What RFK Jr.’s hep B vaccine rollback means for California

For most American babies, the hepatitis B vaccine comes just before the first bath, amid blurry pokes, prods and pictures of a 21st-century hospital birth.

But starting this week, thousands of newborns across the United States will no longer receive the first shot for hepatitis B, the first of the childhood vaccines and the best defense against one of the world’s deadliest cancers.

On Dec. 5, the Centers for Disease Control and Prevention’s powerful vaccine advisory panel voted to override the decades-old birth dose recommendation.

The change was made by Secretary of Health and Human Services Robert F. Kennedy Jr. and his “Make America Healthy Again” movement; The movement has long sought to rewrite the CDC’s childhood vaccination schedule and eliminate state vaccine requirements for kindergarten.

California officials have vowed to keep the state’s current guidelines in place, but federal changes could threaten vaccine coverage by some insurers and public benefit programs and have broader repercussions.

“It’s a gateway,” said Jessica Malaty Rivera, an infectious disease epidemiologist in Los Angeles. “It’s not just hepatitis B, it’s disrupting the entire program.”

Democratic-led states and top-tier insurers are scrambling to bolster access. California joined Hawaii, Oregon and Washington to form the West Coast Health Alliance to maintain uniform public policy on vaccines in the face of official “misinformation and disinformation.”

“Universal hepatitis B vaccination at birth saves lives, and moving away from this science is reckless,” California Governor Gavin Newsom said in a statement. “The Trump administration’s ideological policies continue to result in increasingly higher costs for parents, newborns, and our entire public health system.”

The matter has already been resolved in court.

The Supreme Court on Tuesday sent a case over New York’s vaccine rules back to the 2nd U.S. Circuit Court of Appeals for review, signaling doubts about strict vaccine requirements for schools pioneered in California. On Friday, public health officials in Florida appeared poised to lift their schools’ hepatitis B vaccine mandate, along with vaccinations that have long been the leading cause of chickenpox, a dozen types of bacterial pneumonia and fatal meningitis.

Supporters of the Hep B amendment said it replaces impersonal prescriptions with “shared clinical decision-making” about whether and how to get the vaccine, while maintaining stricter advice for children of infected mothers and children whose status is unknown.

Critics say families have always been free to refuse the vaccine. 20% did it nationwide in 2020, according to data published by the CDC. This is the only shot at the program where children on Medicaid benefit at the same rate as privately insured children.

Critics say that instead of improving informed consent, the CDC committee’s decision and the dramatic public battle that led to it have driven down vaccination rates even among children of infected mothers.

Hepatitis B Foundation president Dr. “Hepatitis B is the most vulnerable vaccine in the program,” Chari Cohen said. “The message we’re hearing from pediatricians and gynecologists is that parents are making it clear that they don’t want their babies to get the birth dose, they don’t want their babies to be vaccinated.”

Much of this sensitivity has to do with timing: While the first dose is given within hours of birth, symptoms of the disease may not appear for decades.

“The whole Day One thing really confuses people,” Rivera said. “They think, ‘This is my perfect fresh baby and I don’t want to put anything in them.’”

U.S. surgeon general nominee Casey Means called the universal birth dose recommendation “absolute insanity” and said in a post on X last year that it “should make every American pause and question the healthcare system’s instructions.”

“The disease is transmitted only through needles and sex,” he said. “There is no benefit to the baby or the wider population for a child who is not at risk of sexual or IV transmission to receive this vaccine. There is only risk.”

In fact, at least half of transmission occurs from mother to child, usually at birth. A smaller percentage of babies contract the disease by sharing food, nail clippers, or other common household items with their fathers, grandparents, or daycare teachers. Because infections are often asymptomatic, most people don’t know they have the virus, and at least 15% of pregnant women in the U.S. have not been tested for the disease, experts said.

Babies who contract hepatitis B are very likely to develop chronic hepatitis leading to liver cancer or cirrhosis in middle age. In contrast, vaccination much less likely It is more likely to cause even minor reactions such as fever than the flu or chickenpox.

D., medical director of the Viral Hepatitis Programs and Asian Health Center at Cooperman Barnabas Medical Center in New Jersey, lives with the disease. “We have administered 50 billion doses of hepatitis B vaccine and have not seen signals that worry us,” Su Wang said.

Yet “sex and drugs” remains a popular topic of discussion not only among Kennedy’s allies in Washington and Atlanta, but also among leading pediatricians in Los Angeles.

Studio City pediatrician and MAHA leading figure, Dr. Joel Warsh’s latest book, “Between a Shot and a Hard Place,” targets vaccine-hesitant families.

Hepatitis B also disproportionately affects immigrant communities, further stigmatizing a disease that entered mainstream consciousness in the 1980s as an early proxy for HIV infection before it was fully understood.

At last week’s committee meeting, member Dr. Evelyn Griffin has called illegal immigration the “elephant in the room” in the birth dose debate.

The move comes as a post-pandemic wellness culture has further fueled vaccine hesitancy, broadening objections from a long-debunked link between the measles-mumps-rubella vaccine and autism to the more general, equally mistaken belief that “healthy” children who eat whole foods and play outside are less likely to get sick from vaccine-preventable diseases and, if so, can be treated with “natural” remedies like beef tallow and cod liver oil.

“It’s about your quality of life, it’s about what you put in your body, it’s about your wellness journey — we’ve debunked this before,” Rivera said. “This is eugenics.”

In Southern California, pediatricians, preschool teachers and public health experts say they are seeing an increase in the number of families seeking to exclude certain vaccines from the schedule because of “individualized risk,” with many trying to delay others. The trend has spawned a cottage industry of e-books, Zoom workshops from “vaccine-friendly” doctors offering alternative schedules, personalized vaccines and post-vaccine detox regimens.

CDC data shows state exemptions for kindergarten vaccinations have increased since the peak of the COVID-19 pandemic, with about 5% of schoolchildren in Georgia, Florida and Ohio, more than 6% in Pennsylvania and about 7% in Michigan falling outside the mandate last year.

In Alaska and Arizona, these figures exceeded 9%. In Idaho, 1 in 6 kindergarten students is exempt.

California is one of four states, along with New York, Connecticut and Maine, that do not have religious or personal belief exemptions for school vaccinations.

It is also among at least 20 states that have committed to making hepatitis B birth dose for babies covered by public insurance, which covers about half of American children. It’s unclear whether the revised advice will affect government coverage of the vaccine in other states.

Experts warn that the success of birth dose reversal, over near-universal objection from the medical establishment, forces a takeover of the entire pediatric vaccine program and threatens the school-based rules that enforce it.

Experts said ongoing measles outbreaks in Texas and elsewhere, which have killed three people and sickened nearly 2,000, indicate the risk of rolling back requirements.

Hepatitis is not as contagious as measles, which can remain airborne for about two hours. But experts said it is still fairly easy to catch and devastating for those who contract it.

“These decisions made today will have terrible effects later,” said Rivera, the L.A. epidemiologist. “I can’t imagine having to deal with this situation as a new mother.”