Introduction to the Vaccine Advisory Committee’s Decision
A federal vaccine advisory committee on Thursday voted to delay a decision on whether newborns should still get the hepatitis B vaccine on the day they’re born.
The Advisory Committee on Immunization Practices, meeting in Atlanta, voted to delay the decision until Friday after committee members voiced confusion about voting language — and some voiced concern about taking such a step.
Background on Hepatitis B Vaccination
For decades, the government has advised that all babies be vaccinated against the liver infection right after birth. The shots are widely considered to be a public health success for preventing thousands of illnesses.
But U.S. Health Secretary Robert F. Kennedy Jr.’s committee is considering whether to recommend the birth dose only for babies whose mothers test positive, which would mark a return to a public health strategy that was abandoned more than three decades ago. For other babies, it will be up to the parents and their doctors to decide if a birth dose is appropriate.
Committee’s Decision-Making Process
Committee member Vicky Pebsworth said a work group was tasked in September with evaluating whether a birth dose is necessary when mothers tested negative for hepatitis B.
“We need to address stakeholder and parent dissatisfaction" with the current recommendation, she said.
The committee makes recommendations to the director of the Centers for Disease Control and Prevention on how already approved vaccines should be used. CDC directors almost always adopted the committee’s recommendations, which were widely heeded by doctors and guide vaccination programs. But the agency currently has no director, leaving acting director Jim O’Neill to decide.
Controversy Surrounding the Committee
Kennedy, a leading anti-vaccine activist before he became the nation’s top health official, fired the entire 17-member panel earlier this year and replaced it with a group that includes several anti-vaccine voices.
The panel has made several decisions that angered major medical groups.
At a June meeting, it recommended that a preservative called thimerosal be removed from doses of flu vaccine even though some members acknowledged there was no proof it was causing harm.
In September, it recommended new restrictions on a combination shot that protects against chickenpox, measles, mumps and rubella. The panel also took the unprecedented step of not recommending COVID-19 vaccinations, even for high-risk populations such as seniors, and instead making it a matter of personal choice.
Hepatitis B and Its Risks
Hepatitis B is a silent liver infection that can cause serious illness, including cancer. A pediatric infectious disease expert explains how it spreads, why the vaccine is given at birth, and how it protects babies for life.
Several doctors groups said the changes were not based on good evidence, and advised doctors and patients to follow guidance that was previously in place.
They renewed some of that criticism. Dr. Jason M. Goldman, president of the American College of Physicians, commented during the meeting, calling it “political theater” and adding that “you are basing this on concerns of individuals who don’t want the vaccine.”
Committee Members’ Concerns
Some committee members argued that safety studies in the past were limited and it’s possible that larger additional studies could uncover a problem with the birth dose. But two other committee members — Dr. Joseph Hibbeln and Dr. Cody Meissner — saw no documented evidence of harm from the birth doses and wondered whether the concern behind the discussion is just, as Hibbeln said, “speculation.”
Hepatitis B is a serious liver infection that, for most people, lasts less than six months. But for some, especially infants and children, it can become a long-lasting problem that can lead to liver failure, liver cancer and scarring called cirrhosis.
Spread of Hepatitis B
In adults, the virus is spread through sex or through sharing needles during injection drug use.
But it can also be passed from an infected mother to a baby. As many as 90% of infants who contract hepatitis B go on to have chronic infections, meaning their immune systems don’t completely clear the virus.
In 1991, the committee recommended an initial dose of hepatitis B vaccine at birth. Over about 30 years, cases among children fell from about 18,000 per year to about 2,200.
Presentations and Criticisms
Cynthia Nevison, an autism and environmental researcher, presented at the meeting. Nevison has written opinion pieces published by Children’s Health Defense, an anti-vaccine advocacy organization Kennedy previously led. She also co-authored a 2021 article in the Journal of Autism and Developmental Disorders that the publication retracted after concerns were raised about the paper’s methodology and about nondisclosed ties between the authors and anti-vaccine groups.
Another presenter was Mark Blaxill, a co-author of the retracted paper, who spoke about vaccine safety.
In the past, committee meetings have relied on presentations by the CDC scientists involved in tracking vaccine-preventable diseases and assessing vaccine safety. The agenda for this meeting listed no CDC scientists, but rather featured a prolonged public airing of anti-vaccine theories that most scientists have deemed as discredited.
Conclusion
The delay in the decision on hepatitis B vaccination for newborns has sparked controversy and criticism from medical groups. The committee’s consideration of recommending the birth dose only for babies whose mothers test positive has raised concerns about the potential risks and benefits of the vaccine. The final decision will have significant implications for public health policy and the prevention of hepatitis B infections in children.
FAQs
- What is hepatitis B and how is it spread?
Hepatitis B is a liver infection that can be spread through sex, sharing needles, or from an infected mother to a baby. - Why is the hepatitis B vaccine given at birth?
The vaccine is given at birth to protect babies from the risk of chronic infection and long-term health problems. - What are the risks and benefits of the hepatitis B vaccine?
The vaccine is considered safe and effective in preventing hepatitis B infections, but some committee members have raised concerns about potential risks and limitations of safety studies. - What is the current guidance on hepatitis B vaccination for newborns?
The current guidance advises a dose within 24 hours of birth for all medically stable infants who weigh at least 4.4 pounds, plus follow-up shots to be given at about 1 month and 6 months. - What are the implications of the committee’s decision for public health policy?
The final decision will have significant implications for public health policy and the prevention of hepatitis B infections in children, and may impact the guidance on vaccination schedules for U.S. children.
