Following in the wake of public health turnabouts from the United States’ chief public health agency, on Dec. 5, the Advisory Committee on Immunization Practice (ACIP) has rescinded its 30-year policy for hepatitis B vaccination at birth.
The new recommendation was announced at midday but has yet to be formally adopted by the acting director of the Centers of Disease Control and Prevention (CDC). The decision, which was anticipated for months after the previous ACIP panel was replaced by current Health and Human Services Secretary Robert F. Kennedy Jr.’s supporters, has been widely denounced by medical advocacy groups.
“The Advisory Committee on Immunization Practices’ vote to weaken the birth-dose recommendation for the hepatitis B vaccine is reckless and undermines decades of public confidence in a proven, lifesaving vaccine,” the American Medical Association wrote in a statement, released the same day as the ACIP decision. “Today’s action is not based on scientific evidence, disregards data supporting the effectiveness of the hepatitis B vaccine, and creates confusion for parents about how best to protect their newborns.”
The new members of the ACIP include a nurse with a Ph.D. in public health who serves on the board of a nonprofit that questions the safety of vaccines and a Swedish biostatistician who works with a think tank focused on opposing vaccines. The CDC adopted the hepatitis B vaccination recommendations in 1991 with the explicit goal of eliminating any transmission of the virus in the United States.
For Cindy Le, who works as a nail technician in Houston, Texas, the chance to be vaccinated against hepatitis B was something she wished she had.
“I was born with [hepatitis B],” Le said. “Both my parents have it, and since I was born in Vietnam, in a rural area, I wasn’t offered that shot that kids would usually have if their parents have hepatitis B.”
Le has lived with her symptoms for the last 20 years, and has to constantly monitor what she eats and drinks to prevent a flare-up. She says vaccination would’ve prevented her years of struggling with the mental and physical burden of the disease.
“I still have to be very careful around other people not to share a toothbrush or share a razor … to be safe,” Le said. “I’m not supposed to share drinks with other people, just in case I could pass my hepatitis B … Now if I have children, they have to take a shot.”
Le also noted that the new guidelines aligned with the Trump administration’s hostile stance against immigration. The CDC’s press release stated that the majority of births to women who test positive for hepatitis B are to non–US-born women, primarily from Africa and East Asia.
“I believe if anybody needs it, they should have access to [the vaccine] and not be discriminated against,” Le said.
HepVu, a data platform from the Rollins School of Public Health at Emory University that analyzes national hepatitis data, recently released an analysis showing the predicted rise in cases if the new recommendations are adopted.
“By delaying the birth dose to 2 months among infants whose mothers are not known to be living with hepatitis B, there could be at least 1,400 preventable hepatitis B infections among children, 300 excess cases of liver cancer, 480 preventable deaths and over $222 million in excess healthcare costs, for each year the revised recommendation is in place,” a press release from HepVu reads.
The combined financial and emotional toll that hepatitis B takes on patients is something that Le thinks about often. Due to the fluctuating nature of her job, she doesn’t have health insurance and hasn’t visited a liver specialist in years.
“I went to a liver specialist for a little bit in high school,” Le said. “They told me. ‘Yeah, you’re fine right now [but] we can’t give you a shot to help you get rid of the hepatitis B, because [you’re] too young.’ I was under 18, but they told me as long as I’m healthy, I’m eating right, I’m not at risk of getting liver cancer unless I’m like … obese. I did get the warning about liver cancer.”
Treatment for hepatitis B is targeted towards reducing active liver inflammation which may cause liver scarring or jaundice. Long-term treatment aims to reduce the amount of hepatitis B viral particles in a patient’s blood to prevent liver cancer and death.
“The American people have benefited from the committee’s well-informed, rigorous discussion about the appropriateness of a vaccination in the first few hours of life,” said Deputy Secretary of Health and Human Services and CDC Acting Director Jim O’Neill in a statement posted on the CDC website. The CDC did not respond in time for publication.
For Le and others in her community, the vaccine represents hope for a healthier future, both for her and her future children. When asked what she hoped would improve for children who were in her situation, she hesitated.
“I don’t know,” Le said. “I just hope there’s better access for the vaccines for those who need it because … when I got here I was a lot older, so it was too late for me to get the vaccine … I hope there’s a better cure for [that] age group.”
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