RFK Jr. Wants To Delay the Hepatitis B Vaccine. Here’s What Parents Need To Know.

Working at a tribal hospital in Anchorage, Alaska, liver specialist Brian McMahon spent decades treating the shadow of hepatitis B. Before a vaccine was available in the 1980s, he watched the virus claim young victims in communities across western Alaska with staggering speed.

One of his patients was 17 when he first examined her for stomach pain. McMahon discovered she had developed liver cancer caused by hepatitis B, just weeks before graduating high school as valedictorian. She died before the ceremony.

McMahon often thinks of an 8-year-old boy who showed no signs of illness until he complained of pain from what turned out to be a rapidly growing liver tumor.

McMahon can still hear his voice.

“He was moaning in pain, saying, ‘I know I’m going to die soon,’” he recalls. “We were all crying.” The boy died at home a week later.

The hepatitis B virus is transmitted through blood and bodily fluids, even in microscopic amounts, and the virus can survive on surfaces for up to a week. Like many of his patients, McMahon said, both children contracted hepatitis B at birth or in early childhood.

This outcome is now avoidable. A dose of vaccine at birth, recommended for newborns since 1991, is up to 90% effective in preventing infection of the mother if administered within the first 24 hours of life. If babies receive all three doses, 98% of them are immune to the incurable virus, with protection lasting at least 30 years.

In western Alaska communities, years of targeted testing and widespread vaccination efforts have led to falling case numbers.

“Liver cancer is gone in children,” McMahon said. “We haven’t seen a case since 1995. And to our knowledge, we also don’t have any children under 30 who have been infected.”

He fears that these hard-won gains will soon be reversed.

Push back the dose?

A Centers for Disease Control and Prevention vaccine advisory committee appointed by Health and Human Services Secretary Robert F. Kennedy Jr. is expected to discuss and vote on the hepatitis B birth dose recommendation during its two-day meeting beginning Dec. 4, potentially limiting children’s access.

On Tucker Carlson’s podcast in June, Kennedy falsely claimed that birth dose of hepatitis B was a “likely culprit” for autism.

He also said the hepatitis B virus is not “occasionally contagious.” But decades of research show that the virus can be transmitted through indirect contact, when traces of infected fluids like blood enter the body when people share personal items like razors or toothbrushes.

The committee’s recommendations carry weight. Most private insurers must cover vaccines approved by the Advisory Committee on Immunization Practices, and many state immunization policies are directly linked to its guidelines.

Neither the ACIP nor the CDC are regulatory. They cannot impose vaccination. It is up to the States to do it. But maintaining the recommendation for a hepatitis B vaccine at birth preserves the widest range of options for families. They can choose to get vaccinated at birth, wait until later in childhood, or not get vaccinated at all, and insurance will continue to cover the cost of the vaccine as long as it remains approved by the Food and Drug Administration.

Two top FDA officials — Commissioner Marty Makary and top vaccine regulator Vinay Prasad — suggested in late November that changes could be made to the vaccine approval process. Vaccines must be approved by the FDA to be administered in the United States.

In internal agency emails obtained by PBS NewsHour and the Washington Post, Prasad questioned the common practice of “administering multiple vaccines at the same time.” It is unclear whether he was referring to combination vaccines providing immunity to multiple diseases in a single shot. Three of the nine hepatitis B vaccines currently approved by the FDA are combination vaccines. The birth dose of hepatitis B vaccine is administered only as a stand-alone vaccine.

“Sowing distrust”

If private insurers choose to continue covering the vaccine, misinformation from the meeting could still lead families to falsely believe the vaccine could harm their babies, said Sean O’Leary, chair of the American Academy of Pediatrics’ infectious diseases committee and assistant professor of pediatrics at the University of Colorado School of Medicine.

“Whatever the outcome of this disaster that is the December meeting, it will be primarily to sow distrust and spread fear,” he said.

President Donald Trump, Kennedy, and some newly appointed ACIP members have misinterpreted how liver disease spreads, ignoring or downplaying the risk of transmission through indirect contact. The hepatitis B virus is much more contagious than HIV. Unvaccinated people, including children, can become infected from microscopic amounts of blood spilled on a table or toy, even if the infected person is asymptomatic.

McMahon has cared for children who tested negative at birth and were later infected through indirect contact. In a study in the 1970s, nearly a third of these children developed chronic hepatitis B without ever showing symptoms, he said.

“It’s a very contagious virus,” McMahon said. “That’s why giving everyone the dose at birth is the best way to prevent this disease.”

The CDC recommends that all pregnant women be screened for hepatitis B, but it estimates that up to 16% are not tested and fall through the cracks. O’Leary and other experts say it’s impossible to test mothers for the virus shortly before or after giving birth because most hospitals are understaffed and under-resourced.

The three-dose vaccine has a long safety history. Many studies show that it is not associated with an increased risk of infant death, fever or sepsis, multiple sclerosis, or autoimmune diseases, and that serious reactions are rare.

“We have an incredible safety profile,” O’Leary said. “No one expects to get into a car accident, do they? And yet we all wear seat belts. It’s the same.”

The CDC estimates that 2.4 million people in the United States have hepatitis B and half do not know they are infected. The illness can range from an acute infection to a chronic infection, often with few or no symptoms. If the disease is left untreated, it can lead to serious illnesses such as cirrhosis, liver failure and liver cancer. There is no cure.

Expert advice for parents: Talk to a doctor

William Schaffner, a professor of preventive medicine at Vanderbilt University School of Medicine and a former ACIP voting member, said some parents have difficulty understanding why a healthy newborn needs a vaccine so soon after birth, especially for a virus they are sure they don’t have and often wrongly associate only with risky behaviors. These perceptions, he said, combine with declining confidence in public health and growing skepticism about vaccines.

Her advice to expectant parents who are hesitant is to talk to their doctor about injections. Even if the pregnant woman tests negative, he said, it is still important to give the baby the birth dose, because false negatives are possible and because the virus can spread so easily through contact with a surface. Babies who receive the full series of vaccines from birth have their risk of liver cancer reduced by 84%.

“If you wait a month and the mother tests positive, or the baby receives it from a caregiver, at that time the infection is established in that baby’s liver,” Schaffner said. “It’s too late to prevent this infection.”

He said that if fewer people got vaccinated, hepatitis B would circulate at higher rates in U.S. communities and the risk of contracting the virus would increase for anyone who did not get vaccinated.

And more cases of hepatitis B could lead to higher costs for patients and the health system as a whole. The CDC estimates that treating someone with a less severe form of the disease costs between $25,000 and $94,000 per year. For patients requiring a liver transplant, annual medical costs can exceed $320,000, depending on their treatment.

Over the past 30 years, the main side effects reported by parents in their babies receiving the birth dose have been fussiness and crying, which disappear quickly. Schaffner said this is a very strong safety profile – for a neonatal vaccine with a proven track record of protecting babies against an incurable disease.

“The data is very clear on this,” Schaffner said. “Many other countries started this program. They modeled it after us.”