ACIP Postpones Controversial Vote On Hepatitis B Birth Dose After Fractious Meeting

Advisers Delay Decision After Confusing, Contentious Session

The Advisory Committee on Immunization Practices (ACIP), the independent panel that advises the US Centers for Disease Control and Prevention (CDC), postponed a vote on proposed changes to the hepatitis B birth-dose recommendation after a contentious and sometimes chaotic meeting marked by shifting ballot language and sharply divided testimony.

Advisers had been scheduled to consider whether to change current guidance that recommends a dose of hepatitis B vaccine for newborns. The vote was moved to Friday after multiple revisions to the voting language and concerns that members — some participating remotely — did not have a clear, consistent question to consider.

Contested Presentations and Questions About Evidence

The session featured presentations by outside speakers and a CDC contractor that some public-health experts said selectively cited evidence and raised doubt about the need for the birth dose. Dr. Cynthia Nevison, an atmospheric scientist who identified herself as a CDC contractor, argued that horizontal transmission of hepatitis B to otherwise healthy infants is rare and that the risk has been overstated. Her work has been associated with a retracted paper coauthored with Dr. Mark Blaxill, and the journal that retracted that study said the authors misrepresented and selectively cited data.

Public-health authorities and many ACIP members pushed back. Dr. Michael Osterholm and other experts pointed to decades of research — including hundreds of studies — showing that the birth dose is a critical tool for preventing mother-to-child hepatitis B transmission and long-term liver disease. They warned that weakening the recommendation could reverse dramatic gains: reported hepatitis B infections in infants dropped from an estimated 18,000 cases annually before universal infant vaccination to roughly 20 per year after the CDC’s 1991 recommendation.

Procedural Confusion and Political Context

Committee members also expressed frustration about last-minute changes to the motion. "This is the third version of the questions that most of the ACIP received in 72 hours," said Dr. Joseph Hibbeln, calling it a "moving target." After a brief recess prompted by audiovisual and slide issues, the committee voted 6–3 to delay final action to allow additional time to review the proposed language.

Members noted the broader political context: earlier this year, HHS Secretary Robert F. Kennedy Jr. removed the committee’s 17 prior members and appointed a new slate of advisers — a move that critics say has injected political controversy into an otherwise technical process. The question of whether ACIP can sustain public trust in its scientific recommendations was raised repeatedly during the meeting.

What ACIP Will Consider

The most recent proposed language scheduled for consideration lists three separate items:

• Whether to recommend a birth dose of hepatitis B vaccine and immunoglobulin for infants born to mothers who test positive for hepatitis B, and to recommend shared decision-making with a health care provider for infants born to mothers who test negative — with the vaccine suggested no earlier than two months if not given at birth.
• Whether to reaffirm the current recommendation to provide vaccine and immunoglobulin at birth when a mother’s hepatitis B status is unknown.
• Whether to advise that parents consult health care providers about hepatitis B testing before subsequent vaccine doses.

Broader Reactions

Several medical and public-health leaders criticized the meeting’s presentations and process. Dr. Jason Goldman called portions of the session "not following science" and urged the panel to adjourn rather than vote on inadequately framed motions. Dr. Amy Middleman recommended returning to systematic, comprehensive evidence review rather than focusing on individual studies. Senator Bill Cassidy and other critics argued that the panel’s credibility has been damaged by the recent membership changes and by high-profile invitees who have litigated against vaccine requirements.

Friday’s resumed session was expected to include further discussion of the childhood vaccine schedule, with a scheduled presentation by attorney Aaron Siri, who has challenged vaccine approvals and mandates in court. His inclusion drew criticism from some lawmakers and public-health advocates.

Bottom line: The ACIP delay reflects both procedural confusion over ballot language and deep disagreements about interpretation of evidence. The outcome could have meaningful effects on clinical guidance, state policy, insurance coverage and public trust in vaccination recommendations.