Why the US Is Rethinking Newborn Hepatitis B Vaccines – And What It Means for Global Public Health
A powerful US advisory panel has just voted to roll back a 30-year policy that all newborns should receive a hepatitis B vaccine at birth. The move is already rippling through public-health circles worldwide – and could reshape the global vaccine debate in ways that go far beyond one infection.
Key Points
A US federal vaccine advisory panel has voted to end the universal recommendation that all newborns receive a hepatitis B shot at birth, instead favouring “individual decision-making” for babies whose mothers test negative for the virus.
The change affects a policy in place since 1991, credited with cutting hepatitis B infections in American children by around 95–99%.
Babies born to mothers who are hepatitis B-positive or whose status is unknown are still recommended to receive a birth dose plus hepatitis B immune globulin.
The panel was hand-picked by US health secretary Robert F. Kennedy Jr, a long-standing critic of mainstream vaccine policy, raising concerns that science is being sidelined by ideology.
Major medical organisations warn the shift could increase preventable infections, liver cancer and deaths, and send a confusing signal to parents worldwide.
Although the recommendation applies only to the US, it may embolden anti-vaccine movements globally and complicate efforts to maintain high immunisation coverage in Europe and beyond.
Background and Context
What is hepatitis B – and why was the birth dose introduced?
Hepatitis B is a viral infection that attacks the liver. In adults it is often manageable, but in newborns and infants it is far more dangerous. Up to 90% of babies infected in the first year of life go on to develop chronic hepatitis B, which can lead to cirrhosis, liver cancer and premature death.
Because of this risk, the US introduced a policy in 1991 recommending that all newborns receive a dose of hepatitis B vaccine within 24 hours of birth, regardless of the mother’s test result. This acted as a “safety net” because:
Antenatal testing can miss infections.
Results can be delayed, mis-filed or lost.
Some mothers acquire the infection late in pregnancy, after being tested.
Over the following decades, the US recorded a dramatic collapse in childhood hepatitis B infections — roughly a 95–99% reduction.
Across Europe, most countries vaccinate infants against hepatitis B as part of early-childhood combination vaccines, usually starting around six to eight weeks. The approaches differ, but the overall trajectory has been similar: wide coverage and fewer infections.
What Has Just Happened in the US?
From universal birth dose to “individual decision-making”
On 5 December 2025, the US Advisory Committee on Immunization Practices (ACIP) voted 8–3 to end the standing recommendation that every newborn should receive a hepatitis B shot at birth.
Under the new approach:
Babies whose mothers test negative for hepatitis B will rely on parental choice and healthcare-provider discussion.
If the parents choose not to give the vaccine at birth, the series can begin at two months of age or later.
For babies born to mothers who are hepatitis B-positive or whose status is unknown, the guidance does not change:
A birth dose remains recommended.
Hepatitis B immune globulin should be given shortly after birth.
How final is the decision?
ACIP’s recommendations go to the CDC director for approval. Although not legally binding, US insurers, hospitals and state-level vaccine requirements typically follow ACIP guidance. In practice, even advisory decisions tend to reshape real-world behaviour.
Why the Decision Is So Controversial
No new safety signal – just a new panel
The controversy is not driven by newly discovered safety risks. The hepatitis B vaccine has been used for decades with a strong record of safety and effectiveness.
What has changed is the composition of the advisory panel itself. In 2025, the existing ACIP membership was dismissed and replaced with individuals including long-time critics of established vaccine policy. This restructuring has raised concerns that political ideology, rather than medical evidence, is now driving key decisions.
Equity, access and the risk of “missed babies”
Critics warn the new approach could lead to:
More infants falling through gaps in screening or documentation.
Higher infection risk in communities where antenatal care and early infant check-ups are inconsistent.
A slow but measurable rise in chronic hepatitis B cases, liver cancer and related deaths.
Analysis presented to the committee suggested that delaying the first dose until two months could result in over a thousand additional chronic infections per year.
Confusing messaging
The shift comes at a moment of widespread vaccine misinformation. Changing a long-standing birth-dose recommendation may:
Increase parental confusion.
Encourage vaccine hesitancy.
Undermine trust in public-health authorities already under pressure.
How Does This Compare With Europe and the Rest of the World?
Supporters of the change point out that many European countries do not use a universal birth dose, beginning vaccination later as part of combined infant jabs. While true, the comparison is incomplete:
European programmes generally achieve very high vaccine coverage with robust systems for antenatal testing and follow-up.
Europe is not rolling back existing policies — its schedules were designed around later vaccination from the start.
European health authorities still consider early-life protection a priority, even if the exact timing differs.
For lower-income countries, where record-keeping and follow-up are less reliable, the US shift could create political and funding challenges, particularly if opponents use it to question the value of infant hepatitis B vaccination altogether.
Why It Matters – and Who It Affects
Direct impact in the US
If widely adopted, the new recommendation will mean fewer newborns receiving the birth dose. Public-health experts expect a modest but real increase in hepatitis B transmission among babies whose mothers either were not tested, were tested incorrectly, or did not receive their results in time.
Communities with inconsistent access to antenatal care or primary-care follow-up stand to be most affected.
Global ripple effects
Beyond the US:
Anti-vaccine groups are likely to cite the move as justification to weaken other childhood vaccine programmes.
International organisations may face pressure to defend or re-explain global hepatitis B elimination strategies.
UK and European public-health bodies may need to communicate why their infant vaccination schedules remain unchanged.
As with many vaccine debates, the global discussion may become less about the scientific evidence and more about perception, politics and public trust.
Big Picture: What This Signals About the Future of Vaccination Policy
Several broader themes emerge:
Politicisation of expert bodies
The restructuring of the US advisory panel sets a precedent. Other vaccines — including COVID-19, measles and HPV — may face renewed scrutiny for political rather than scientific reasons.
Shift from public good to personal preference
Reframing vaccination as an individual choice rather than a population-level intervention could weaken herd immunity and increase vulnerability to preventable diseases.
Growing divergence between countries
Historically, Western health agencies broadly aligned on vaccine schedules. Visible fragmentation could hinder future pandemic co-ordination and undermine public trust.
Precedent for rolling back other recommendations
Once one birth-dose policy is softened, advocates worry it becomes easier to question others.
What to Watch Next
1. CDC Director’s Final Decision
The CDC leadership may endorse, modify or push back on the guidance. Any hesitation will attract significant attention.
2. State-Level Adoption
US states determine vaccine requirements for schools and childcare. A patchwork of differing rules is likely.
3. Insurance Coverage
Changes in recommendations can shift what insurers routinely pay for, influencing take-up even without legal mandates.
4. International Responses
Expect statements from European health agencies and the WHO either defending existing schedules or clarifying positions.
5. Early Infection and Coverage Data
Surveillance over the next several years will show whether chronic childhood hepatitis B infections rise — and whether the recommendation is reconsidered.
One Policy Change, A Much Bigger Question
On the surface, the US decision is about timing — birth versus two months. In reality, it reflects a wider tension shaping vaccine policy in the 2020s:
Will decisions continue to be driven primarily by long-term public-health evidence, or increasingly shaped by political ideology and online narratives?
For families in the US, that question is now playing out in maternity wards. For the UK, Europe and the rest of the world, the implications will be felt in how confidently health authorities can maintain alignment, trust and momentum in the years ahead.
