety and efficacy.
Hepatitis B virus can cause cirrhosis (chronic liver disease) or liver cancer. Risks are age dependent. About 95 percent of adults infected with hepatitis B virus will recover completely. Children, on the other hand, are far more vulnerable. About 90 percent of infants infected with the virus and 30 percent of 1 to 5-year-olds will develop cirrhosis or liver cancer. In other words, failing to quickly identify infants and children exposed to hepatitis B virus is a ticket to a shortened life.
The hepatitis B vaccine was first licensed in 1981. One year later, in 1982, the CDC recommended that all babies born to mothers infected with hepatitis B virus during first-trimester screening receive the hepatitis B vaccine before leaving the hospital. Because almost all babies born through a birth canal containing hepatitis B virus are infected, this was an easy recommendation to make. Before the availability of the vaccine, between 200,00 to 300,000 people in the United States were infected with hepatitis B virus every year, including about 20,000 children.
The birth dose recommendation in 1982 didn’t make much of dent in the incidence of hepatitis B infection. In response, in 1988, the CDC expanded the birth dose to include racial and ethnic groups at highest risk (such as Alaskan Natives and Southeast Asian refugees). Again, not much of an impact. So, in 1991, the CDC further expanded its birth dose to all U.S. newborns. At the time, about 30,000 children less than 10 years of age were infected with hepatitis B virus. Why didn’t the original strategies to target newborns whose mothers were infected or likely to be infected work?
First, about 15 percent of women in the United States don’t receive first-trimester screening for hepatitis B virus. Indeed, among developed world nations, the United States is one of the worst in assuring pre-natal screening.
Second, like all screening tests, detection of hepatitis B virus isn’t perfect. About 5 percent of those who are infected are missed by the screening test. In other words, the test can be falsely reassuring.
Third, because the screening test is performed in the first trimester, mothers can still be infected in the second or third trimester.
Fourth, and this is the big one, only half of the 30,000 children less than 10 years of age in 1991 had acquired the disease from their mother! The rest were infected from relatively casual contact with people who were chronically infected with hepatitis B virus, most of whom didn’t know they were infected. (This is why hepatitis B is called “The Silent Epidemic”.) People infected with hepatitis B virus can have as many as 10 billion infectious particles per milliliter of blood. And the virus can live on surfaces for up to seven days. Children can unknowingly be exposed to unseen blood on towels, washcloths, nail clippers, or razors. Indeed, hepatitis B virus is 50-100 times more contagious than HIV, the cause of AIDS. Few people seem to understand this. For example, on September 23, 2025, President Trump said, “Hepatitis B is sexually transmitted. There’s no reason to give a baby that’s almost just born hepatitis B. I would wait until the baby is 12 years old and formed and take hepatitis B.”
About 2.4 million people in the United States are chronically infected with hepatitis B virus. Do you know who they are? Do you know whether someone at day care or someone taking care of your baby or a relative who holds your baby isn’t infected given that they often don’t know. Delaying the birth dose offers no benefits. Only risks. Even if the risk is small, why take it. The vaccine is as safe at birth as it is at 2 or 3 months of age.
In October 2025, the ACIP will likely recommend delaying the birth dose for hepatitis B vaccine. They will argue that other countries like Denmark don’t give the vaccine until 2 months of age. But Denmark has a much lower incidence of hepatitis B infections and is much better at performing prenatal screening. We aren’t Denmark. Why jump without a net?
This is a clear explanation of why vaccination of newborns with HepB protein is essential to prevent hepatitis. Thank you, Paul
Thank you, Paul, for this excellent and accurate denouement of the universal birth dose of the hepatitis B vaccine. I remember the evolution of this landmark initiative (as a retired pediatrician), and appreciate your laying out of the struggle that the health care community underwent to finally come to this unique and inevitable solution. The history of vaccines needs to be remembered, not forgotten and ignored, as it has been in recent times.