A crucial vote on the future of hepatitis B vaccinations for newborns in the United States has been postponed for a second time, casting uncertainty over a decades-old public health policy.
Committee Vote Postponed Amid Confusion
The Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP) was scheduled to vote on Thursday afternoon. However, the panel, recently appointed by Health and Human Services Secretary Robert F Kennedy Junior, opted for a delay. Members cited confusion over the precise nature of the vote and noted that the language of the proposal had been altered multiple times.
The vote is now expected to take place on Friday morning. While the committee's recommendations are not legally binding, they hold substantial sway and are historically followed by medical professionals and institutions across the nation.
High Stakes for a Lifelong Infection
The debate centres on whether the hepatitis B vaccine should continue to be administered to all newborns within 24 hours of birth, a practice established in the US in 1991. Hepatitis B is a viral infection that attacks the liver and can lead to chronic disease, cirrhosis, liver failure, and cancer. It is incurable.
The virus spreads through contact with infected blood and bodily fluids and can survive on surfaces for up to a week. Infants are particularly vulnerable; up to 90% of those infected develop a chronic, lifelong infection, which carries severe risks later in life.
The current US schedule recommends a three-dose vaccine: the first within a day of birth, followed by doses at one month and six months of age. Research indicates this regimen is up to 90% effective at preventing transmission from an infected mother to her child if the initial dose is given promptly.
Leadership Changes and Historical Context
The delay occurred during a meeting where the committee's chair, Dr Kirk Milhoan, was absent, reportedly boarding a plane. Dr Robert Malone, the vice chair who presided, is a former University of Maryland physician known for promoting unfounded claims about Covid-19 vaccines.
Dr Milhoan, a paediatric oncologist and former US Air Force flight surgeon, was appointed chair just three days prior. He replaced Dr Martin Kulldorff, a Swedish biostatistician and lead author of the Great Barrington Declaration, who moved to a senior role within the Department of Health and Human Services.
This marks at least the second postponement for this vote, following a previous delay in September when the committee felt evidence was insufficient for a "confident evidence-based recommendation."
Epidemiology and Global Comparison
An estimated 20,000 infants are born to hepatitis B-positive mothers in the US each year, with higher rates among foreign-born and non-white ethnic groups. Thanks largely to the vaccination programme, only about 10 babies now contract the virus from their mothers annually.
Overall, roughly 640,000 US adults live with chronic hepatitis B, though half are unaware. Infection rates are highest among non-Hispanic Asian and Pacific Islander communities.
While the US mandates universal newborn vaccination, several European nations, including the UK, France, and Germany, take a different approach. They typically vaccinate only high-risk infants at birth, with the broader childhood population receiving the jab at around eight weeks old. Despite its more targeted policy, the UK has a higher rate of hepatitis B infection than the US.
The outcome of Friday's delayed vote will be closely watched, as it has significant implications for a cornerstone of American paediatric preventive healthcare.
