On Dec. 5, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention voted to reverse its decades-long recommendation for universal vaccination against hepatitis B beginning at birth. Public health expert and infectious disease physician Janet A. Jokela is the senior associate dean for engagement and a clinical professor in the Carle Illinois College of Medicine at the University of Illinois Urbana-Champaign. She talked with News Bureau biomedical sciences editor Liz Ahlberg Touchstone about the vaccine, the committee's decision and its potential impacts.
Why do newborns receive the hepatitis B vaccine?
Hepatitis B is an infection which may cause liver disease, cirrhosis, liver cancer and premature death. It is highly contagious; it may be passed from mother to child at birth and also can be passed to infants from other infected caregivers and contacts, who often do not know they are infected. Hepatitis B is transmitted through blood and other body fluids, which means items like towels, wash cloths and toothbrushes can transmit the infection. It is environmentally resilient and can remain infectious on solid surfaces for up to seven days.
Prior to implanting the birth dose, only mothers who tested positive were vaccinated. This still resulted in infant infections: Some infants missed vaccination due to logistical issues, some mothers were never screened, some mothers' tests returned falsely negative and some infants acquired the infection from other caregivers. This is why the decision was made to move to the universal birth dose of HepB vaccination.
Since implementing the birth dose of HepB vaccine in 1991, chronic hepatitis B infections in children and adolescents have fallen by 99%. More than 500,000 childhood infections and an estimated 90,100 childhood deaths have been prevented. This recommendation was strengthened and reaffirmed in 2005 and 2018.
How did the committee vote to change the recommendations for infant hepatitis B vaccination? What was the reasoning?
The committee voted to remove the universal vaccination recommendation for the birth dose of HepB vaccine, despite no new evidence of harms and disregarding the clear benefits. They also recommended that parents ask clinicians for an antibody blood test to determine the need for subsequent doses of the vaccine, despite the lack of evidence to support this approach.
The rationale to delay vaccination is unclear. The safety of this vaccine has been studied and examined in depth over decades, and the benefits are significant. Approximately 90% of infants infected near birth develop chronic hepatitis B infection. They also are at risk of cirrhosis, liver cancer and premature death. Additionally, those with active untreated hepatitis B are at risk of infecting others. Moving away from the birth dose of HepB vaccine increases all of these risks.
What is the Advisory Committee on Immunization Practices? How can their decisions affect whether parents can access vaccines for their children?
ACIP, historically, is an advisory committee to the CDC comprised of experts in vaccines, vaccinations, vaccine safety and infectious disease epidemiology. That changed, however, when Health and Human Services Secretary Robert F. Kennedy Jr. fired the entire expert membership of the committee in June 2025. Now many on the committee have little or no clinical experience, significant undeclared conflicts of interest, and apparent bias; their backgrounds indicate many have significant ties to antivaccine efforts. Moreover, vaccine experts have been excluded from committee deliberations, and the careful decision-making process, typically requiring months of careful preparation, has been abandoned.
Typically, ACIP recommendations are accepted by the CDC director and then become national health policy. Insurance companies are required to cover the vaccinations recommended, and the Vaccine for Children Program requires ACIP approval for vaccine coverage for uninsured or underinsured children. In addition, many state policies and laws concerning insurance coverage for vaccines are tied to ACIP decisions. Thus, there are significant monetary and policy implications of this group's decisions and recommendations. This is one reason why we now are seeing some states issuing their own vaccine guidance including for insurance coverage: They no longer trust ACIP decisions and CDC recommendations.
The committee also discussed the broader childhood vaccine schedule and may make more changes in future meetings. How was the schedule set in the first place? Would there be any benefit to spacing out shots or separating combination vaccines?
The pediatric vaccinations and the vaccine schedule have been extensively studied and carefully reviewed for decades. Vaccine and vaccination experts have always been open to reviewing the schedule and vaccinations to ensure that they meet the highest standards of safety. Current data does not support changes to the pediatric vaccination schedule such as eliminating the birth dose of HepB immunization, spacing out shots nor separating combination vaccines into their individual components. Given the broadly supported desire to minimize the number of injections, combination vaccines help to achieve this. Separating combination vaccine components will increase the risk that vaccinations will be missed and that children will become ill from vaccine-preventable infections.
