Pandemics: Beyond “women and children first”

Key Federal Vaccine Panel Tables Vote On Delaying Newborn Hepatitis B Shot

By Anil Oza

Sept. 19, 2025

General Assignment Reporter

A key government advisory committee voted Friday to postpone a vote on whether to delay infants' first hepatitis B vaccine — temporarily alleviating fears that a new recommendation on shot timing could reverse the significant progress made in controlling the disease's spread in recent decades.

The decision followed a lengthy deliberation on Thursday by the newly reconstituted Advisory Committee on Immunization Practice, which pressed scientists from the Centers for Disease Control and Prevention on the necessity of the birth dose, and brought into question the veracity of the data presented on the risks and benefits of the vaccine. But ultimately, members voted to push the vote. 

"I believe that there's enough ambiguity here and enough remaining discussion about safety, effectiveness, and timing that I believe that a vote today is premature," Robert Malone, a member of the committee, said on Friday. All of the members of the committee, except its chair, Martin Kulldorff, voted to table the vote. 

"We will increase the risk of harm based on no evidence of benefit, because there will be fewer children who will get the full hepatitis B vaccine series," Cody Meissner, a member of the committee, said during the discussion Thursday. "It's an extremely safe vaccine, a very pure vaccine. So I think we will be creating new doubts in the mind of the public that are not justified. There is no evidence of harm from administering the neonatal vaccine that I've heard presented or that I'm aware of from my readings, so I would be concerned if we were to change the recommendation for that neonatal dose."

The vote was intended to be on Thursday, but was delayed in order to rectify a "discrepancy" in how the recommendation is aligned with language about how the vaccine is covered by the Vaccines for Children (VFC) program, which provides low-cost or free vaccines for about half of the children in the country who are uninsured or on Medicaid. Officials did not specify how they're going to address the discrepancies, or what a fix might look like.

Federal advisory committee restricts access to MMRV shot for some low-income children

A spokesperson for the Department of Health and Human Services added that the vote was moved to ensure anyone who wants the hepatitis B shot can get it.

The vote followed another, split vote to recommend that children under 4 receive the measles, mumps, rubella vaccine and varicella vaccine separately, rather than receiving the combined MMRV vaccine — but voted to not to align VFC coverage with that recommendation, meaning low-cost or free MMRV vaccines will no longer be available for some children, but separate MMR and varicella shots will be. In a re-do vote Friday morning, the committee moved to align the recommendation for the split vaccine for children covered by VFC.

The analyses presented to ACIP by CDC staffers showed that the hepatitis B vaccine is safe and effective, but several members questioned that data and said there's a lack of research on the long-term safety of hepatitis B vaccines. Member Vicky Pebsworth pointed to higher rates of irritability and fussiness observed in babies who received the vaccine and said that "they may be early symptoms of neurologic problems that will need to be followed up." CDC studies have not found any increased risk of neurological problems.

The committee did vote to recommend that all pregnant people be tested for hepatitis B. (Some experts questioned whether the committee has purview over testing.)

CDC Advisers Punt On Hepatitis B Vaccine Vote, After Changing Guidance On MMRV

Martin Kulldorff, chairman of the CDC's Advisory Committee on Immunization Practices, speaks during a Thursday meeting of the panel in Chamblee, Ga. Elijah Nouvelage/Getty Images hide caption

toggle caption Elijah Nouvelage/Getty Images

A panel of vaccine advisers to the federal government —now embroiled in controversy under the leadership of Health Secretary Robert F. Kennedy Jr. — has voted in favor of changing the childhood vaccine schedule for one vaccine — and deferred a proposed change to another.

On Thursday afternoon, the Advisory Committee on Immunization Practices, or ACIP, voted 8-3 to change the current recommendations that allow children under 4 to receive the MMRV vaccine, a combination shot for measles, mumps, rubella and chickenpox (or varicella).

The vast majority of children in the U.S. — about 85% — get separate shots for MMR and chickenpox, though parents currently have the option to give their children the single shot to cover all four diseases.

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The panel, which advises the Centers for Disease Control and Prevention, also debated changes to the current recommendations for the hepatitis B vaccine. Although some on the panel seemed enthusiastic about pushing the first dose recommendation later in life, after some discussion on Friday morning, there was a small revolt against tackling this issue at all.

"I move to postpone the question indefinitely," Dr. Robert Malone, a close Kennedy associate, said early in the day. "I believe that there's enough ambiguity here and enough remaining discussion about safety, effectiveness and timing that I believe that a vote today is premature."

The panel overwhelmingly agreed, voting 11 to 1 — the only member who disagreed was chair Martin Kulldorff.

Later on Friday, the panel will vote on recommendations on who should be eligible for the latest COVID-19 vaccines.

On Thursday, amid a lot of confusion, the panel voted to allow the MMRV vaccine for children under 4 to continue to be paid for by the Vaccines for Children program. But on Friday morning, they reversed course. After a second vote on the same question, they removed the vaccine from that program, which covers vaccines for many low-income children. Coverage by Children's Health Insurance Program and Medicaid will also be affected by the vote and may not cover these shots anymore.

The moves to overhaul the children's vaccine schedule represent the latest victory in Secretary Kennedy's long-running campaign to reshape policy. There was vocal opposition to the proposed changes from representatives of major medical groups who were present at the meeting.

"A question I've had all along through these discussions is why? Why are we addressing this hepatitis B vaccine recommendation? Is there really a reason?" asked Dr. Flor Muñoz, a pediatric infectious disease clinician who spoke at the meeting.

The proposed changes to the vaccine schedule also run counter to the hours of data presented by the CDC's own scientists throughout the meeting on the rationale for these recommendations.

Many in public health had warned that Kennedy was aiming to retool the vaccine schedule, after he replaced all 17 members of ACIP with his own handpicked roster, including five members he added this week. Many of those he chose have a history of being critical of vaccines.

The panel's votes still require final approval from the acting CDC director Jim O'Neill, an ally of Secretary Kennedy's who's expected to greenlight their recommendations.

MMRV no longer recommended for kids under 4

Tension between the committee and the medical establishment surfaced throughout the discussion over changes to the MMRV vaccine guidance.

At issue was evidence, presented by CDC staff, showing a slightly increased risk of fever-related seizures in children ages 12-23 months after receiving the MMRV shot compared to the MMR, which concerned some committee members.

"I would go with the option that seems to be safer," said ACIP member Retsef Levi, an MIT professor of operations management who gained prominence during the pandemic for criticizing COVID vaccines.

But Dr. Cody Meissner, a pediatrician at Dartmouth College and ACIP member, pointed out that fever-related seizures, while "frightening" for the family, are not uncommon. They occur in 3% to 5% of all children.

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"Every pediatrician is experienced in febrile seizures. We know that the prognosis is excellent," he said.

Removing the MMRV shots from the vaccine schedule for children under age 4 would spark more public confusion, compromise insurance coverage and potentially lead to fewer kids being vaccinated, said Dr. Jason Goldman, president of the American College of Physicians who is acting as a liaison to the committee.

"I urge this committee not to change the recommendations if they truly want to give the power to the parents to decide what is best for their child," he said.

Several liaisons from major medical groups criticized the committee's process.

Goldman said it failed to bring in the voice of subject matter experts, clinicians and patients, noting that the representatives from medical groups had been removed from ACIP workgroups.

A potential break with existing policy on hepatitis B

The proposed changes to the hepatitis B vaccine schedule would have marked a major departure — one that pediatricians and medical groups caution could reverse decades of progress in lowering rates of illness in the U.S.

Existing policy is to give the vaccine to all babies at birth regardless of the mother's hepatitis B status. The new recommendations would have upended this, instead guiding doctors to screen all mothers and offer the vaccine only to those who do not test negative in an initial screening.

Several new ACIP members questioned why a universally given birth dose was necessary, if mothers could be adequately screened ahead of time.

"Are we asking our babies to solve an adult problem?" said Dr. Evelyn Griffin, an OB-GYN and ACIP member, "Are we trying to lower the prevalence of hepatitis B in a high-risk population by vaccinating them on day one?"

But CDC scientists explained that gaps in prenatal screening could leave many babies vulnerable to catching a debilitating, sometimes fatal illness. And an infant could be infected by exposure to someone else in the household who is infected — around half of people with hepatitis B don't know they have it.

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"I have not seen any data that says that there is any benefit to the infant of waiting a month, but there are a number of potential harms to the infants of waiting," responded Dr. Adam Langer, a CDC scientist who was presenting on the data.

Meissner echoed these sentiments, pointing out that efforts to identify high risk groups had failed in the past, which is why the recommendations were made in the first place.

"It's an extremely safe vaccine," said Meissner, "If we change the recommendations, we will increase the risk of harm based on no evidence of benefits because there will be fewer children who get the full hepatitis B series."

"We will be creating new doubts in the mind of the public that are not justified," he added.

Political tensions around the vaccine guidance process

The meeting comes on the heels of a contentious Senate hearing on Wednesday with the recently-ousted CDC director Susan Monarez.

Monarez testified that she was fired after clashing with Kennedy over his demands that she preemptively agree to approve vaccine recommendations from ACIP, and fire career scientists.

"He said the childhood vaccine schedule would be changing starting in September and that I needed to be on board with it," she said.

Kulldorff, an epidemiologist, acknowledged the "controversy" at the outset, with pointed comments against his critics — among them a slate of former CDC directors who have said the new members, selected by Secretary Kennedy, are "unqualified" and "share his dangerous and unscientific views. "

Kulldorff rebuffed the idea that he or others on the panel were "anti-vaxxers" and challenged the former directors to an "open public debate."

"If they want to be trusted, they should all accept," he said.

Another sign of the increasingly polarized nature of vaccine policymaking was the notable absence at this week's meeting of a liaison from the American Academy of Pediatrics — the leading national group representing pediatricians in the U.S. That would usually collaborate with the panel.

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The AAP had decided to boycott the meetings, arguing federal vaccine policymaking is no longer a "credible process." Kennedy has barred professional medical groups such as the AAP from serving in their traditional roles as expert liaisons to workgroups of the advisory committee.

ACIP member Meissner said the AAP was making a "grave mistake not to participate" and "moving itself to irrelevance."

Dr. Susan J. Kressly, president of the AAP issued a statement Thursday noting the group had published its own immunization schedule "to ensure providers and families have evidence-based guidance rooted in the best interests of children's health."

The group continues to recommend that the combination MMRV shot "should remain an option for families," Kressly said.

CDC Panel Abandons, For Now, More Controversial Vaccine Proposals But Casts Doubt On Safety

Retsef Levi, a member of the CDC's Advisory Committee on Immunization Practices and professor of operations management at the Massachusetts Institute of Technology, signaled that the committee could revisit other vaccine recommendations in future meetings. Maya Homan/Georgia Recorder

This story was updated at 10:45 a.M. On Sept. 22.

ATLANTA —  A key vaccine advisory panel at the Centers for Disease Control and Prevention has indefinitely postponed a controversial change to guidelines on administering hepatitis B vaccines to newborn babies, and altered long-standing recommendations around COVID-19 vaccine access for children and adults, though a proposal to require prescriptions for all individuals seeking the shot narrowly failed. 

The panel also voted to reverse a decision they made only Thursday that would have prevented updated guidelines on the MMRV vaccine, which protects against measles, mumps, rubella and varicella, from applying to children enrolled in the Vaccines for Children program. 

Vaccines for Children is a federal program which covers the cost of vaccines for more than half of American children. The decision to implement different standards for children enrolled in VFC caused confusion among top health officials as well as some committee members when it was introduced Thursday. 

Jason Goldman, the president of the American College of Physicians who also serves as a liaison to the committee, criticized Thursday's vote, arguing that the changes were not backed by scientific evidence. 

"Would you consider that the second vote actually revealed the truth, that you do not have the data or evidence to challenge the current standing and that there is no associated harm?" Goldman asked the committee.

The committee's reversal on Friday standardizes the updated MMRV vaccine recommendations for all children. If ACIP's recommendations are approved by CDC officials, doctors will be advised to administer separate MMR and varicella vaccines for all children under 4 years of age.

ACIP tables a rule delaying Hepatitis B vaccine for newborns

In what appeared to be another reversal, the panel shelved a resolution that sought to alter current CDC recommendations around hepatitis B vaccines for newborn children. 

The current three-dose series for hepatitis B, an incurable viral infection that attacks the liver, includes one vaccine administered to infants within 24 hours of birth, and subsequent booster shots given a month and six months after the initial dose. ACIP has been recommending a hepatitis B vaccine for all newborn babies since 1991, which resulted in a 99% drop in serious infections between 1990 and 2019.

If ACIP members choose to implement the changes at a later meeting, official CDC guidelines will recommend that pediatricians delay administering the first dose of the hepatitis B vaccine until 30 days after birth for all children whose mothers test negative for the disease.

The panel did not provide any evidence indicating that delaying the vaccine improved children's health, or that there were any widespread or serious instances of harm caused by administering hepatitis B vaccines to newborns. However, some ACIP members also cast doubt on the accuracy of data showing the shot is safe.

"I think that there are gaps in what we know and understand about the effects of hepatitis B, particularly on very young infants," said Vicky Pebsworth, a committee member who is a registered nurse and who sits on the board of the National Vaccine Information Center, which advocates for vaccine exemptions. "I think that the conclusion that we know that it is safe is, perhaps, premature." 

Dr. Adam Langer, who serves as the principal deputy director of the CDC's National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention, urged the panel to reconsider narrowing the recommendations.

"One of the primary reasons for recommending universal birth dose in the U.S. Is to serve as a safety net for infants born to mothers with unknown test results," Langer said during his presentation to the committee on Thursday. 

"To date, no country in the world has reverted from universal to selective birth dose recommendations," he added.

The meeting, which was held at the CDC's Chamblee campus, also inspired a demonstration organized by a group of former CDC workers, who dressed up as preventable diseases and waved signs to the passing cars while the meeting was underway. 

Cindy Weinbaum, who retired from the CDC in 2021, said Friday that it was commendable that the committee skipped a vote that would have recommended babies not be vaccinated for hepatitis B within a day after being born, which is the current standard. Jill Nolin/Georgia Recorder

Cindy Weinbaum, who spent about a decade of her career at the CDC in the division of viral hepatitis, said she commended the committee for deciding to table a vote that would have changed the recommendations for hepatitis B vaccinations.

"I think it's really commendable, actually, that they delayed this vote because they do not know the implications of not recommending a birth dose of hepatitis B," Weinbaum said.

"So that was a nod to their lack of understanding of vaccine programs, vaccine science and the importance of certain vaccinations for kids," she added.

Weinbaum said the proposal's appearance on the committee's agenda reflects the "vaccine nihilism that the current administration is supporting." She said the shot given to newborns within the first day of their life has found itself in the "cross hairs of the anti-vax movement."

"It's because here's this newborn baby and you're very vulnerable, and sticking it with a needle is kind of a scary thing," she said. "They just don't understand that it's even more scary to get liver cancer, and that's really what we want to prevent."

ACIP moves to center vaccine harm

Though the committee did not implement some of its more controversial proposals, ACIP's new members have signaled that they would like to place a greater focus on examples of vaccine harm and adverse outcomes in future policy proposals.

They have also rejected widely embraced data on vaccine safety, choosing instead to focus on isolated cases and dubious studies, including one paper claiming that rats exposed to the COVID-19 vaccine exhibited "autism-like behaviors" that was eventually retracted by the journal that published it.

Some ACIP members, including Robert Malone, also pushed back against guidelines that advise vaccinating young children and pregnant women, arguing that there is a lack of data proving definitively that vaccines are safe. 

"The default should be the assumption that there is no intervention in the infant and the pregnant woman with the vaccine unless there is definitive evidence of safety," Malone said.

But Dr. Cody Meissner, a professor of pediatrics and medicine at Dartmouth College who has served as a past committee member, pushed back against the argument that any medical intervention should be entirely risk-free.

"I just want to point out that it's very, very difficult to prove the absence of harm, it's simply not a practical objective," Meissner said.

"I think it's important for everyone to understand that no vaccine is 100% safe and no vaccine is 100% effective," he added. "What's important for the provider before administering a vaccine is to think about that particular patient and does the benefit of protection exceed any possible side effect from the vaccine." 

Retsef Levi, an ACIP member and professor of operations management at the Massachusetts Institute of Technology, speaks with reporters after the Sept. 19 meeting. Maya Homan/Georgia Recorder

But in a conversation with reporters after the meeting, Retsef Levi, an ACIP member and professor of operations management at the Massachusetts Institute of Technology, signaled that the committee could revisit other vaccine recommendations in future meetings.

"I think we need to review vaccines, in general, from time to time," Levi said. "It's part of a good process. I don't think that I need now to single out one vaccine or another. I think that, in general, it's actually in the mission of ACIP. . . To actually review every vaccine."

Georgia Recorder editor-in-chief Jill Nolin contributed to this report.

Correction: An earlier version of this story mischaracterized ACIP's 1991 recommendation for the first dose of the hepatitis B vaccine. The 1991 recommendation was for all newborn babies to receive the shot, but not specifically within the first day of being born.

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