The hepatitis B vaccine has emerged as the latest flashpoint as health secretary Robert F. Kennedy Jr. continues to question the safety of the vaccine.
Vaccines are given to babies on a daily basis right after birth. This is because hepatitis B can be transmitted from mother to child, an incurable infection that can lead to liver disease, cancer and death during childbirth.
During a Senate Finance Committee hearing with Kennedy on Thursday, Sen. Roger Marshall of R-Kan said he would offer the hepatitis B vaccine “meaningless” to all newborns, especially if their mother tests negative for the virus.
Marshall, OB-Gyn, who said he had given birth to 5,000 babies, said he supports vaccinating newborns in women who have not received prenatal care or are not tested for hepatitis B, but he questioned the need for universal vaccination.
He’s not just Republican senators who are critical of vaccines.
“If the mother is not infected, there is no medical reason to offer the newborn HEP B vaccine. Every mother giving birth in the hospital will be tested,” Kentucky’s Rand Paul wrote in X last week.
This led to Senator Bill Cassidy (R-La.) responding.
“Empirically, this is not true. Not all mothers have prenatal care,” writes Cassidy. “Some people get infected between early pregnancy tests and delivery. In some cases, tests are overlooked.”
Paul and Cassidy are both doctors. Paul is an ophthalmologist and Cassidy is the gastroenterologist who treated patients with hepatitis.
This problem cannot disappear anytime soon. Next week, the committee advises the Centers for Disease Control and Prevention on Vaccines will discuss the hepatitis B vaccine. Kennedy fired all 17 members of the previous committee in June, carefully selecting seven alternatives, some of which expressed anti-vaccine views.
New Committee Chair Martin Kruldorf – A biostatistician who said he was fired from Harvard University raised questions about the hepatitis B vaccine at the group’s first meeting in June.
“Unless the mother tests positive for hepatitis B, we can argue that we will delay the vaccine due to this infection,” Kruldorf said.
That argument contains dangerous assumptions, said Chari Cohen, chairman of the Hepatitis B Foundation. A 2019 report found that only 84% to 88% of pregnant women were tested for the virus.
Cohen said hepatitis testing is not perfect and sometimes results in false results. Additionally, pregnant women may not tell their doctor about past or present behavior because they are afraid of stigma. The virus spreads to inject drugs by sharing sexual contact or needles.
Without vaccination, 90% of babies exposed to the hepatitis B virus at birth develop chronic hepatitis. It’s an incurable disease that destroys the liver, Cohen said. Many of these children ultimately require a liver transplant. In rare cases, babies can die of an overwhelming infection.
Why do newborns get the hepatitis B vaccine?
Dr. Rabbi Javeli, director of infectious diseases at Lurie Children’s Hospital in Chicago, vaccinates the baby on the first day of his life, as the vaccine is most effective.
If an infant is infected during childbirth, the hepatitis B virus enters the bloodstream and heads towards the liver, allowing for a lifetime infection, Jhaveri said. Newborns who are vaccinated immediately after birth give birth the opportunity to quickly fight infections, rather than allowing the virus to multiply and gain scaffolding. Studies have shown that older babies exposed to hepatitis B are not effective, he said.
Hepatitis B spreads through contact (even through microscopic volumes) with infected blood and body fluids, making it incredibly infected.
Children can get into the home with the virus, especially if they share toothbrushes, razors and earrings, Cohen said. Newborns who are vaccinated before they leave the hospital protect them from being infected throughout childhood.
Dr. Swan, an internal medicine physician, learned that he had hepatitis B after donating blood while in college. Her mother was not sick, but other families did.
Wang took antiviral medications for hepatitis B and remains healthy. She said she confirmed that all four children got the vaccine when they were born, and that they provided the body with the dose of hepatitis B immunoglobulin. Vaccines can take a week to two weeks, but immunoglobulins provide immediate protection from the virus, Wang said.
“It’s very reassuring that you don’t have to worry about your four children having hepatitis,” Wang said.
When the hepatitis B vaccine was first introduced in 1982, doctors only offered it to high-risk adults. Two years later, the CDC recommended a vaccine for high-risk neonates, Jhaveri said. The number of perinatal infections remained stubbornly high.
However, hepatitis B infections plummeted after the CDC began recommending a universally dosage of hepatitis B vaccine at birth in 1991. Cases of acute hepatitis B infections in children fell by 99% from 1990 to 2019.
Vaccinated babies appear to protect them for at least decades, Jhaveri said.
Drug injectors are at a higher risk of hepatitis B, but doctors have not seen many cases of infectious disease in people in their teens, 20s and 30s. As children who were vaccinated at birth grow older, doctors will learn whether these shots will prevent infection in middle age.
“It’s a truly horrible disease,” says Dr. James Campbell, vice-chairman of the Infectious Diseases Committee of the American Academy of Pediatrics Committee. “Hepatitis B can be eliminated with very inexpensive vaccines known to be safe and effective.”
If the CDC’s upcoming vaccine panel is recommended for hepatitis B vaccinations at birth, it could make the vaccine even more difficult. CDC vaccine recommendations affect which vaccinations are covered by insurance, and all CDC recommended vaccines are included in the federal Vaccine For Children Program. This will allow vaccinations to be available free of charge. Approximately half of US children are eligible for the free vaccine through the program.
Last month, Kennedy confirmed that CDC director Susan Monares had been fired. Because an editor in the Wall Street Journal stated that it would not “before” the vaccine panel recommendations.
Things you need to know about Hepatitis B
When adults contract hepatitis B, their immune systems often overcome the virus, making it no longer a threat, Campbell said. Babies with an undeveloped immune system usually develop chronic infections for the rest of their lives.
The longer people live with chronic inflammation caused by infection, the higher the risk of liver damage and cancer, Cohen said. Cancer should not be developed from a preventable infection, she said.
“We want to give every baby born in the United States an absolute right to a long, healthy life,” she said.
Louisiana Senator Cassidy is a voice supporter of the hepatitis B vaccine.
In his Louisiana home town, he created a public-private partnership to vaccinate 36,000 children from the Baton Rouge area against hepatitis B.
At Kennedy’s confirmation hearing in January, Cassidy spoke about “the worst day of my medical career,” and shared her experience treating a young woman with hepatitis B on her way to a liver transplant. “It was an inflection point in my career,” he said. “Since then, I have tried to do everything I can to make sure I don’t have to tell other parents about a child dying from a vaccine-preventable disease.”
Preventing a disease is virtually always cheaper than treating it. Hepatitis B shots are some of the cheapest vaccinations. The cost of a liver transplant in 2020 is $878,400. A 2024 survey found that treatment for liver cancer is $93,228.
A 2015 survey found that the US spent more than $1 billion a year on hospitalizations for hepatitis B.
“People in their teens and 20s can die of liver cancer due to hepatitis B. “These are the risks we will take on if we stop using this safe and effective vaccine.”
