When Public Health Fails Our Children

Why this week’s Hepatitis B vote matters to your family.

“If they need to talk to someone about why it’s a bad idea to cause more people to need a liver transplant, maybe you should just send them to me.”

Those words came from my 13-year-old son, Sammy Kass, a liver transplant patient and our family’s newest public health advocate.

We were discussing the recent Advisory Committee on Immunization Practices (ACIP) meeting and its vote to remove the birth dose vaccination recommendation for hepatitis B. I explained that ACIP is supposed to be a group of experts that recommends vaccine policy to the Centers for Disease Control and Prevention and the Department of Health and Human Services. As a liver transplant family, we talk about news that feels relevant to our experience, and this felt dinner-table worthy. We talked about what hepatitis is, what chronic hepatitis does, and how effective the birth dose vaccination (a universal recommendation to vaccinate all babies at birth against hepatitis B) has been.

We talked about the patients who no longer develop chronic liver infections and scarring, and the reduction in liver cancer—thanks to this vaccination at birth. I shared an article from a physician colleague and friend, Dr. Helen Ouyang, whose own father contracted hepatitis B before the birth dose vaccine was recommended. She doesn’t know how he contracted it. He died of liver cancer at 35 years old.

Many excellent articles have already been written about the ACIP meeting. I have been reading them with interest and think they are more useful for me to quote them and share, rather than describe the meeting myself.

Katelyn Jetelina, the writer of Your Local Epidemiologist, wrote this in her Substack:

The two-day meeting of ACIP—the committee that once guided evidence-based U.S. vaccine policy before being upended under RFK Jr.—just wrapped. And … it was something else. Disgraceful. Unprepared. Dysfunctional. Incompetent. Terrifying. Embarrassing. Opaque.

Our children deserve better. Period.

In the end, the committee voted to move America back to pre-1991 by removing the universal vaccination recommendation for the Hepatitis B infant dose despite no new evidence of harm and ignoring clear benefits. They also recommended that parents ask clinicians for an antibody blood test to determine the need for subsequent doses, even though there’s no evidence that this works. This ultimately shifts the burden to clinicians and parents and abdicates the responsibility of the recommending body.

While not the most catastrophic outcome, this change is going to have real consequences—with babies and families paying the price.

Dr. Jeremy Faust, who publishes Inside Medicine, my go-to source for medical reporting in these whiplash-inducing times, reminded us that “Secretary Kennedy unilaterally fired every single expert on the committee this summer, replacing them with hand-picked replacements” when reviewing the process and debate that preceded this vote. He then unpacked the meeting and has appeared on TV a few times to educate the public about the impact of these decisions.

If you want to understand more about the meeting, the evidence that was presented, and the number of falsehoods (at least 60) that were thrown around during the sessions, take a look at these documents from the Evidence Collective. This group works to provide accurate information amid misinformation and mistrust.

Now, let’s get back to the vote and what it means for families around the United States. First of all, vaccine recommendations were never mandates, and parents always had the option to refuse the hepatitis birth dose vaccine. Informed consent, the process we use before all procedures, including vaccination, has been and will remain the standard of care for patients. This ACIP committee felt that only babies born to families with documented risk should be vaccinated at birth, and that for babies born to mothers with no known risk, the vaccine can be delayed or given only if the family requests it.

As Dr. Faust said in his analysis (supported by science and our mutual experience as practicing emergency physicians): “The problem is that not everyone gets tested. People without test results may think they are fine, but some are actually infected. Sometimes there are false negative results. Sometimes mothers (or other close contacts of infants, such as family members) can accidentally transmit the virus to an infant, owing to exposure from cuts or insufficient hygiene.”

The removal of this universal recommendation will not increase parent autonomy or choice—that already existed. It will, based on evidence we had before ACIP recommended universal vaccination, increase the risk that babies who need the vaccine, especially in families where the risk of transmission is unknown, contract this infection. Since 1991, when ACIP first recommended the birth dose vaccine, we’ve seen chronic hepatitis cases drop from tens of thousands per year to nearly zero.

Removing this recommendation will cost lives. The American Academy of Pediatrics (AAP) put out a bulletin last week reminding us that eliminating the universal recommendation will lead to a meaningful increase in infections, with an expected rise in cirrhosis and liver cancer. The selective vaccination strategy the ACIP is recommending has been tried before and failed. History and science have taught us that universal birth dose vaccination is the safest and most effective way to prevent infections, chronic disease, liver cancer, and death from Hepatitis B.

As the new ACIP recommendations were released, the medical community immediately sounded the alarm with a single, unified voice. Forty medical associations issued a joint statement on Dec. 5 rebuking this decision:

For example, ACIP’s decision to downgrade the longstanding recommendation to vaccinate all newborns against hepatitis B at birth will lead to more childhood hepatitis B infections, will lead to more chronic infections that will follow patients into adulthood, and will complicate vaccine access for children. No new data was presented during the ACIP meeting to justify this change.

As expert after expert has said, there is no legitimate public health reason to reverse this decision now, and many hope parents and pediatricians will come together to ensure that babies still get vaccinated at birth despite ACIP’s new action.

The most important takeaway from this meeting isn’t just about one vaccine. It’s that our public health infrastructure has been corrupted by ideologues pursuing an agenda unrelated to public health or science. The CDC has devolved under leadership uncommitted to science, creating a new generation that rightfully mistrusts government health guidance. Even if we restore knowledgeable scientific leadership to the CDC or HHS, we might never rebuild that trust.

The harm will be cumulative: Babies born during this period will face exposure and potential chronic hepatitis, and when we eventually try to restore evidence-based recommendations, people may not believe us anymore.

If you’re pregnant or know someone who is, please know that the hepatitis B vaccine is still available for your baby at birth, and if you want it, your insurance will cover it. Unfortunately, now you might need to ask for it.

Talk to your friends and family. Share that the vaccine is available and that there’s no evidence against birth dose vaccination. We must continue educating our communities about the availability and necessity of vaccinations as the CDC, ACIP, and HHS abdicate their responsibilities as public health professionals.

If Health Secretary Robert F. Kennedy Jr. or ACIP committee members are confused about the harm they are causing by increasing the risks of liver disease, cancer, and transplant, I can put them in touch with Sammy Kass.

He’d be happy to explain what they seem to be missing.

Dara Kass is an emergency physician and the founder of FemInEM, an organization dedicated to the advancement of women in emergency medicine and addressing reproductive healthcare issues in our emergency departments.

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