Contentious CDC Panel Delays Vote on Infant Hepatitis B Vaccine Amidst Anti-Vaccine Influence
A Centers for Disease Control and Prevention (CDC) advisory panel postponed a crucial decision regarding infant hepatitis B vaccinations today, a meeting marred by what observers described as racist undertones and the promotion of debunked anti-vaccine claims. The Advisory Committee on Immunization Practices (ACIP) delayed its vote on whether to scale back the recommended vaccination schedule, a move that has ignited concern among public health officials. The committee is now scheduled to revisit the issue tomorrow.
The hepatitis B vaccine is a widely recognized public health triumph, yet it has become a focal point for vaccine skepticism, particularly from Health and Human Services Secretary Robert F. Kennedy, who has previously, and without evidence, linked the vaccine to autism. This backdrop fueled a contentious meeting where the very process of deliberation appeared compromised.
Several ACIP members voiced concerns that they hadn’t been adequately consulted during the development of the proposal’s voting questions. “I protest the description that the ACIP members have been consulted in developing these questions,” stated a psychiatrist with a history at the National Institutes of Health. He further explained that the proposal’s wording had been altered three times in the preceding three days, hindering a thorough review. “We are trying to evaluate a moving target,” he said. “We really need to know what we are voting on.”
The shifting proposal also disrupted a CDC scientist’s presentation on the potential impact of any changes to the Vaccines for Children (VFC) Program, which funds immunizations for roughly half of all children in the US. Representatives from both the VFC Program and the Centers for Medicare and Medicaid Services affirmed their continued coverage of the hepatitis B vaccine.
The decision to revisit the vaccine’s safety was questioned by a liaison member representing the Pediatric Infectious Diseases Society, who noted the absence of new research warranting such a review. The response from Vicky Pebsworth, PhD, RN, research director of the National Vaccine Information Center – a long-standing anti-vaccine organization – was ambiguous, stating, “We were aware that there was pressure coming from stakeholder groups wanting the policy to be revisited.”
This isn’t the first instance of difficulty reaching a consensus within the ACIP. A vote on hepatitis B vaccines was also postponed at the committee’s September meeting, and a decision regarding coverage for the MMRV vaccine (measles, mumps, rubella, and chickenpox) was reversed the day after it was initially made, due to member confusion.
Concerns are mounting over the composition of the ACIP itself, with many members reportedly holding anti-vaccine views. Kirk Milhoan, MD, PhD, the recently appointed chair, is a senior fellow at the Independent Medical Alliance, an organization that has criticized mRNA vaccines and promoted the use of ivermectin – a drug proven ineffective against COVID-19 – despite clinical trial data. Milhoan did not participate in today’s discussion, with Vice Chair Robert Malone, MD, citing a flight to Asia as the reason for his absence.
Further fueling skepticism, two invited speakers – Mark Blaxill, MBA, and climate researcher Cynthia Nevison, PhD – co-authored a retracted study on autism due to methodological flaws and undisclosed conflicts of interest.
The discussion took a troubling turn when Nevison introduced the issue of race, pointing out the higher prevalence of hepatitis B infections in people of Asian descent. She suggested testing immigrants for the virus before entering the country, a proposal that overlooks the fact that the CDC already recommends hepatitis B testing for adult immigrants and that most refugees are tested prior to arrival in the United States. Later, another ACIP member, Evelyn Griffin, MD, echoed these sentiments, referencing “years of illegal immigration, undocumented people coming in from higher endemicity countries.”
Despite the contentious debate, only two ACIP members – physicians Joseph Hibbeln and H. Cody Meissner, MD – actively defended the safety and efficacy of the hepatitis B vaccine. Hibbeln highlighted the vaccine’s success in virtually eliminating chronic hepatitis B infections since its recommendation in 1991, calling it one of the greatest achievements in modern medicine. He noted a 99% reduction in acute hepatitis B infections among children and young adults between 1990 and 2019, and that the vaccine has prevented over 500,000 childhood infections and an estimated 90,100 childhood deaths. “We have a high burden of proof to change this system or change our recommendations,” he asserted, criticizing presentations suggesting the vaccine’s risks outweigh its benefits as “speculation based on limited evidence.”
The meeting grew confrontational at times, with Meissner dismissing the morning’s first three presentations as misleading. He strongly disagreed with numerous statements made, and challenged a claim that vaccine protection against hepatitis B diminishes over time, explaining that immune memory cells provide lasting protection even with low antibody levels.
Liaison members representing medical professional organizations also criticized the ACIP’s selective use of evidence. “You are wasting taxpayer dollars by not having scientific, rigorous discussion on issues that truly matter,” said Jason Goldman, MD, president of the American College of Physicians. “The best thing you can do is adjourn the meeting and discuss vaccine issues that actually need to be taken up. You are basing this whole presentation on the concerns of individuals who want to refuse the vaccine. Please have respect for the American public and the science and do what is right by making sure you use a process that we can depend on, and stop cherry-picking the data by individuals who do not have the scientific evidence and data-driven background to make those presentations.”
Some committee members proposed limiting the birth dose of the hepatitis B vaccine to infants born to mothers who test positive for the virus, suggesting universal prenatal screening as an alternative. However, a recent review of 400 studies revealed that 18% of pregnant women are not tested for hepatitis B before delivery, highlighting the continued need for the universal birth dose as a safety net.
The debate underscored the critical importance of vaccination, with one physician sharing her personal story of contracting hepatitis B as a child due to exposure from visiting family members. She emphasized that vaccination offers a crucial layer of protection against a preventable disease.
Experts warn that delaying the birth dose could have far-reaching consequences, potentially impacting the entire childhood vaccination schedule. Jose Romero, MD, of the American Academy of Pediatrics, described the meeting as a “radical departure from the way ACIP was conducted in the past,” and warned that the haphazard process erodes public trust in vaccine recommendations. He emphasized that a race-neutral, evidence-based approach – including universal screening and vaccination – remains the most effective strategy for preventing hepatitis B.
Tomorrow’s ACIP meeting is slated to address further topics favored by anti-vaccine advocates, including the safety of aluminum in vaccines and a comparison of US and Danish vaccination schedules. The agency has yet to provide specific details regarding the discussion of the childhood/adolescent immunization schedule.
