After a fiery and passionate meeting, the Advisory Committee on Immunization Practices (ACIP) voted 8-3. As a first response, they chose to revise the recommendations for hepatitis B vaccinations among newborns. This is not a trivial decision. It has enormous implications for public health. It threatens to delay lifesaving vaccines from birth to two months, which has critics sounding the alarm that would lead to thousands of unnecessary infections and deaths.
The ACIP meeting started 20 minutes before scheduled start time. Furious arguments exploded between newly-appointed U.S. Health Secretary Robert F. Kennedy Jr. and Jim O’Neill, acting director of the CDC. The titanic clashes highlighted just how serious the stakes are around the recently released recommendation.
Dr. Cody Meissner, a professor of pediatrics at the Geisel School of Medicine at Dartmouth College, emerged as a vocal opponent of the proposal. He sounded the alarm on dire statistics. Stopping administration of the hepatitis B vaccine even temporarily will result in at least 1,400 new infections, 300 new cases of liver cancer and approximately 480 deaths annually. Meissner said the reason for giving the vaccine at birth is critical to understand.
“We’re giving it to protect the infant against a potentially fatal disease,” – Dr. Cody Meissner
This error led the ACIP to unwittingly recommend that parents revaccinate their newborns at birth. If not, they need to delay giving the vaccine for a minimum of two months. The advisers unanimously urged that babies get blood tests following their initial injection. This will inform decisions about whether and when they may require any further doses.
Michaela Jackson, program director at the Hepatitis B Foundation, worried about unintended negative outcomes that could come from this updated recommendation. The impact of these changes would be catastrophic for the people most in need.
Joseph Hibbeln, a neurologist and former advisor to the National Institutes of Health, shared his concern. Perhaps most critically, he called out the lack of evidence supporting the requested changes. More than that, he challenged the logic of changing long-standing practices around vaccination.
“In addition to this not being discussed, there has been no data presented that this plan would actually work,” – Joseph Hibbeln
Retsef Levi, a professor of operations management at the MIT Sloan School of Management, He’s an adviser to the committee and has taken part in many of those deliberations, but he decided not to comment publicly on the vote.
Judy Shlay, a liaison from the National Association of County and City Health Officials, acknowledged the diverse opinions shared during the meeting. The contentious Congressional debate revealed a significant rift emerging between public health authorities over how to handle hepatitis B vaccination among newborns.
Although the current strategy to vaccinate against hepatitis B has been key to decreasing transmission rates, it has not completely eradicated infection. According to the National Cancer Institute statistics, liver cancer has a disturbing 18% five-year survival rate here in the US. The potential increase in infections due to delayed vaccination raises serious concerns among health advocates who fear a reversal of progress made in combating this disease.
Jim O’Neill to consider these recommendations. His determination whether the U.S. should officially discontinue its policy of universal hepatitis B vaccinations for newborns will depend on the ACIP’s vote. This holds tremendous implications for public health strategies from near to far, and national to local.