Did someone forward you this? Subscribe here free!
Good morning, Roca Nation. Here are today’s four need-to-know stories:
Australia became the first country to ban social media for children under 16
President Trump announced that Nvidia would be allowed to sell its advanced H200 computer chips to China
Honduras' electoral authorities have still not declared a winner for the presidential election that took place more than a week ago
SpaceX announced plans for an initial public offering that would raise more than $30B
By Aleko Brice
If you were born after 1991, there’s a high likelihood that you received the hepatitis B vaccine as a newborn.
While first made available in the 1980s, it was in the early ‘90s that the Advisory Committee on Immunization Practices (ACIP) began recommending universal infant vaccination at birth. Expressing concern that the previous strategy of targeting high-risk populations was proving ineffective, this new recommendation led to most children receiving the shot before even leaving the hospital.
There has since been a drastic drop in hepatitis B virus (HBV) infections among babies and young children, the population most vulnerable to the virus. Public health officials claim the vaccination strategy led to this decline and the corresponding reductions in liver disease and liver cancer.
On Friday, ACIP voted 8-3 to end this strategy.
Under the new guidance, only babies whose mothers test positive for hepatitis B or have an unknown status will be automatically recommended to get the birth dose. Other parents can still elect to vaccinate their babies; however, the first dose won’t be recommended until the infant is at least two months old.
So what are the implications of this? Is the decision being driven by ideology or a sensible desire to increase trust in public health?
That’s the subject of today’s deep-dive.
Hepatitis B – a virus that attacks the liver – affects an estimated 1.25-1.89M Americans. Over time, chronic HBV dramatically increases the risk of many diseases, including cirrhosis, liver cancer, and early death. The risks of developing chronic HBV are especially severe when the virus is contracted at or near birth. Without intervention, infants infected shortly after birth have up to a 90% chance of developing lifelong chronic infection.
In the 1980s, after the first HBV vaccines were licensed in the US, the vaccine was initially recommended only for moderate to high-risk groups, like children born to infected mothers, health care workers, or other demographics with known exposure risk. But by the late 1980s, many children were continuing to contract HBV.
Public health officials believed this was because risk was consistently being underestimated, with mothers not being screened or exposure occurring unpredictably. That led to a critical turning point. In November 1991, ACIP adopted a universal-birth-dose policy: Every newborn should receive the first dose of hepatitis B vaccine shortly after birth.
The results were dramatic. In the 30 years following the universal vaccination strategy, perinatal and early-childhood HBV infections plummeted. The number of reported cases of acute hepatitis B among children younger than 19 had fallen by 99%, leading to a substantial reduction in long-term liver cancer risk, chronic disease, and future deaths.
Public health experts attributed this to universal infant vaccinations closing a critical “safety net” gap: Namely, that universal birth-dose vaccinations covered babies whose mothers’ infection status was unknown, whose prenatal screening may have failed or been incomplete, or who could be exposed later in infancy via household contacts or other exposures. This strategy became the cornerstone of HBV prevention in the US – until Friday.
ACIP’s new policy reflects a view held by Health Secretary RFK Jr. and others that considers the hepatitis B vaccine to be unnecessary for most children. RFK Jr. laid out his view on this in a 2023 interview with Joe Rogan, saying:
Why would you give, you get hepatitis B from, you know, from sharing needles or from like going to a really seasoned prostitute or from, you know, sort of compulsive homosexual behavior…why would you give it to a one-day-old baby, you know, or a three-hour-old baby, and then four more times when that baby is not going to be even subject to it for 16 years and it may not even?
Where public health experts would say that it’s because universal vaccination is a low-risk strategy that’s been proven to prevent disease, RFK Jr. believes it’s because vaccine recommendations are captured by Big Pharma. As he claimed during that same interview:
Originally what happened is Merck and the CDC designed [the hep B vaccine] for prostitutes and for male homosexuals, promiscuous male homosexuals, and they couldn't sell any because those cohorts had other better things to do with their money and they didn't, you know, they weren't going to buy the vaccine. Merck went back to CDC and said, we built all these plants and we got the thing and got it approved and we were, you know, a billion dollars in. What are you going to do? And the CDC said, well, just recommend it for children. And that way they keep what they call the warm production lines. They keep the vaccine. They like to have a lot of vaccines in case there's emergency. They have a lot of lines out there that they can manufacture a pandemic response on. This is what they say.
As of Friday, ACIP no longer recommends that all newborns be vaccinated for hepatitis B. It does not recommend the vaccine to infants born to mothers testing negative, because those babies are considered “low risk.”
“What we are doing here is trying to undo some really, really bad decision processes we had in the past,” said ACIP member Retsef Levi. Levi, an MIT professor, has in the past said that he believes there are gaps in the data about the vaccine’s safety.
Proponents of this change argue that the shift is justified by evolving epidemiology, improved maternal screening, and a desire to tailor medical decisions more precisely to individual risk.
By making vaccination optional in certain cases, supporters say the policy respects parental choice and avoids subjecting every newborn to a shot when the likelihood of benefit may be minimal. Some advisors at the CDC meeting have alleged that the vaccine could be a net negative, worrying about a link between this vaccine and chronic health conditions, including autism.
Panel members have also argued that the US is out of sync with international practices, with “peer countries” such as Denmark, Finland, and Iceland not recommending universal newborn HBV vaccination. Given the reduced prevalence of hepatitis B and widespread prenatal screening, the US could, according to the panel, safely adopt a more selective immunization schedule.
The medical establishment disagrees. The American Academy of Pediatrics, echoing a wide range of institutions, called the changes “irresponsible and purposely misleading.”
“There is no new or concerning information about the hepatitis B vaccine that is prompting this change, nor has children’s risk of contracting hepatitis B changed,” it said. “Instead, this is the result of a deliberate strategy to sow fear and distrust among families.”
These critics believe that removing the universal newborn dose abandons the public health safety net that helped virtually eliminate perinatal and early-childhood hepatitis B in the US. They argue that relying on screening pregnant women is imperfect: Some do not receive prenatal care; others slip through cracks in testing, documentation, or follow-up. Maternal infection can also be acquired late in pregnancy or after testing. As a result, risk-based vaccination based strictly on maternal status may miss infants at real risk for infection.
By delaying the first dose until two months after birth, they believe, ACIP is creating a window of vulnerability during which infants will be susceptible to the disease.
RFK Jr. and other ACIP members have said that updating the guidance is bigger than hepatitis: Namely, that this is a step toward restoring trust in public health institutions.
During a pre-vote meeting last week, ACIP member Vicky Pebsworth – who has a Michigan PhD and is a board member of the vaccine-skeptic National Vaccine Information Center – quoted a recent survey showing that roughly one in six parents say they have skipped or postponed scheduled childhood vaccinations, often citing worries over safety and side effects. She also noted that of the 20 countries with the lowest hepatitis B prevalence, only the US has universal birth-dose vaccination. France, Germany, Ireland, the Netherlands, and Sweden are among the countries that do not. The UK has universal vaccination beginning at eight weeks, not birth.
Whether changing the recommendation fixes or harms trust in America’s medical establishment remains to be seen. What seems likely, though, is that a lot fewer babies will be leaving the hospital with the shot.
Editor’s Note
So, what do you think? Ideology or responsibility? Are changes like this needed to restore trust in medical institutions, or is the vaccine board playing politics? Let us know by replying here.
Also, we’re in the process of upgrading our newsletter. Yesterday, that prevented us from sending out a We The 66, and it’s blocking access to our archive. Please bear with us as we work out these kinks. We promise it’ll be worth it in the long run!
If you’ve missed our latest reports, find them here:
Thanks for reading. We’ll see you again tomorrow.
—Max and Max
