A CDC vaccine advisory panel's decision to stop recommending universal hepatitis B vaccination for newborns has sparked a split between federal advisors and the medical societies that guide clinical care.
After the recently revamped Advisory Committee on Immunization Practices (ACIP) voted to weaken its hepatitis B vaccine birth-dose recommendations, leaders of organizations including the American Academy of Pediatrics (AAP) and multiple state and local health departments indicated that they do not plan to follow the revised guidance and instead will continue advocating for the vaccine at birth.
"If the political appointees running our health agencies and communities are going to ignore data and evidence, we must absolutely ignore them going forward," said Michael T. Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, which hosts the Vaccine Integrity Project.
AAP will team with other experts and organizations to publish independent vaccine recommendations, said Aaron Milstone, MD, a pediatric infectious disease expert at Johns Hopkins University School of Medicine in Baltimore.
"Medical experts and many parents have lost confidence in the decisions of the current ACIP committee," he said. "Parents and pediatricians look to public health leaders, like the CDC, for clear guidance. That was not the outcome of last week's chaotic ACIP meeting."
The committee voted Dec. 5 to end its longstanding recommendation for universal hepatitis B vaccination at birth, breaking with more than three decades of public health policy. The panel adopted a shared clinical decision-making model for infants born to mothers who test negative for the virus' surface antigen. For families opting to delay the birth dose, the panel suggested administering the first dose at 2 months.
Earlier this year, HHS Secretary Robert F. Kennedy Jr., a longtime vaccine critic, dismissed all 17 members of the previous ACIP panel and replaced them with a smaller group that includes some vaccine skeptics. ACIP's recommendations historically have shaped national vaccination policy, clinical guidance, and insurance coverage.
"In the past, we've had a consistent message. We've had a uniform process," said Ronald G. Nahass, MD, MHCM, president of the Infectious Diseases Society of America. "Because the ACIP is not following the evidence, not following the science, and not collaborating, we now have an effort across the country to offset that confusion and chaos. We are here to advocate for a unified approach."
Some states have formed "health alliances" to develop public policies independent of ACIP's guidance. Medical society leaders emphasized that clinicians and patients in areas not covered by such alliances may take cues from the guidance those organizations promote.
"We rely on good evidence-based recommendations to make our decisions, and when there is an absence of it, we have to turn to trusted sources," said Jason Goldman, MD, president of the American College of Physicians. "When Secretary Kennedy's vaccine committee cannot be trusted, we have to go to trusted sources. So physicians throughout the country should be turning to the various medical specialty societies ... and follow the guidelines, the science, and the evidence to make those best recommendations."
Insurance coverage is another concern, with most private insurers required under the Affordable Care Act to cover ACIP-recommended vaccines at no cost. Two major insurance groups told MedPage Today that they will continue to recommend coverage of all vaccines recommended by ACIP earlier this year through 2026 with no cost-sharing. The Blue Cross Blue Shield Association said its companies will provide coverage for all immunizations recommended as of Jan. 1, 2025. AHIP (formerly America's Health Insurance Plans) said its health plans will continue to cover all vaccinations recommended as of Sept. 1.
Goldman pointed out that Kennedy, whose office also oversees CMS, could use his authority to enforce compliance with his hand-picked ACIP's recommendations, potentially affecting reimbursement or vaccine labeling.
"Their decisions have real-world consequences on how it is reimbursed, how physicians can stock vaccines," Goldman said. "There are so many ways the secretary can cause damage."
Public health leaders acknowledge that a solution is not yet in place but remain committed to addressing the situation.
"I don't want anybody to walk away from this ... feeling like we've got this thing solved. We don't," Osterholm said. "I think it's important you see we're working on it. We understand it. We get it. And I think that's the really important message right now to get out. We will try to help every practicing clinician in any community, whether they're in a red state or a blue state, try to deal with this very challenging situation."
