34 Years of Public Health, Erased: RFK Jr.’s ACIP Goes After Newborn HBV Vaccination
Unqualified ideologues are sabotaging vaccine policies that prevent cancer and chronic liver disease. Is this the "health revolution" you wanted?
This newsletter is free, but consider supporting a biomedical scientist trying to combat the war on health by upgrading to a paid subscription:
I hope everyone is staying as sane as possible these days. It’s been a couple of weeks since I’ve written a longer piece here, but that’s because life has been lifeing. If you aren’t aware, I work full-time in life sciences biotech, which has been understandably volatile this year (thanks, war on science). So work has been pretty demanding.
3 of my cats have also had convergent medical issues:
Maxwell continues chemo for large cell GI lymphoma (75% through cycle 3)
Zara had radioiodine therapy on November 18 to treat her hyperthyroidism
And…Oliver’s “quick check” of a skin growth turned out to be a mast cell tumor, which he had surgery to remove.
I’m happy to say we are through the bulk of that, though!
Zara is released from radiation isolation (we are both glowing a delightful hue of yellow now) and will get thyroid levels checked in a couple months.
Ollie’s surgery showed clean margins and pathology was very positive. The tumor was “as close to benign” as possible (words from Maxwell’s oncologist) and he won’t need additional treatment unless another tumor appears.
More on all of these topics to come, since many of you have requested science-forward content on veterinary immunology/oncology (and yes, the pseudoscience is strong in the pet health world too).
But now that I’ve got a bit of breathing room, let’s get into it!
Yesterday, RFK Jr.’s cadre of anti-science propagandists kicked off Day 1 of the latest CDC' ACIP (Advisory Committee of Immunization Practices) meeting.
This summer, RFK Jr. replaced the previous ACIP members with his anti-science allies that have no credible expertise or knowledge in immunology, vaccine science, clinical development, or public health (data sciences like epidemiology). As a result, they don’t know how to review and interpret vaccine-related data, which has caused varying degrees of head scratching, contradiction, and chaos during ACIP meetings.
Read more below:
The Anti-Vaccine Takeover of ACIP
RFK Jr staffed ACIP with a cadre of his allies: conspiracy theorists, science deniers, and people with long histories of undermining evidence in favor of personal opinions.
This meeting, one of their targets is whether to revoke the current and long-standing evidence-based recommendation for universal hepatitis B vaccination for newborns in the US.
The current ACIP couldn’t get their stories straight after a day of conspiracy theories and lies and ended up delaying their vote on the newborn hepatitis B vaccine until today. I can’t predict the future, but the only outcome that would surprise me would be if they upheld the recommendation that all newborns receive a hepatitis B vaccine dose.
The recommendation that all newborns be vaccinated for hepatitis B is supported by over thirty years of data.
RFK Jr. and his anti-vaccine allies don’t operate on evidence, they operate on vibes. But there are very good reasons why this recommendation exists and why it saves lives, even if those making our Federal vaccine policy choose to deny reality.
Universal newborn hepatitis B vaccination prevents infection, chronic hepatitis, cancer, and death.
Before we get into the science, it’s worth emphasizing: everything in this article is the scientific foundation for why the birth dose has been universally recommended for more than three decades. These are not abstract biological trivia. This is the evidence the ACIP is supposed to weigh when determining whether newborns should remain protected. This is the evidence the current ACIP is now ignoring. This meeting wasn’t called because of new data—it was called because RFK Jr. has his ideologues installed and he wants to unravel health policy. And that’s why all of us need to understand the data, the context, and the history, and why the current ACIP is not only wholly unqualified, but are actively endangering our lives.
The hepatitis B vaccine prevents infection with the hepatitis B virus (HBV).
HBV is an incredibly contagious virus and is transmitted through contact with bodily fluids: blood, mucosal fluids, semen, and vaginal secretion. The virus spreads when there is a break in the skin or through mucous membranes (eyes, respiratory tract, vagina, etc). It’s also incredibly hardy: HBV can survive on inanimate objects and surfaces for 7 days.
HBV infection initially causes acute hepatitis (a catchall term for inflammation of the liver). But HBV is a DNA virus in the Hepadnaviridae family (hepa- for liver, dna- for DNA = hepadna-), which makes its replication cycle more complex. Part of it enables HBV to shuttle its DNA into our cell nuclei (liver cells, specifically) where the virus can persist indefinitely if not eliminated by our immune system.
There are other hepatitis viruses: Hepatitis A, C, D, and E, but these viruses aren’t related to each other. They are called hepatitis viruses because they all lead to hepatitis: infection and inflammation of liver cells, called hepatocytes.
HBV can cause persistent infection even after acute illness.
Persistent HBV infection can cause chronic hepatitis which can progress to liver damage, cirrhosis (liver scarring), liver cancer, and death.
Many people living with chronic HBV are completely asymptomatic for years — even decades — unknowingly at risk for severe liver damage, cancer, and premature death.
And since HBV is so contagious, many people are carriers and have no idea. That means they can unintentionally infect others while also being at risk for severe outcomes themselves.
Children are at highest risk for severe hepatitis B outcomes — and HBV isn’t “only sexually transmitted.”
Contrary to anti-vaccine activists who claim that infants don’t need a “vaccine for a sexually-transmitted infection,” HBV is not just sexually transmitted.
HBV spreads through numerous bodily fluids, which means someone can become infected with HBV through sexual activity, perinatally (mother to child), unsafe medical practices, unsanitary needle practices (including piercing/tattooing), and other person-to-person fluid exchange.
While saliva does not contain infectious HBV, it can be transmitted through sharing of toothbrushes, drinkware, if an infected person has even a small cut or small sore in the mouth.
Children are infected with HBV through two main routes:
Perinatally (during birth), when during delivery the newborn is infected by the mother. This is also called vertical transmission.
Direct contact with an infected individual (family member, medical professional, classmate at daycare, etc)
HBV infection during the first year of life poses the highest risk of both acute and chronic hepatitis.
90% of infants under 1 year old will develop chronic hepatitis if they are infected with HBV.
There’s more.
58% of all liver cancers are linked to chronic hepatitis B.
Wouldn’t it be great if we could prevent infant hepatitis B infections and all the complications associated with chronic hepatitis, including liver failure and nearly 60% of all liver cancers?
Spoiler: we can.
It’s called the newborn hepatitis B vaccine dose.
This heightened susceptibility in infancy is why the birth dose is so critical. When a virus has a near-perfect success rate at establishing lifelong, cancer-causing infection in babies, delaying vaccination is puts newborns at incredible risk during their most vulnerable period of life.
The first hepatitis B vaccine was developed and approved in 1981, but vaccination recommendations were limited in scope because of manufacturing limitations of the serum-based vaccine. In 1986, the US deployed technology to manufacture recombinant HBV antigen (proteins that trigger the immune response) in yeast cells, which enabled more doses to be manufactured.
To widen the scope, CDC’s ACIP recommended hepatitis B vaccination for infants born to mothers who tested positive for that HBV protein, HBsAg, starting in 1988. During this time, HBV testing during pregnancy (for those who had access to prenatal care) became semi-standard to try to identify highest-risk infants.
But this recommendation didn’t lead to substantial reduction in HBV infections.
In the 1980s, there were 26,000 reported HBV infections in the US every year, with a estimate of 200,000 true new infections every year.
At this point, the data were clear that the vast majority of chronic hepatitis B cases were a result of infection early in life, so preventing infection in infancy was critical to combat hepatitis B, including infection, chronic hepatitis, liver failure, and cancer.
Enter:
Universal newborn HBV vaccination recommendations.
In 1991, CDC’s ACIP (Advisory Committee on Immunization Practices) implemented universal newborn vaccination recommendations. This shift just 5 years after widespread availability of the recombinant HBV vaccine had incredible impact.
Hepatitis B prevalence plummeted.
By 2002, chronic hepatitis B prevalence in US children under the age of 5 dropped to less than 0.1%. Previously, 4.7% of children under 5 had hepatitis B infection.
There was an 89% reduction in HBV infection rates, solely due to this change in newborn vaccine recommendations.
Perinatal HBV transmission declined by over 90%.
By 2010, acute HBV had declined by 82% among all age groups in US.
Among adolescents, HBV incidence dropped by 98%. (this is the demographic that was the first group to receive newborn vaccination)
What’s more? Newborn hepatitis B vaccine prevents liver cancers.
37 years of follow up in randomized controlled trials in Taiwan following their universal vaccine adoption show that newborn hepatitis B vaccination prevents liver cancers by up to 72%. That’s huge.
This is what happens when you vaccinate at birth. This recommendation was one of the most successful infectious disease interventions in U.S. history. If today’s ACIP weakens or revokes this recommendation, it isn’t because evidence changed—it’s because the committee is staffed with people who no longer care about evidence.
It’s weird, right? RFK Jr. and his MAHA allies claim they “care” about chronic illness and prevention, yet they are undermining an incredibly safe preventive medicine that prevents…chronic illnesses? If it hasn’t become clear to you yet, it should. RFK Jr. and the MAHA movement don’t actually care about anyone’s health. Certainly not children.
Here’s the reality that ACIP is choosing to ignore: maternal testing alone has never been sufficient to prevent early-life HBV infections. The data from the 1980s proved it, and the biology still proves it. Any proposal that relies on maternal HBsAg screening as a benchmark for birth-dose vaccination ignores decades of evidence. The science has been clear and ignoring it will cause immeasurable harm.
A negative HBV test is not an excuse to opt your child out of newborn hepatitis B vaccination.
A common refrain from anti-vaccine activists centers around this rhetoric: that if a pregnant woman tests negative for HBV, then there’s no risk to the infant and therefore, they don’t need vaccination.
This is wrong. And we have data to show that.
You can be infected with HBV, be contagious, and not test positive on the HBsAg test.
When someone is newly infected with HBV, there is a time called the window period. The window period is the interval between when someone is infected with HBV and when there is enough virus in their blood to detect that viral protein, the HBsAg, on the diagnostic tests.
The window period can be up to 10 weeks, which means you can be infected with HBV, but test negative, for two and a half months.
I’m sure you can see where I’m going here, but if someone is tested in the early second trimester for HBV, tests negative, assumes they’re uninfected, that may not actually be the case. Even if someone tested negative late in pregnancy, that does not guarantee they are uninfected, if they are in the window period.
This idea that a negative test means your infant isn’t at risk creates a false sense of security. Universal vaccination at birth ensure we protect all newborns, even if early infection isn’t caught by testing during the window period. Or if someone doesn’t have access to appropriate prenatal medical care. Or if an infant is infected through other close contacts outside of birth, since routine HBV testing of the entire population isn’t standard. You know, all of the scientific and evidence-based reasons for why universal vaccination at birth has been recommended for 34 years.
We even have epidemiological data to support the biology. In the 1980s, when only high-risk infants (those born to explicitly HBsAg-positive mothers) were vaccinated, there was no decline in HBV infections.
For more details on HBV replication, biology, and vaccine development, read this piece from the summer:
Newborn hepatitis B vaccines save lives, prevent cancer, and don't cause autism
This newsletter is free, but it’s able to sustain itself from support I receive from a small percentage of regular readers. If you value science-based information, consider upgrading to a paid subscription:
The US isn’t ‘over-vaccinating’ children—we are protecting people from deadly illness.
A common refrain is that the US is “over vaccinating” children compared to other countries. Well, that’s not true. In fact, many other countries implemented universal HBV newborn vaccination recommendations similar to the US.
Nearly 190 countries globally have universal newborn hepatitis B recommendations.
These include Taiwan, Thailand, China, Australia, Japan. In fact, Taiwan adopted newborn vaccination in 1984, 7 years before the US did. Just like the US, in countries who adopted universal infant vaccination, prevalence of HBV has dropped from ~5% in the 1980s to <1% by 2020. Vaccination programs have reduced new infections among kids by over 95% in areas with high vaccine uptake.
What’s more? Rates of liver cancers have also declined. Prevent hepatitis infection? Prevent all the long-term complications of it, too.
Public health recommendations are [supposed to be] designed for the population they serve. The US has higher HBV prevalence, inconsistent prenatal care access, and higher variability in healthcare utilization than countries like the UK, Norway, Sweden that have robust national healthcare programs. Universal newborn vaccination is a health policy rooted in the reality of American healthcare infrastructure.
Universal Newborn Hepatitis B Vaccination Recommendations is Based on Science, Not Vibes.
RFK Jr and his MAHA allies repeat the claim that they are returning US health policy to ‘gold standard science,’ yet they don’t understand science and are doing the opposite.
This discourse on newborn hepatitis B vaccination exemplifies that. Because newborn HBV vaccination:
Provides immediate, reliable protection to all newborns — not just those whose mothers test positive.
Closes gaps caused by missed, delayed or imperfect maternal testing.
Prevents lifelong chronic disease, liver cancer, and premature death.
Has a decades-long safety record with billions of doses administered globally.
Is more effective at preventing infection and disease than ‘catch-up’ vaccination later in childhood or in adulthood, especially in a country like the US where we don’t have equitable healthcare access.
Hepatitis B causes around 1.1 million deaths globally ever year due to cirrhosis, liver failure, and liver cancers. In the US, at least 5,000 deaths every year are a result of liver cancer and failure due to chronic hepatitis due to infections that occurred decades before, in infancy. That’s with our current newborn vaccine recommendations.
If today’s ACIP vote revokes that? We will see a rapid and predictable resurgence of preventable HBV infections. From there, we will see an increase in chronic diseases, including liver cancers, plus all of the associated increased economic and healthcare burden from more sick people.
Even slight delays in the first HBV vaccine dose can contribute to hundreds of additional cancer cases and deaths. Imagine if the official word from our government becomes “nah, it’s not important?” Well, we might not have to imagine, if RFK Jr gets his way.
This is why the ACIP vote matters. Birth-dose vaccination is what holds HBV prevention together. Remove it or weaken it and the snowball effect will be catastrophic: infections will rise, chronic carriers will increase, liver cancers will emerge decades later, and the burden on the healthcare system and families grows.
Public health decisions cause generational impact. Undoing the birth dose today doesn’t just change the present—it will cause damage for decades.
And this is the absurdity of the MAHA talking points. They claim to care about “root causes” and “chronic disease,” while dismantling the very interventions that prevent chronic disease. They fearmonger about cancer while undermining two vaccines—HBV and HPV—that literally prevent cancer. Hypocrisy, am I right?
When do I get to tell Calley Means that he and his idol are directly to blame for “cancer rates skyrocketing” because they’ve systematically undermined vaccines like HBV and HPV that…literally prevent cancers?
Letting anti-vaccine rhetoric dictate our health policy will cause preventable illness and death, now and in the future. That’s not hyperbole, that’s reality.
The ACIP ‘debate’ about newborn hepatitis B vaccination isn’t benign: it will determine whether conspiracy theorists will allow preventable chronic illness to take hold in the next generation.
We all must join in the fight for science.
Thank you for supporting evidence-based science communication. With outbreaks of preventable diseases, refusal of evidence-based medical interventions, propagation of pseudoscience by prominent public “personalities”, it’s needed now more than ever.
Stay skeptical,
Andrea
“ImmunoLogic” is written by Dr. Andrea Love, PhD - immunologist and microbiologist. She works full-time in life sciences biotech and has had a lifelong passion for closing the science literacy gap and combating pseudoscience and health misinformation as far back as her childhood. This newsletter and her science communication on her social media pages are born from that passion. Follow on Instagram, Threads, Twitter, and Facebook, or support the newsletter by subscribing below:
Thank you for this. What you’re documenting isn’t a policy debate. It’s the replacement of scientific judgment with ideology, and the consequences will be measurable in cancer, liver disease, and preventable childhood illness. The public needs to understand that ACIP is now being driven by people who have spent years attacking evidence rather than producing it.
Your breakdown of the new members makes something unmistakably clear. This isn’t dissent from qualified experts. It’s the elevation of individuals whose careers have been built on misreading data, spreading false claims, and advancing narratives that collapse under scrutiny. The perspective in NEJM from eleven former FDA commissioners underscored the same point. Dismantling the evidentiary foundation of vaccine policy is not reform. It is sabotage.
And on a personal note, I hope things ease up for you and your cats. Caring for sick pets is emotionally exhausting even when the outcomes are good. I’m glad your updates were reassuring.
Andrea - once again I am speechless at the absurdity of the situation where the idiom of “if it ain’t broke don’t fix it” is becoming “if it ain’t broke let’s break it”! Beyond your expertly crafted scientific narrative is a simple premise that the whole point of vaccines is to prevent bad things happening not just at an individual but at a population level. Keep up the excellent work and best wishes for the cats.