The federal Vaccine Advisory Committee voted Friday to end its long-standing recommendation that all infants in the United States receive the hepatitis B vaccine on the day they are born.
A chorus of medical and public health leaders condemned the commission's actions. The current members of the committee were all appointed by U.S. Secretary of Health Robert F. Kennedy Jr., who was a leading anti-vaccine activist before becoming the nation's top health official this year.
“This is a group you can't shoot straight at,” said Dr. William Schaffner, a vaccine expert at Vanderbilt University who has been involved with ACIP and its workgroups for decades.
For decades, governments have recommended that all infants be vaccinated against liver infections immediately after birth. This vaccination is widely considered a public health success, preventing thousands of diseases.
However, President Kennedy's Advisory Committee on Immunization Practices decided to recommend administering the drug at birth only for infants whose mothers have tested positive and whose mothers have not been tested.
For other babies, it is up to the parents and their doctor to decide whether the birth dose is appropriate. The committee voted in favor of proposing that if a family decides not to vaccinate at birth, a series of vaccinations should begin when the child is two months old.
Jim O'Neill, acting director of the Centers for Disease Control and Prevention, will decide whether to accept the committee's recommendations.
The decision marks a return to a public health strategy abandoned more than 30 years ago.
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Asked why the newly appointed committee moved so quickly to reconsider the recommendations, committee member Vicki Pebsworth on Thursday cited “pressure from stakeholder groups to review the policy.” He did not say who was pressuring the committee, and Mr. Kennedy's press secretary did not respond to questions about the matter.
Committee members said the risk of infection for most infants is very low and that there is insufficient research to date to show that vaccination is safe for infants.
They were also concerned that in many cases doctors and nurses did not adequately discuss the advantages and disadvantages of birth-dose vaccination with parents.
Committee members expressed interest in hearing from public health and medical experts, but chose to ignore repeated pleas from experts to leave the recommendations alone.
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Dr. Peter Hotez of the Texas Children's Hospital Vaccine Development Center in Houston said in an email to The Associated Press that he declined to speak before the group “because ACIP appears to have shifted its mission away from science and evidence-based medicine.”
The committee advises the director of the Centers for Disease Control and Prevention on how approved vaccines should be used. CDC directors almost always adopted the committee's recommendations, and physicians widely listened to those recommendations to guide vaccination programs.
However, the department currently does not have a director, leaving decisions to Acting Commissioner O'Neill.
In June, President Kennedy fired the entire 17-member commission earlier this year and replaced it with members that included several anti-vaccine voices.
Hepatitis B is a serious liver infection that lasts less than six months for most people. But for some people, especially infants and children, it can become a long-term problem that can lead to liver failure, liver cancer, and scarring called cirrhosis.
In adults, the virus is transmitted through sexual intercourse and the sharing of needles during injection drug use. However, it can also be passed from an infected mother to her baby.
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In 1991, a committee recommended the first dose of hepatitis B vaccine at birth. Experts say rapid vaccination is key to preventing the infection from taking hold. In fact, the number of infected children has decreased dramatically.
Still, some members of the Kennedy Commission expressed discomfort with vaccinating all newborns. They argued that past safety studies of the vaccine in newborns were limited and that larger, longer-term studies could clarify the issue of birth doses.
However, two committee members said they had found no documented evidence of harm from birth doses, suggesting concerns were based on speculation.
The committee was scheduled to vote Thursday, but voted to postpone after some members said they had just received a rich ballot proposal and wanted more time to explain and consider it.
Three panel members asked about the scientific basis for why the first dose should be delayed by two months for most infants.
“This is unconscionable,” said committee member Dr. Joseph Hibeln, who reiterated his opposition to the proposal during the sometimes heated two-day meeting.
Dr. Kirk Milhoan, chairman of the committee, said two months was chosen as the point at which infants grow beyond the neonatal period.
Hibbeln countered that no data had been presented to show that two months was an appropriate cutoff.
Some observers criticized the conference, noting recent changes in the way it was run. CDC scientists no longer present vaccine safety and efficacy data to the committee. Instead, slots were given to people who have become prominent voices in anti-vaccination circles.
Elizabeth Jacobs, a member of Defend Public Health, an advocacy group of researchers who have opposed the Trump administration's health care policies, said the committee is “no longer a legitimate scientific organization.”
In a statement, she described this week's meeting as an “epidemiological crime scene” and provided a sweeping critique of how disease control experts typically examine and act on evidence.
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