A major shift in US vaccination policy is underway after a federal advisory panel voted to end the longstanding recommendation that all newborns receive the hepatitis B vaccine on their first day of life.
A Controversial Policy Shift
The committee, appointed by US Health Secretary Robert F. Kennedy Jr, decided on Friday, 5 December 2025, that the birth dose should now only be mandated for infants whose mothers test positive for the hepatitis B virus (HBV) or whose infection status is unknown. For all other babies, the decision will be left to parents and their doctors.
For parents who opt out of the birth dose, vaccinations are advised to start no sooner than when the infant is two months old. This proposal marks the most significant change to national immunisation policy under Kennedy, who has a history of promoting anti-vaccine views.
The vote has triggered significant alarm among numerous medical and doctors' groups. They argue the concerns driving the decision are speculative and warn that the policy change will inevitably lead to more children becoming infected with the potentially deadly virus.
Understanding Hepatitis B and the Vaccine's Role
Hepatitis B is a virus that attacks the liver and is the leading cause of liver cancer globally. While many infected adults show no symptoms and can clear the infection, it becomes chronic in over 90% of infected infants and up to 50% of young children. Decades later, these chronic infections can lead to liver failure, necessitating a transplant. Crucially, there is no cure for HBV, and the disease often recurs even after a liver transplant.
The virus is transmitted through contact with infected body fluids. Before the vaccine was widely available, mother-to-baby transmission during childbirth was the most common route. In the US pre-vaccination, about 85% of newborns contracted HBV from mothers with active infections.
Universal vaccination at birth was implemented to protect infants whose mothers' HBV status was unknown or incorrectly recorded, and to guard against transmission from other infected family members or caregivers. The strategy has been overwhelmingly successful. US HBV infection rates have plummeted by nearly 90%, from roughly 9.6 per 100,000 people before widespread vaccination to about one per 100,000 in 2018.
Globally, the World Health Organization (WHO) estimates 254 million people were living with chronic hepatitis B in 2022, with 1.2 million new infections annually. The birth dose practice has been adopted by 190 of 194 WHO member countries.
Safety, Efficacy, and the Road Ahead
The hepatitis B vaccine is widely regarded as safe. Typical side effects are mild, such as soreness at the injection site or a low-grade fever. Serious allergic reactions are extremely rare. The Centers for Disease Control and Prevention (CDC) has stated that "scientific evidence overwhelmingly supports the safety" of all licensed US vaccines, including those for hepatitis B.
Under the previous CDC guidelines, in place since October 2016, all medically stable newborns were to receive their first HBV dose within 24 hours of birth. This policy is now set to be rolled back, placing the onus of decision-making on individual families for the first time in decades.
The long-term consequences of this policy shift remain to be seen, but the medical community's concern is clear: moving away from a universal, evidence-based protocol risks reversing decades of hard-won progress against a silent but serious public health threat.
