Blue States Push Back Against Hepatitis B Vaccine Advice Changes

States and cities led by Democrats are balking at US vaccine advisers’ calls to no longer require all babies get hepatitis B vaccines within 24 hours of being born, portraying the recommendation as troubling and at odds with scientific consensus.

New York and Maine are among the states going against the Advisory Committee on Immunization Practices’ suggestions and leaving their current practices intact. The panel’s recommendation change, rendered by advisers selected by Health and Human Services Secretary Robert F. Kennedy Jr., sent shock waves through state and local health departments.

ACIP “used to be a group of experts that we would look to that was kind of the best of the best in understanding vaccine efficacy and safety research in general,” said David Margolius, director of public health for Cleveland. “Now we don’t have that body that we can trust.”

ACIP advises the HHS’ Centers for Disease Control and Prevention on vaccine matters. Last week’s vote allows parents to delay a hepatitis B shot for at least two months or skip it entirely should the mother test negative for the virus. In response, state and local health entities are moving to ensure the status quo for patients.

During the ACIP meetings, New Jersey acting Health Commissioner Jeff Brown signed an executive directive for licensed health-care providers in state to follow hepatitis B vaccine schedules laid out by the American Academy of Pediatrics, and for the state to remove accessibility obstacles for patients. Meanwhile, Massachusetts Gov. Maura Healey’s office noted the governor had signed legislation allowing the state’s Department of Public Health to set immunization requirements and schedules.

“We are going to continue to work with other states to ensure that all of our residents can receive the vaccines they need and want,” Healey said in a statement.

ACIP Overhaul

Last week wasn’t the first time ACIP shook up the immunization landscape.

Previously, the panel narrowed guidance on Covid-19 shots and recommended splitting up a combined measles, mumps, rubella, and varicella (chickenpox) shot.

Under the Affordable Care Act, health plans are required to cover ACIP-recommended shots without patient cost-sharing. Insurers plan to continue covering the hepatitis B shot.

The US’ changing health posture has led coastal states to come together for their own vaccine guidance.

In the East, New York, Pennsylvania, Connecticut, and other states established the Northeast Public Health Collaborative. Prior to December’s ACIP meeting, the group issued a recommendation that newborns still get their hepatitis B shot within 24 hours of delivery.

On the other side of the country, California, Oregon, and Washington banded together as the West Coast Health Alliance, with Hawaii joining shortly after. The West Coast alliance said in a statement that the universal recommendation for all infants to get hepatitis B shots at birth “has reduced pediatric hepatitis B infections in the United States by 99 percent,” and that a Vaccine Integrity Project review found the vaccine to be “safe regardless of when it is given, and there are no safety benefits to delaying the first dose.”

“Delaying the first dose increases the risk of infection and jeopardizes completion of the full vaccine series, which is required for long-lasting protection. Many with chronic hepatitis B do not know they are infected, and infants may unknowingly be infected by household and other contacts following birth,” the statement said.

Lisa Costello, chair of the Committee on State Government Affairs for the American Academy of Pediatrics, said in a Monday press conference that West Virginia, where she lives and works, has “some of the highest cases of chronic hepatitis B in the country, and the majority of those cases are among those who are unvaccinated.”

“By eliminating or delaying the birth dose, we’re placing infants at preventable risk. Without timely immunizations, some children become infected. And unfortunately, some will die of a disease we can easily prevent,” said Costello, who is also a pediatrician.

Also speaking at the press conference was Manisha Juthani, commissioner of the Connecticut Department of Public Health, who said she brings “the perspective of what many state health departments are experiencing right now.”

ACIP’s votes don’t “inhibit our ability to order, the ability of pediatricians to administer, and by and large, for insurance companies to cover” vaccines, she said. But, she added, its calls “create a lot of confusion on the part of parents.”

Staying the Course

ACIP’s hepatitis B recommendation comes amid a broader change to how the US approaches vaccines, driven largely by Kennedy, a vaccine skeptic.

Under the HHS secretary, the CDC has updated its website to suggest vaccines may cause autism. Additionally, a Food and Drug Administration official recently claimed Covid shots played a role in the deaths of 10 children.

Meanwhile, President Donald Trump on Dec. 5 posted on Truth Social how he was signing a presidential memorandum directing the HHS “to ‘FAST TRACK’ a comprehensive evaluation of Vaccine Schedules from other Countries around the world and better align the US Vaccine Schedule.”

States and local governments for now are staying the course with their hepatitis B vaccine recommendations, looking toward medical groups other than ACIP for advice.

“Babies will continue to get this vaccine in our hospitals. Doctors will continue to recommend it. It is still the standard of care,” Cleveland’s Margolius said.