Outrage of the Month: Senselessly Undermining the Success of Hepatitis B Vaccination
Health Letter, January 2026
By Robert Steinbrook, M.D.
Director, Public Citizen's Health Research Group
If you’re not outraged, you’re not paying attention!
Read what Public Citizen has to say about the biggest blunders and outrageous offenses in the world of public health, published monthly in Health Letter.
(A version of this column appeared in the January 2026 issue of Worst Pills, Best Pills News)
For 35 years vaccination at birth has protected millions of newborns in the United States from the hepatitis B virus, safeguarding them from the risks of chronic viral infection and life-threatening liver disease later in life. Tragically, in December 2025, the hepatitis B vaccine became a victim of its own success.
Espousing unfounded doubts about vaccine safety and the number of childhood immunizations, the Advisory Committee on Immunization Practices (ACIP) at the Centers for Disease Control and Prevention (CDC) recommended replacing the universal practice of administering the first dose of the vaccine at birth to all newborns with “individual-based decision-making, in consultation with a health care provider,” for parents deciding whether to give the birth dose of the hepatitis B vaccine to infants who are born to hepatitis B surface antigen (HbsAg)-negative women. The term “HbsAg-negative” means that a person does not have an active infection with the hepatitis B virus at the time of the test.
At present the CDC recommends three doses of the hepatitis B vaccine — the first dose at birth, with subsequent doses at one or two months and between six and 18 months of age. When the birth dose of the vaccine is delayed, the committee suggested that the initial dose “be administered no earlier than two months of age.”
Undermining the evidence-based childhood vaccination schedule is likely to confuse and alarm the public and clinicians. Calling for individual-based decision-making would be an abdication of responsibility by the CDC, which should be providing definitive recommendations about the hepatitis B vaccine and other immunizations whose benefits far outweigh their risks.
On Dec. 16, federal health officials signed off on this change. The likely consequences of the CDC decision include reduced vaccination rates and eroded trust in the safety and effectiveness of potentially lifesaving immunizations. As was the case with its false claims about a connection between autism and vaccines, the federal government’s ability to provide sound vaccine guidance will be called into question. Unvaccinated children will be vulnerable to undiagnosed infection in their mothers and exposure to the virus after birth.
Although thousands of infants are born each year to women with hepatitis B virus infection, about one in five pregnant women in the United States do not receive hepatitis B testing and one-third of women who test positive do not receive recommended follow-up care.
The ACIP recommendation could have been worse. The recommendation should maintain the availability of the vaccine for all newborns regardless of the mother’s infection status, as well as insurance coverage for a birth dose. The recommendation also does not affect the current practice of administering a birth dose of the hepatitis B vaccine and hepatitis B immunoglobulin for infants born to women who test positive for hepatitis B or whose status is unknown.
The ACIP also recommended that, when considering the need for more than one dose of the hepatitis vaccine, parents consult with health care providers to decide about testing antibody levels to evaluate the protection conferred by the first dose. This secondary recommendation is under review by the CDC and as of the end of December had not been adopted. If adopted, the ad hoc recommendation about antibody testing is likely to further decrease the number of children who are fully vaccinated with three doses of the vaccine.
Upending a public-health success because of baseless doubts about the hepatitis B vaccine is a tragedy in the making. Now more than ever, state health departments and medical professional societies must provide the public with the sound vaccine guidance that is no longer routinely available from the ACIP and the CDC, and health insurers must maintain coverage of the recommended vaccines.