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ACIP Votes to End Universal Hepatitis B Birth Dose, Shifts to Shared Decision‑Making

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ACIP Approves Shift From Universal to Individual Decision‑Making The Advisory Committee on Immunization Practices voted 8‑3 to replace the routine hepatitis B birth‑dose with a shared‑clinical‑decision model, allowing parents of HBsAg‑negative mothers to defer the first dose until at least two months of age [1][2]. The new language also authorizes post‑vaccination anti‑HBs antibody testing before additional doses [1][2]. The vote was recorded after a brief postponement caused by confusing wording in the original proposal [3][4].

Committee Reconstitution Sparks Concerns Over Scientific Independence Secretary of Health and Human Services Robert F. Kennedy Jr. removed all 17 incumbent ACIP members in June 2025 and appointed a new slate that includes several individuals known for anti‑vaccine positions [1][2][3][4][5][6]. The overhaul has been criticized as undermining the panel’s traditional scientific autonomy [3][4]. New members presented material questioning the necessity of the birth dose, citing a retracted study and modeling that suggested delayed vaccination could increase preventable cases [3][5].

Professional Medical Societies Issue Strong Opposition The American Academy of Pediatrics, the American Medical Association, the Infectious Diseases Society of America, and other public‑health groups issued statements labeling the recommendation “reckless,” “harmful,” and “unscientific” [1][2]. Critics emphasized the vaccine’s long‑standing safety record and its role in reducing pediatric hepatitis B cases from roughly 18,000 annually in the early 1990s to about 20 today [5]. The societies warned that eliminating the birth dose could reverse these gains, especially in populations with limited maternal screening [1][2].

Potential Public‑Health Consequences Highlighted by Experts Local health departments and epidemiologists cautioned that delaying the birth dose may raise infection rates in communities where follow‑up is weak [1][2]. A CDC analysis notes the United States is one of only eight high‑income nations that still recommends a universal birth dose, underscoring the policy’s uniqueness [4]. The committee also proposed covering serology testing costs through insurance, a move opposed by several members who argue it adds unnecessary complexity [1][2].

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Timeline

1991 – The CDC issues its first universal hepatitis B birth‑dose recommendation, a policy that drives pediatric cases down from roughly 18,000 per year to about 20 by 2025, underscoring the vaccine’s historic public‑health impact. [5]

June 9, 2025 – HHS Secretary Robert F. Kennedy Jr. removes all 17 sitting ACIP members and installs a new panel that includes several anti‑vaccine advocates, fundamentally reshaping the advisory body that sets U.S. vaccine guidelines. [3][4]

Dec 4, 2025 – The reconstituted ACIP gathers for a two‑day session to consider revising the hepatitis B birth‑dose schedule; the agenda features disease‑burden and safety data, and the meeting is filmed in a “C‑Span‑style” studio for the first time to increase public visibility. [4][6]

Dec 4, 2025 (afternoon) – After three rapid revisions to the voting language, members vote 6‑3 to postpone the decision, citing confusion over wording and pressure from stakeholder groups; the delay gives the committee extra time to review the proposal. [3][4]

Dec 5, 2025 – ACIP votes 8‑3 to drop the universal hepatitis B birth‑dose, replacing it with shared clinical decision‑making and a minimum first dose at two months for infants of HBsAg‑negative mothers; the panel also adopts a new recommendation for post‑vaccination anti‑HBs serology testing before additional doses. [1][2]

Dec 5, 2025 (professional backlash) – The American Academy of Pediatrics, Infectious Diseases Society of America, and American Medical Association issue statements calling the change “reckless,” “harmful,” and “unscientific,” warning it could raise infection rates. [2]

Dec 5, 2025 (expert criticism) – ACIP liaison Dr. Jason Goldman says the presentations “are not following science,” while atmospheric scientist Dr. Cynthia Nevison’s reliance on a retracted study draws skepticism from other members. [5]

Dec 5, 2025 (political comment) – Senator Bill Cassidy attacks attorney Aaron Siri’s participation, labeling him a “trial attorney who makes his living suing vaccine manufacturers.” [3]

Dec 5, 2025 (global context) – CDC analysis notes the United States is one of only eight of 37 wealthy nations that still recommends a hepatitis B dose at birth, highlighting the policy’s outlier status. [4]

Dec 5, 2025 (public‑health impact) – Local health departments warn that delaying the birth dose could increase hepatitis B transmission, especially in communities with limited maternal screening, and the new VFC guidance now advises a two‑month delay for infants who miss the birth dose. [2]

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