Congress built the vaccine firewall. Now Congress must defend it. |
Congress built the vaccine firewall. Now Congress must defend it.
At the end of 2025, the Advisory Committee on Immunization Practices walked back a cornerstone of American pediatric medicine: the universal hepatitis B birth-dose vaccine. The new recommendation calls for “shared clinical decision-making” for infants of hepatitis B-negative mothers, and no first dose “earlier than 2 months of age.“
The first numbers are now in. On April 27, JAMA Pediatrics published two studies, neither of which was available to the advisory committee when it voted in December. They used different teams and different methods, but they came to identical conclusions.
The first modeled a single U.S. birth cohort, made up of 3.6 million infants. Even under perfect adherence, a two-month delay of this vaccine projects 90 additional acute hepatitis B infections, 76 chronic infections, 29 hepatitis B-related deaths, and $16.4 million in lifetime healthcare costs from a single year’s births. And these are best-case numbers. Adherence is never perfect, and the same delay reaches infants whose mothers’ hepatitis B status is unknown. Both gaps drive the toll up.
The other study asked what happens when the universal recommendation goes away.
History answered this question in 1999, when the American Academy of Pediatrics and the U.S. Public Health Service recommended precisely this kind of delay over concerns about the vaccine. Birth-dose coverage among infants of unscreened mothers collapsed from 53 percent to 7 percent before the policy was reinstated.
Apply that historical floor to the December change, and you get 628 additional infant infections per cohort. Roughly 90 percent of perinatally acquired hepatitis B becomes chronic; one in four of those children will die prematurely of cirrhosis or hepatocellular........