The enhanced premium tax credits that since 2021 have helped millions of Americans pay for insurance on the Affordable Care Act marketplaces will expire Dec. 31, despite a last-ditch effort by Democrats and some moderate Republicans in the House of Representatives to force a vote to continue them. That vote will happen, but not until Congress returns in January.

Meanwhile, the Department of Health and Human Services canceled a series of grants worth several million dollars to the American Academy of Pediatrics after the group again protested HHS Secretary Robert F. Kennedy Jr.’s changes to federal vaccine policy.

This week’s panelists are Julie Rovner of 麻豆女优 Health News, Lizzy Lawrence of Stat, Tami Luhby of CNN, and Alice Miranda Ollstein of Politico.

Panelists

Among the takeaways from this week’s episode:

• The House on Wednesday passed legislation containing several GOP health priorities, including policies that expand access to association health plans and lower the federal share of some Affordable Care Act exchange marketplace premiums. It did not include an extension of the expiring enhanced ACA premium tax credits 鈥� although, also on Wednesday, four Republicans signed onto a Democratic-led discharge petition forcing Congress to revisit the tax credit issue in January.
• In vaccine news, the American Academy of Pediatrics spoke out against the federal government’s recommendation of “individual decision-making” when it comes to administering the hepatitis B vaccine to newborns 鈥� and HHS then terminated multiple research grants to the AAP. Meanwhile, the Centers for Disease Control and Prevention is funding a Danish study of the hepatitis B vaccine in West Africa through which some infants will not receive a birth dose, a strategy that critics are panning as unethical.
• Also, a second round of personnel cuts at the Department of Veterans Affairs is expected to exacerbate an existing staffing shortage and further undermine care for retired service members.
• The FDA is considering rolling back labeling requirements on supplements 鈥� a “Make America Health Again”-favored industry that is already lightly regulated.
• And abortion opponents are pushing for the Environmental Protection Agency to add mifepristone to the list of dangerous chemicals the agency tracks in the nation’s water supply.

Also this week, Rovner interviews Tony Leys, who wrote the latest “Bill of the Month” feature, about an uninsured toddler’s expensive ambulance ride between hospitals.

Plus, for a special year-end “extra-credit” segment, the panelists suggest what they consider 2025’s biggest health policy themes:听

Julie Rovner: The future of the workforce in biomedical research and health care.听

Lizzy Lawrence: The politicization of science.听

Tami Luhby: The systemic impacts of cuts to the Medicaid program.听

Alice Miranda Ollstein: The resurgence of infectious diseases.听

Also mentioned in this week’s podcast:

• The Washington Post’s “.,” by Lena H. Sun and Paige Winfield Cunningham.
• MedPage Today’s “,” by Jeremy Faust.
• The Washington Post’s “,” by Meryl Kornfield, Hannah Natanson, and Lisa Rein.
• NBC News’ “,” by Berkeley Lovelace Jr.
• Politico’s “,” by Alice Miranda Ollstein and Ariel Wittenberg.
• The Washington Post’s “,” by Paige Winfield Cunningham.
• Politico’s “,” by Joanne Kenen.

[Editor’s note:听This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]听

Julie Rovner:听Hello,听from 麻豆女优 Health News and WAMU Public Radio in Washington, D.C., and welcome to听What the Health?听I’m听Julie Rovner, chief Washington correspondent for 麻豆女优 Health News, and听I’m听joined by some of the best and smartest health reporters in Washington.听We’re听taping this week on Thursday,听Dec.听18,听at 10听a.m. As always, news happens fast,听and things might have changed by the time you hear this. So, here we go.听

Today, we听are joined听via video conference by Tami Luhby of CNN.听

Tami Luhby:听Hello.听

Rovner:听Alice听Ollstein听of Politico.听

Alice Miranda听Ollstein:听Hi, there.听

Rovner:听And I am pleased to welcome to the podcast panel Lizzy Lawrence of Stat听News. Lizzy, so glad听you’ll听be joining听us.听

Lizzy Lawrence:听Thanks so much for having me.听I’m听excited.听

Rovner:听Later in this episode,听we’ll听have my interview with Tony Leys, who reported and wrote the latest 麻豆女优 Health News听“Bill of the Month”听about yet another听very expensive听ambulance ride. But first, this week’s news.听

Well, remember when House Speaker Mike Johnson complained during the government shutdown that the issue of the听additional听ACA听[Affordable Care Act]听subsidies expiring was a December problem? Well, he sure was right about that. On Wednesday, the House,听along party lines,听passed听a听bill that Republicans are calling the听“Lower Healthcare Premiums听for All听[Americans]听Act,”听which听actually doesn’t, but听we’ll听get to that in a moment. Notably,听not听part of that bill was any extension of the enhanced tax credits that now are听going听to expire at the end of this year, thus doubling or,听in some cases,听tripling what many consumers who get their coverage from the ACA marketplaces will have to pay monthly starting in January. Speaker Johnson said he was going to let Republican moderates offer an amendment to the bill to continue the听additional听subsidies with some changes, but in the end, he听didn’t.听

So, four of those Republicans,听from more purple swing districts worried about their constituents seeing their costs spike, yesterday signed on听to a Democratic-led discharge petition, thus forcing a vote on the subsidies, although not until Congress returns in January. Before we get to the potential future of the subsidies though, Tami, tell us听what’s听in that bill that just passed the House.听

Luhby:听Well, there are four main measures in it, but none of them, as you say听鈥μ齮hey will lower potentially some premiums for certain people, but听they’re听really a bit of a laundry list of Republican favorite provisions.听

So, one of the main ones is association health plans. They would allow more small businesses听鈥斕齛nd,听importantly, the self-employed听鈥斕齮o band together across industries. This could lower health insurance premiums for some people, but these plans also听don’t听have to adhere to听all of听the ACA protections and benefits that are offered. So, it may attract more healthier people or be more beneficial for healthier people, but not for everyone, for sure.听

There are some PBM, pharmacy benefit manager,听reforms. They would have to provide a little more information to employers about drug prices and about the rebates they get, but it may not really have听鈥� the experts I spoke to said听it’s听really just听tinkering around at the edges and may not be that consequential.听

Rovner:听And听it’s听not even as robust a PBM bill as Republicans and Democrats had agreed to last year听鈥μ�

Luhby:听Exactly.听

Rovner:听鈥� that Elon Musk got struck at the last minute because the bill was too long.听

Luhby:听Exactly,听it’s听a narrower transparency. There are narrower transparency provisions. It would also,听importantly, refund the听cost-sharing听provisions. And remember, there are two types of subsidies in the Affordable Care Act. There are听the premium听subsidies, which is what everyone is talking about, the enhanced premium subsidies.听But these are cost-sharing reductions that lower-income people on the exchanges receive to actually reduce their deductibles and their copayments and coinsurance, their听out-of-pocket听expenses.听

President听[Donald]听Trump, during his first term,听in an effort to听weaken the Affordable Care Act, ended the federal funding for these cost-sharing subsidies, but the law requires that insurers continue to provide them.听So听what the insurers did was they increased the premiums of the听“silver”听plans听in order to听make up some of the difference, but those silver plans, remember, are tied to听鈥μ齮he cost of those silver plans are what听determines听the premium subsidies that people get. So, basically,听by refunding or by once again funding these cost-sharing subsidies, insurers will lower the premiums for those silver plans, which will,听in turn,听lower the premium subsidies that the government听has to听pay and save the government money.听

The people in silver plans听probably won’t听be affected as much, but what happened after Trump ended the cost-sharing subsidy funding is that with these increased premium subsidies that are tied to the silver plans, a lot of people were able to buy听“gold”听plans. They were able to buy better plans for less because they got bigger premium subsidies, or they were able to buy听“bronze”听plans for听really cheap.听So basically, this听provision will end, will reduce the premium听assistance听that people get,听and听it’ll听effectively raise premium payments for people in a lot of plans, which will make it more difficult for them.听

Rovner:听Which was a wonderful explanation, by the way, of听something听that’s听super complicated.听

Luhby:听Thank you.听

Rovner:听But听I’ve听been trying to say it听basically moves听money around. It takes money that had been听鈥μ齣t lowers how much the federal government will have to pay, while at the same time loading that back onto consumers.听

Luhby:听Right.听

Rovner:听So, hence my original statement that the听“Lower Premiums听for All”听Act听doesn’t听lower premiums for all. So, this is听鈥μ�

Luhby:听No, there’ll be a lot of people in gold and bronze and听“platinum”听plans who will be paying a lot more, or they’ll have to, if they’re in gold, they may have to shift to silver, which means they’ll just be paying more out-of-pocket when they actually seek care.听

And then听there’s听a fourth provision听that’s听not as consequential:听It’s听called choice plans.听It’s听to help employers give听鈥μ齣t’s听to make it easier for employers to give money to people to buy coverage on the exchanges.听

Rovner:听Yeah, which听I think nobody听disagrees with. But Alice,听there’s听another even catch to the cost-sharing reductions, which is that听it’s听only for states that ban abortion or that听don’t听ban abortion. Now I听forget, which is it?听

Ollstein:听So, it’s,听yeah.听So听the great compromise of the Affordable Care Act was that听it’s听up to states whether to allow, require, or prohibit plans on the Obamacare exchanges from covering abortion. And as states do, they went in different directions, so about half ban it and about the other half, it’s听50-50 on requiring abortion coverage and just allowing it, leaving it up to individual plans. And so yes, this provision听sought听to penalize states that allowed abortion. And so, it’s expanding the definition of the Hyde Amendment from where it was before, basically saying if any federal funding is going to a plan that uses other money to pay for abortion, then that counts as funding abortion, even though the money is coming out of different buckets.听

And so, this has been a big fight on Capitol Hill this year. And as I wrote yesterday,听it’s听nowhere near being resolved. I mean, even if lawmakers were going to come together on everything else related to the subsidies, which they are not, the abortion debate was still in the way as听an impediment, including in the Senate as well.听

Rovner:听Yeah. So, what are the prospects for these听additional听subsidies? And I should go back and reiterate that what Tami and I were talking about were the original tax credits that were passed with the Affordable Care Act, not the enhanced ones, the bigger tax credits that are expiring at the end of the year. So, Republicans have now forced this vote, so we know that the House is going to vote on extending these subsidies听鈥斕齣n January,听after听they’ve听expired, which is a whole issue of complication itself. But I mean, is there any prospect for a compromise here?听Might they go home and get enough pushback from constituents who are seeing their costs go up so much they’re going to have to drop their insurance that they might change their minds?听

Ollstein:听Well, Democrats and advocacy groups are trying to ramp up that pressure.听We’ve听been covering some ad campaigns and efforts. Democrats are holding town halls in Republican districts where the representatives are not holding town halls to shine a light on this.听They’re听highlighting the stories of individual, sympathetic-character folks who are having their premiums go听way up.听

So, there were press conferences just this week I saw with retirees and people who are on听Social听Security听Disability and small-business owners and single parents,听and听it’s听not hard to find these stories;听this is happening to tens of millions of people. And so,听I think this听is going to be a major, major political message going into next year. Whether听it’s听enough to make Republicans who are still so ideologically opposed to the Affordable Care Act agree on听some kind of an听extension, that remains to be seen. And we really听haven’t, despite the defection of a small handful this week in joining the Democrats on an extension听鈥斕齱hich was听really notable听and a sign that Speaker Johnson is not keeping his caucus in array.听But the vote hasn’t happened yet, and we’ll see if spending time back in the districts over the holidays makes people more or less willing to compromise.听It can听go either way.听

Rovner:听I saw a lot of people yesterday saying that,听Well, even if the House were to pass the clean three-year extension of the enhanced subsidies听鈥斕齱hich is what’s in the Democrats’听bill听鈥斕�the Senate just voted on it last week and voted it down, so it wouldn’t have any chance.听To which my response was,听“Hey, Epstein files.”听When the jailbreak happened in the House on that, the Senate voted, I believe, unanimously for it. So, things can change in the Senate. Sorry, Tami, I interrupted you;听you wanted to say something.听

Luhby:听No, I was just going to say that yes, things can certainly听change听and there have been surprises before, but this is obviously also not a new issue. I mean, the Democrats have been running ads, people have been speaking out. We have all been听writing听stories about听the cancer听survivors or cancer patients who may have to drop their coverage in the middle of their treatment because they听can’t听afford the new premiums, or听all of听these stories. So, none of this is new, but听we’ll听see.听There’s听obviously听鈥μ齱hat is听somewhat new听is the administration’s message on increasing affordability, and this is a huge affordability issue. So,听maybe that听will spur some change in votes or change in mindset.听

Rovner:听Well, definitely a January story too.听

Well, moving on to this week in vaccine news, the Centers for Disease Control and Prevention has made it official听鈥斕齛fter being blessed by the acting director of the agency, who is neither a doctor nor a public health professional听鈥斕齮he U.S.听government is no longer recommending a birth dose of the hepatitis B vaccine, which by the way, has been shown to reduce chronic hepatitis B in children and teenagers by 99% since the recommendation was first issued in 1991.听

And merging two stories from this week, there’s also听news about the American Academy of Pediatrics, which has been among the most vocal medical groups protesting the vaccine schedule changes. The AAP said the hepatitis B change will听“harm children, their families, and the medical professionals who care for them.”听And in a move that seems not at all coincidental, the Department of Health and Human Services on Wednesday听terminated听seven federal grants to the AAP worth millions of dollars, for work on efforts including reducing sudden infant deaths, preventing fetal alcohol syndrome, and听identifying听autism early. According to听The Washington Post, which听, an HHS听spokesman听said the grants were canceled because they听“no longer align with the听Department’s mission or priorities.”听

First, this is not normal. Second, however,听it’s听HHS in 2025 in a microcosm, isn’t it? Either get with the program or get out. Lizzy,听you’re听nodding.听

Lawrence:听Absolutely. Yeah, I think this has become very commonplace in this administration.听And also听interestingly, yesterday, the HHS posted in the federal register that the CDC offered a $1.6 million grant to a group of Danish researchers who study in Guinea,听West Africa,听to run a placebo-controlled trial of hepatitis B vaccine for newborns. And so,听we’re听seeing an active removal of funds from the American Academy of听Pediatricians听[Pediatrics], and听then giving funds now to research. And this is a research group听actually that听RFK Jr. has cited their studies before, they study overall health effects of vaccines. And so, it will be听really interesting听to see if this is a trend that continues, if听they’re听kind of听鈥μ齱e already know that HHS, the CDC’s vaccine panel,听there’s听been discussions about making our vaccine schedule closer to Denmark’s. Now听there’s听this money being given to Danish researchers who align with the way that they think about vaccines is听similar to听Kennedy and to another official at FDA,听called Tracy Beth Høeg, who is also on the CDC’s panel as the FDA representative. So,听yeah.听

Rovner:听And who is Danish, I believe.听

Lawrence:听Yes, her husband is Danish, and so she lived in Denmark for many years.听

Rovner:听I saw some scientists complain about that study in Guinea-Bissau, because they say听it’s听actually unethical听to use a placebo to study the hepatitis B vaccine because we know that it works.听So听if听you’re听giving a placebo to children,听you’re听basically exposing听them to hepatitis B.听听

Lawrence:听Right.听

Ollstein:听Yeah. I saw听that听too. And a lot of folks were saying this would never be approved to be done in the U.S. And so, doing it in another country is reminding people of听colonial experiments听in听medicine that were听really unethical听and subjected people to more risks than would be allowed here. And like you said,听basically knowingly听withholding something that is safe and effective and giving someone a placebo instead.听

Another issue I saw raised was that it is not a double-blind study;听it is a single-blind study. And so, that allows for potential biases there as well.听

Lawrence:听Right. And I was also seeing that the Guinea Ministry of Health is planning to mandate a universal hep B dose in 2027.听

Rovner:听Oops.听

Lawrence:听So, that’s a crazy听鈥μ齳eah, you have babies born before that year who are not given this dose, and then after听鈥μ齭o yeah, it raises all kinds of ethical concerns,听and it’s just remarkable that the government would just pull away and offer this money to them.听

Rovner:听HHS in 2025.听Specifically on the听covid听vaccine, there听were听two stories this week. One is a study in the Journal of the American Medical Association that found that pregnant women vaccinated against听covid-19 are less likely to be hospitalized, less likely to need intensive care, and less likely to deliver early, if they can track the virus, than those who are unvaccinated. And over at听,听editor Jeremy Faust,听who’s听both a doctor and a health researcher, says that FDA听vaccine听chief Vinay Prasad overstated his case when he said the agency has found at least 10 children听who’ve听died听as a result of听receiving the听covid听vaccine. Turns out the actual memo from the scientists assigned to research the topic concludes the number is somewhere between zero and seven, and five of those cases have only a 50-50 chance of being related to the vaccine. This听isn’t听great evidence for those who want to stop giving the vaccine to children and pregnant women, I would humbly suggest.听

Lawrence:听Right,听right.听Yeah, the memo that Vinay Prasad sent, which was听immediately听leaked, was remarkable in that it included no data backing up his claims.听And this is a really tricky area, when I’ve talked to scientists at the agency who focus on these issues.听I think sometimes听it’s听hard to say that there are cases that are very subjective, and so this is a discussion that needs to be handled delicately,听and听it’s听a听really severe听claim to say that this has killed 10 children. And so, that discussion needs to be shared transparently and听allow for听experts to really weigh in.听

Rovner:听Yeah. Well, another issue听that’s听going to bleed over into January. All听right,听we’re听going to take a quick break.听We will be right back.听

So听in other administration health news, it appears, at least听, that the on-again,听off-again听cuts to medical personnel at the Department of Veterans Affairs are on again. The听Post is reporting that the VA is planning to eliminate up to 35,000 doctors, nurses, and support personnel.听That’s听on top of a cut of 30,000 people earlier in 2025. Altogether,听it’s听about a 10% cut in total.听Apparently, most听of the positions are currently unfilled, but that听doesn’t听mean that听they’re听unneeded, particularly after Congress dramatically expanded听the听number of veterans eligible for health benefits by passing the PACT Act during the Biden听administration.听That’s听the bill that allowed people to claim benefits if they were exposed to toxic burn pits. What is this second round of cuts going to mean for veterans’听ability to get听timely听care from the VA? Nothing good, I imagine.听

Luhby:听Well,听I’ve听been speaking over the past year or two听to听a VA medical staffer,听who wishes to remain anonymous for obvious reasons.听And one thing they told me is that their boss, who was also a medical practitioner, took one of the retirements, and that they have to now cover their boss’听shift.听And听they’ve听asked if the boss is going to be replaced because they obviously听can’t听do two people’s jobs well, and听they’ve听been told that the boss will not be replaced.听

There’s听also,听on top of all of this,听there’s听a hiring freeze and there’s restrictions in hiring. So,听it’s听been听very difficult听for agencies, including the VA, including听the medical听personnel, to get new people. And again, the person听I’ve听spoken to said that the veterans are not getting the care, as听good care听as they were last year because this person just听can’t听do two people’s jobs. And听it’s听on the medical side, but the source also said that听it’s听throughout the hospital with the support staff and even the custodial staff. I mean, just听鈥μ齮here’s听a lot of unfilled positions that are affecting overall care.听听

Rovner:听I feel like a big irony here is that during the first Trump听administration, improving care at the VA and lowering the wait times was a huge priority for President Trump, not just for the administration. He talked about it all the time. And yet, here听he’s听basically undoing听everything that he did for veterans during the first administration.听

All right. Well, meanwhile,听听that the FDA is considering rolling back the rule that requires dietary supplement makers to note on their labels that their products have not been reviewed by FDA for safety and efficacy. This was a compromise reached by Congress after a gigantic fight over supplements in 1994听鈥斕齀 still have scars from that fight听鈥斕齠ollowing a series of illnesses and deaths due to tainted supplements a couple of years before that. The idea was to let supplements continue to be sold without direct FDA approval,听as long as听customers were informed that they were not intended to听“diagnose, treat, cure, or prevent any disease,”听a phrase that听I’m听sure听you’ve听heard many times in commercials. Of course, diet supplements are听practically an听article of faith for followers of the听“Make America Healthy Again”听movement. I would assume that this is part of RFK Jr.’s vow to loosen what he has called the听“aggressive suppression”听of vitamins and dietary supplements. Lizzy,听you’re听nodding.听

Lawrence:听Yeah, this is super interesting because this was one of the first things a year ago,听when听RFK was announced as the HHS听secretary, when people were听speculating听on what some of his priorities would be, deregulating supplements was a big one.听And so, I think this will be a really interesting space to watch and see.听And听it’s听emblematic,听too,听of the uneven view of products regulated by the FDA,听where there are some products where there’s听鈥μ齮hat RFK and other leaders at the FDA are super听“pro”听and听well, we听don’t听actually need听as much evidence here. And then others, like vaccines or SSRIs听[selective serotonin reuptake inhibitors], where听it seems that they听want to really raise evidence standards, which is not how the FDA is supposed to work.听It’s听supposed to be听dispassionately, with no bias, reviewing medical products.听

Rovner:听And I would point out, in case I听wasn’t听clear before, that supplements are barely regulated now. Supplements are regulated so much less than most everything else that the FDA regulates. Sorry, Alice, you wanted to say something.听

Ollstein:听Yeah. It also, I think, reveals an interesting public perception issue, where the message that a lot of people are getting is that the pharmaceutical industry is this big, bad, evil corporate thing that is out to harm you, and it has all these documented harms, whereas supplements are natural and wellness and seen as the underdog and the upstart. And I think people should remember that supplements are a huge corporate industry as well, and,听like Julie and Lizzy have been saying, regulated a lot less than pharmaceuticals. So, if听you’re听taking a prescription drug,听it’s听been tested a lot more than if听you’re听taking a supplement.听

Rovner:听Yeah, absolutely. So while most of the coverage of HHS in 2025 has been pretty critical, this week, two of our fellow podcast panelists,听Joanne Kenen听and听Paige Winfield Cunningham, have stories on how the breakout star at HHS in this first year of Trump 2.0 turns out to be Dr. Oz. Apparently being an Ivy League-trained heart surgeon with an MBA actually does give you some qualifications to run the agency that oversees Medicare, Medicaid, the Children’s Health Insurance Program, and the Affordable听Care Act.听I think I听noted way back during his confirmation hearings that he clearly already had the knack of how to deal with Congress:听flatter them and take their parochial concerns seriously.听That’s something that his boss, RFK Jr., has most certainly not mastered as of yet.听And it turns out that Dr. Oz has both leadership and policy chops. Who could have predicted this going into this year?听

Luhby:听Well, one thing听that’s听interesting is that we were all, I think, watching what Dr. Oz would do with Medicare and Medicare Advantage, because听it’s听obviously something that he had promoted on his shows.听It’s听something that the Biden听administration was trying to crack down on. And it has been interesting that he has not been giving carte blanche to the insurers. He has been cracking down on them as well. I listened to a speech that he gave before the Better Medicare Alliance, which is the group that works with Medicare Advantage insurers. And he听said basically,听“You guys have to step up,”听and so,听it’ll听be interesting to听see going forward听what听additional听measures they take. But听yeah,听he’s听certainly not bending over to the insurers.听

Rovner:听Yeah. I will say, like I said, I noticed from the beginning, from when he came to his confirmation hearing,听that somebody had briefed him well.听Apparently, according, I think听,听he’s听been talking regularly to his predecessors from both parties about how to run the agency, which surprised me a little bit. I will be interested to see how this all progresses, but if you had asked me to bet at the beginning of the year of the important people at HHS who were running these agencies who would do the consensus best job, I’m not sure I would’ve had Dr. Oz at the top of my list.听

Luhby:听Well, and one thing to also point out that was听, particularly,听is that what听we’ve听been hearing at other agencies听鈥斕齮he CDC, and across the Trump听administration听鈥斕齮hat a lot of the political appointees are really at odds with the staff.听They’re听not communicating with the staff;听there were concerns about that after the CDC shooting over the summer. And one thing that,听obviously,听Dr. Oz is very听personable,听he knows how to reach out to an audience. And in this case, his audience is also his staff. And it was notable that Paige听detailed about听how he really is interacting a lot with the staff. And听I’m听sure听that’s听obviously helping morale and helping the mission at CMS. Also, of course,听it’s听an agency that RFK has not focused on.听

Rovner:听I say, what a shock, treating career staff with some respect,听like they know what听they’re听doing.听

All right. Well, finally, we end this year on reproductive health,听pretty much the听same way we began it, with anti-abortion groups attacking the abortion pill, mifepristone. We know that despite the fact that abortion is now illegal in roughly half the states, the number of abortions overall has not fallen, and that is because of the easy availability,听even across state lines,听of听medication听abortion. Alice,听you’ve听got quite the story this week about an unusual way to go after the pill. Tell us about it.听

Ollstein:听Yeah.听So听this is a听trend听I’ve听been covering听for the last few years, and听it’s听anti-abortion groups听trying听to use various environmental laws to achieve the ban on the pills that they want to achieve. And so,听there’s听been some various iterations of this over the years. The latest one is that groups are jumping on听a听EPA听[Environmental Protection Agency]听public comment process听that’s听going to kick off any day now. So, this is what the EPA does. Every few years, they update the list of chemicals that need to be tracked in water around the country.听So听this听is a big deal.听It costs a lot to track these chemicals.听There听can only be so many chemicals on the list. And these groups are trying to rally people around the country to demand that the EPA add mifepristone and its components to this list.听

Rovner:听This is wastewater, right? Not drinking water?听

Ollstein:听No, this is drinking water.听

Rovner:听Oh, it is drinking water.听

Ollstein:听There are other efforts to use wastewater laws to restrict abortion pills, yes.听So听we talked to scientists that say there is no evidence that mifepristone in the water supply is causing any harm whatsoever. On the other hand, there is tons of evidence of other chemicals, and so we have听听talking about how if they put mifepristone on this list, it would push out another more dangerous chemical from being on that list.听

So, just to zoom out a little bit, while this听particular campaign听tactic, whatever you want to call it, may not succeed, I think听it’s听part of a bigger project to sow doubt in the public’s mind about the safety of mifepristone in听various ways.听We’ve听been seeing this all year, and for several years. But I think that this kind of gross-out factor of听there’s听abortions in the water!听Even without scientific evidence of that,听I think it听contributes to听the public听perception. And 麻豆女优 had some polling recently showing that doubt about the safety of the pills has increased over the past few years. And so, these kinds of campaigns are working in the court of public opinion, if听not quite yet听at federal agencies.听

Rovner:听Another one we will be watching. All right, that is this week’s news. Now听we’ll听play my听“Bill of the Month”听interview with Tony Leys, and then听we’ll听come back and do our听very special听year-end extra credits.听

I am pleased to welcome back to the podcast 麻豆女优 Health News’听Tony Leys, who reported and wrote the latest 麻豆女优 Health News听“Bill of the听Month.”听Tony, welcome back.听

Tony Leys:听Thanks for having me, Julie.听

Rovner:听So, this month’s patient had听a very expensive听ambulance ride, alas, a story听we’ve听heard as part of this series several times. Tell us who he is and what prompted the need for an ambulance.听

Leys:听He is Darragh Yoder, a toddler from rural Ohio. He had a bacterial skin infection called听[staphylococcal]听scalded skin syndrome, which causes blisters and swelling. His mom, Elisabeth, took him to their local ER,听where doctors said he needed to be taken by ambulance to a children’s hospital in Dayton,听about 40 miles away. They put in an IV and then put him in the ambulance. His mom went听with听and said the driver听didn’t听go particularly fast or use the听siren, but听did get them there in about 40 minutes.听

Rovner:听But it听still was听an ambulance ride. So, how big was the bill?听

Leys:听$9,250.听

Rovner:听Whoa. Now, this family听doesn’t听have insurance, which听we’ll听talk about in a minute. So, it听wasn’t听an in-听or听out-of-network听thing. Was this unreasonably high compared to other ground ambulance rides of this type?听

Leys:听It’s really hard to say because the charges can be all over the place,听is听what national experts told me. But if Darragh had been on Medicaid, the ambulance company听would’ve听been paid about $610, instead of听$9,200.听

Rovner:听Whoa. So, what eventually happened with the bill?听

Leys:听The company agreed to reduce听it听about 40% to听$5,600 if the family would pay it in one lump sum. They听did,听they wound up putting it on a credit card, a no-interest credit card,听so they could pay it off overtime.听

Rovner:听Now, as we mentioned, this family听doesn’t听have insurance, but they belong to something called a听health听sharing听ministry. What is that?听

Leys:听Members pool their money together and basically agree to help each other pay bills. And they were thinking that that would cover听maybe about听three-quarters of what they owed, so听鈥μ�

Rovner:听Have they heard about that yet?听

Leys:听I have not heard.听

Rovner:听OK. So,听what’s听the takeaway here? I imagine if a doctor says your kid who has an IV attached needs to travel to another facility in an ambulance, you听shouldn’t听just bundle them into your car instead, right?听

Leys:听I sure听wouldn’t.听Yeah, no. I mean, at that point,听she felt like she had no choice. I mean, she did say if she听would’ve听just driven straight to the children’s hospital instead of stopping at the local hospital, they听would’ve听gotten there sooner than if once she stopped at the local hospital and they ordered an ambulance. So,听that’s听in retrospect what she wishes she听would’ve听done. But if听they’d听had insurance, the insurer听would’ve听presumably negotiated听a lower rate,听and they听wouldn’t听have had to do the negotiation themselves.听

Rovner:听So, they are paying this off, basically?听

Leys:听Yeah, they paid it in one lump sum, which is a stretch for them, but they felt like they had no choice.听

Rovner:听All right. Tony Leys, thank you very much.听

Leys:听Thanks for having me, Julie.听

Rovner:听OK,听we’re听back.听It’s听time for our听extra-credit听segment.听That’s听usually where we each recognize a story we read this听week听we think you should read too. But since this is our last podcast of the year, I wanted to do something a little bit different.听I’ve听asked each of our panelists to take a minute or two to听talk about what they see, not necessarily as the biggest single health story of the year, but the most important theme that听we’ll听remember 2025 for. Tami, why don’t you start us off?听

Luhby:听OK. Well, I think that Medicaid has been a big issue in 2025 and will continue to be going forward. Among the most consequential health policies enacted this year were the sweeping Medicaid changes contained in the One Big Beautiful Bill听[Act], which Congress passed over the summer. The legislation enacts historic cuts to听[the]听nation’s safety net,听with the biggest chunk coming from Medicaid, which serves low-income Americans. It would slash more than听$900 billion听from Medicaid, according to the Congressional Budget Office. About 7.5 million more people would be uninsured in 2034 due to these Medicaid provisions. And most of that spike would come from听Congress听adding work requirements to Medicaid for the first time. We know that that happened in 2018, states were trying to do听鈥μ齱ell, the Trump听administration allowed certain states to do that. It really only took effect in Arkansas, and about听18,000 people听lost coverage within months from the work requirements, many of whom,听the advocates say,听many people are听working,听they’re going to get caught up in red tape.听They’re听either working or听they’re听eligible for exemptions, but听they’ll听get caught up in red tape.听

So, what the Big Beautiful Bill requires is in states that have expanded Medicaid, working-age adults without disabilities or听[dependent]听children under age 14 would have to work, volunteer, or attend school or job training programs at least听80 hours听a month to remain eligible, unless they qualify for another exemption,听such as being medically frail or having substance abuse disorder. The package also limits immigrants’听eligibility for Medicaid, requires enrollees to pay some costs, and caps state and local government provider taxes, which is a key funding source for听states听and which will have ripple effects across hospitals and across states in general.听

Now,听what’s听important to note听is,听most of these provisions听haven’t听taken effect yet.听Most of them actually take effect after the midterm elections next year.听So,听they’ll听be rolling out in coming听years听and the full impact is yet to come.听

Rovner:听Alice.听

Ollstein:听So, I have chosen the resurgence of infectious diseases that we are seeing right now.听I think measles听is听really the canary in the coal mine.听Because听it’s听so infectious,听that’s听what’s听showing up first, but听it’s听not going to be the last infectious disease that the country had almost squashed out of existence that is now, as I said, resurging. And so,听I think that a lot of different policies and trends听are feeding into this. And听I think we听have the rollback of vaccine requirements at the state level, at the federal level. We have policies that deter people from seeking out testing and treatment, especially some of these anti-immigrant policies that听we’re听seeing. And then just cuts to public health and public health staff, cuts to surveillance, so听it’s听just harder to know where the outbreaks are happening and how bad they are.听It’s听hard to get reliable data on that. And听so听I think, yes,听we’re听seeing measles first, but now we are starting to see whooping听cough,听we’re听starting to see some other things, and听it’s听really troubling,听and it could have a political impact too.听

I have talked to a bunch of candidates who are running in next year’s midterms who say that they’re able to point to outbreaks right there in their state to say,听“This is the consequence of Republican health听policies, and this is why you should vote for me.”听So, I听would be keeping听an eye on that in the coming year.听

Rovner:听Lizzy.听

Lawrence:听So, my chosen theme is the politicization of science. And my focus has been on the FDA as an FDA beat reporter, but听there’s听been the politicization of science in every agency. And this is something that used to be听pretty taboo, right? I keep thinking these days about the听[Barack]听Obama HHS听secretary,听Kathleen Sebelius,听and the legal and political repercussions she faced when she vetoed an FDA decision to make听Plan B听over-the-counter. And those days seem听very far听away, because now听we’re听seeing at听the FDA speedier drug reviews being used as a bargaining chip in deals between the White House and companies in exchange for companies lowering their prices.听

At the FDA and CDC,听you’re听seeing skeptics or more political officials completely taking over operations, reopening debates on things like vaccines, antidepressants during pregnancy, RSV, monoclonal antibodies, based on thin or even听really no听or debunked evidence.听

You’re听seeing the White House just today use CMS to pull funding from hospitals that perform gender-affirming surgeries.听You’re听seeing NIH听[the National Institutes of Health]听pull funding from research studies that go against Trump听administration ideology.听So, there’s really so many examples, too many to count, of political leaders wielding in power and trying to shape science to fit their agendas in the way that they see the world.听

And then听I’d听say that has a trickle-down effect听to听the way that everyday people think about science,听and it calls everything into question and makes听鈥μ齈eople look to politicians and to the heads of public health agencies to tell them the truth. I mean,听maybe not听politicians, but听it seems that doctors and medical experts’听voices听are increasingly being drowned out by the political re-litigating of science that has been settled for a long time. So,听I think this听is听a very important听topic and one that听I’ll听keep watching听closely in the听next year.听

Rovner:听Yep.听So听my topic builds on Lizzy’s.听It’s听how this administration is using a combination of personnel and funding cuts and new regulations to jeopardize the future of the scientific and health听care workforce well into the future. The administration has frozen or听terminated听literally billions听of dollars in grants from the National Institutes of Health and the National Science Foundation, not just causing the shutdown of many labs, but making students who are pursuing research careers rethink their plans, including those who are well into their graduate studies. Some are even going to other countries, which are happily poaching some of our best and brightest.听

And as听we’ve听talked about so many times before in this year’s podcast, the administration also seems intent on听basically choking听off the future health听care workforce. The big budget bill includes caps on how much medical students can borrow听in听federal loans.听That’s听an effort to get medical schools to lower their tuition, but most observers think听that’s听unlikely to happen. The听Education听Department has decreed that those studying to be nurses, physician assistants, public health workers, and physical therapists are not pursuing a听“profession,”听thus also limiting how much they can borrow. And a new $100,000 visa fee听is going to make it even more difficult for hospitals and clinics, particularly those in rural areas, to hire doctors and nurses from outside the U.S., at a time when international medical workers are听literally the听only ones working in many shortage areas. These are all changes that are going to have ramifications, not just for years, but potentially for generations. So, these are all themes that we will continue to watch in听2026.听

OK, that is this week’s show and our last episode for 2025. Thank you to all of you listeners for coming with us on this wild news ride. As always, thanks to our editor, Emmarie Huetteman, and this week’s producer-engineer, Taylor Cook. A reminder:听What the Health?听is now available on WAMU platforms, the NPR app, and wherever you get your podcasts, as well as,听of course, kffhealthnews.org. Also, as always, you can email us your comments or questions.听We’re听at听whatthehealth@kff.org, or you can still find me on X听, or on Bluesky听. Where are听you guys听hanging these days, Alice?听

Ollstein:听Mostly on Bluesky听, and still on X听.听

Rovner:听Tami.听

Luhby:听You could find me at听.听

Rovner:听Lizzy.听

Lawrence:听You can find me at听, on LinkedIn at听, on X听, and on听听鈥斕齛nd I forget my username, but听I’m听somewhere there.听

Rovner:听Don’t听worry about it.听OK, we will be back in your feed in January. Until then, be healthy.听

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“Tenía 18 años, estaba sana, en la universidad”, contó. “Y de repente tenía una enfermedad crónica de la que ni siquiera sabía”.

Wang nació en Florida en 1975, antes de que se aplicara de manera rutinaria la vacuna contra la hepatitis B a los recién nacidos.

Durante años, supuso que se había contagiado por su madre, pero más adelante descubrió que sus padres no tenían el virus. “Resulta que probablemente fueron mis abuelos, quienes me cuidaron después de nacer, quienes me lo transmitieron”, dijo.

“Así de fácil se contagia este virus: no por algún factor de riesgo exótico, sino en el entorno familiar”, agregó.

Hoy, Wang es directora médica de los programas de hepatitis viral en RWJBarnabas Health en Nueva Jersey. Su historia está en el centro de un punto de inflexión histórico en la salud pública.

El 5 de diciembre, el Comité Asesor sobre Prácticas de Vacunación (ACIP, por sus siglas en inglés) de los Centros para el Control y Prevención de Enfermedades (CDC, por sus siglas en inglés) votó para poner fin a la recomendación universal de aplicar la vacuna contra la hepatitis B a los recién nacidos, adoptando en su lugar una política basada en decisiones individuales.

Con este nuevo enfoque, solo los bebés cuyas madres den positivo para la hepatitis B recibirán automáticamente una dosis de la vacuna y anticuerpos contra el virus poco después de nacer. En los demás casos, si los padres deciden vacunar, la primera dosis se puede postergar hasta los 2 meses de edad.

Todos los miembros del comité fueron nombrados por el secretario de Salud y Servicios Humanos, Robert F. Kennedy Jr., un conocido activista antivacunas.

En una votación de 8-3, el panel decidió que, dado que la mayoría de las mujeres embarazadas actualmente se someten a pruebas para detectar hepatitis B, la aplicación de la vacuna al nacer debería reservarse para los bebés cuyas madres den positivo.

Los miembros del panel presentaron el cambio como una forma de reducir intervenciones innecesarias, alinear la vacunación con los resultados de las pruebas y darles a los padres más control sobre el momento de la aplicación.

Quienes apoyaron la decisión la describieron como una medida que promueve la elección de los padres, más que como un reflejo de un cambio en la epidemiología.

Pero para muchos profesionales clínicos y epidemiólogos, este cambio representa un retroceso peligroso que podría revertir tres décadas de avances hacia la eliminación de una enfermedad que aún infecta a unos 2,4 millones de personas en el país y que provoca decenas de miles de muertes cada año.

Perciben ecos de los años 80, cuando un enfoque basado en factores de riesgo dejó a generaciones sin protección, y temen que el país esté por repetir ese error.

Además, la decisión del panel sobre la hepatitis podría ser uno de varios cambios que podrían desestabilizar el calendario nacional de vacunación infantil, una piedra angular de la salud pública.

“No están tratando de cambiar una sola vacuna”, dijo Angela Rasmussen, viróloga y editora de la revista científica Vaccine. “Están tratando de desmantelar la manera en que se establece la política de vacunación”.

La vocera del Departamento de Salud y Servicios Humanos, Emily Hilliard, respondió: “El ACIP revisa toda la evidencia presentada y emite recomendaciones basadas en pruebas y buen juicio, con el fin de proteger de la mejor manera posible a los niños en Estados Unidos”.

Los autores de del Vaccine Integrity Project, que evaluó más de 400 estudios e informes, advirtieron en que retrasar la dosis al nacer “reduciría la protección de los bebés y aumentaría el riesgo de infecciones evitables por el virus de la hepatitis B (VHB), lesionando décadas de avances” hacia su eliminación.

La revisión fue dirigida por investigadores del Centro de Investigación y Políticas de Enfermedades Infecciosas de la Universidad de Minnesota, que creó el Vaccine Integrity Project en respuesta a lo que considera acciones del gobierno de Trump que “ el panorama federal de vacunación”.

La revisión fue evaluada por expertos externos.

“Luchamos mucho para lograr esa dosis universal al nacer”, dijo Wang. “Sabemos lo que pasa cuando uno espera”.

El debate gira en torno a algunas preguntas clave: si las pruebas son lo suficientemente confiables como para reemplazar las protecciones universales, qué tan contagiosa es realmente la hepatitis B, por qué fracasaron las estrategias del pasado y qué significan los cambios internos en los CDC para la política de vacunación en general.

Los límites de las pruebas

Las pruebas de hepatitis B están en el centro de la nueva recomendación del ACIP, pero incluso los CDC reconocen que las pruebas por sí solas no garantizan protección.

Las mujeres embarazadas pueden dar negativo si contraen el virus al final del embarazo o durante el “período de ventana”, antes de que los antígenos de la hepatitis B sean detectables. También hay falsos negativos. Ningún sistema de pruebas, por bien diseñado que esté, puede detectar todas las infecciones.

Por eso se creó la vacunación universal.

Si se desconoce el estado de la madre en el momento del parto, los hospitales deben aplicar la vacuna al bebé dentro de las 12 horas y agregar anticuerpos contra la hepatitis B en el caso de los bebés prematuros o si la madre da positivo más tarde. Pero en la práctica clínica real, estas medidas de seguridad suelen fallar. Los resultados tardan en llegar. Algunas enfermeras omiten o interpretan mal los análisis. Las farmacias retrasan las entregas. Se pierde la documentación.

“Cada paso adicional aumenta la posibilidad de que algo se pase por alto”, dijo Wang. “Retrasar la vacuna simplemente agrega otro paso”.

La votación del ACIP demuestra cómo se está cuestionando esa lógica.

Algunos miembros del comité sugirieron eliminar la tercera dosis de la vacuna si los niveles de anticuerpos se ven elevados después de la segunda.

Pero Brian McMahon, especialista en enfermedades hepáticas que ha tratado hepatitis B durante décadas, dijo al panel que los datos no respaldan esa idea. “Solo entre el 20% y el 30% de los bebés presentan niveles adecuados de anticuerpos después de la primera dosis”, señaló.

“Se necesitan dos dosis para lograr una protección alta”, dijo, y agregó que la tercera proporciona una respuesta más fuerte y duradera.

McMahon dijo que el mensaje general del comité parecía estar orientado a “desalentar la dosis al nacer”.

“Están poniendo cada vez más trabas”, dijo McMahon.

En una segunda votación, el ACIP también alentó a los padres y profesionales a solicitar pruebas serológicas después de la segunda o tercera dosis 鈥攁nálisis de sangre que miden los niveles de anticuerpos protectores鈥�. Según el comité, estas pruebas deberían estar cubiertas por el seguro médico.

Más contagiosa que el VIH o la hepatitis C

El virus de la hepatitis B puede sobrevivir hasta una semana en cepillos de dientes, rasuradoras y superficies del hogar. Se transmite no solo de madre a hijo, sino también mediante el contacto familiar cotidiano: objetos compartidos, heridas abiertas, pequeñas exposiciones a sangre. En los años 80, investigadores descubrieron que cerca de la mitad de las infecciones en niños estadounidenses no provenían de la madre, sino de otros miembros del hogar.

Por eso, los departamentos de salud estatales siguen insistiendo en que se vacune a todos los recién nacidos dentro de las primeras 24 horas, sin importar el estado de salud de la madre.

“Retrasar la vacunación implica perder un período clave de posible exposición”, advirtió . La vacuna, señaló, tiene una efectividad de entre 80% y 100% cuando se aplica a tiempo.

El informe del Vaccine Integrity Project destaca lo que está en juego. Desde que se introdujo la dosis universal al nacer en 1991, las infecciones pediátricas por hepatitis B en Estados Unidos han disminuido más del 99%.

Un de 2024 estimó que el calendario actual ha prevenido más de 6 millones de infecciones por hepatitis B y cerca de 1 millón de hospitalizaciones.

Los beneficios duran toda la vida. Los bebés vacunados al nacer están protegidos no solo de la hepatitis B, sino también de la insuficiencia hepática y el cáncer que puede causar décadas más tarde.

Sin embargo, como la enfermedad avanza lentamente, las consecuencias de los cambios en la política podrían tardar 20 o 30 años en manifestarse.

Trieu Pham, médico de California, no necesita imaginar esas consecuencias. Nacido en Vietnam en 1976, probablemente contrajo el virus al nacer. “Si la vacuna hubiera existido entonces, no habría pasado por todo lo que pasé”, dijo. Le diagnosticaron hepatitis B en sus 20, desarrolló cirrosis a los 40. A los 47, tosía sangre por la ruptura de venas esofágicas. Finalmente, necesitó un trasplante de hígado para sobrevivir.

“Uno vive con un cansancio constante y con miedo”, contó. “Y lo más triste es que era prevenible”.

Sus tres hijos, vacunados a las pocas horas de nacer, no tienen hepatitis B. “Esa es la diferencia que puede hacer un solo día”, dijo Pham.

Una lección aprendida

En 1982, el ACIP recomendó la nueva vacuna contra la hepatitis B solo para adultos con alto riesgo: trabajadores de salud, personas que usan drogas inyectables y hombres que tienen relaciones sexuales con hombres.

Pero a finales de los años 80, quedó claro que la vacunación basada en factores de riesgo no lograba contener la transmisión. Muchos adultos recién infectados no pertenecían a los grupos definidos como de alto riesgo. Identificarlos resultó imperfecto, estigmatizante y, al final, ineficaz.

Mientras tanto, los bebés infectados durante o poco después del parto tenían de desarrollar infección crónica, en comparación con menos del . Sin embargo, las autoridades de salud pública repitieron la misma estrategia focalizada, esta vez con recién nacidos.

En 1988, los CDC recomendaron pruebas prenatales universales y vincularon la vacunación del bebé al resultado de la madre, basando de nuevo la protección en un marcador de riesgo en lugar de vacunar a todos los bebés.

Como antes, la estrategia fracasó.

Muchas madres infectadas no fueron identificadas correctamente. Algunas no se hicieron la prueba, otras la hicieron demasiado temprano, y hubo casos en que los resultados se interpretaron mal o nunca se comunicaron. Demasiados bebés quedaron sin protección, una prueba más de que el enfoque dirigido no era confiable.

En 1991, los CDC emitieron una guía histórica que recomendaba vacunar a todos los recién nacidos, sin importar el estado de infección de la madre, y aplicar dos dosis adicionales durante la infancia.

Para 2005, la política estaba completamente integrada en el calendario de vacunación rutinaria y fue ratificada nuevamente en 2018.

Esta evolución se basó en datos que demostraban que una estrategia universal era más efectiva para prevenir infecciones que una basada en riesgos.

Una cuestión de confianza

La nueva política sobre la hepatitis B de los CDC parte del supuesto de que trasladar la decisión a los padres fortalecerá la confianza en el sistema de vacunación. Quienes la apoyan la presentan como un cambio que empodera, una manera de darles más control a las familias.

En 1999, cuando se recomendó por última vez postergar la primera dosis de la vacuna contra la hepatitis B en bebés cuyas madres no estaban infectadas, las tasas de vacunación entre los bebés de madres que sí lo estaban.

“Las políticas de consentimiento suenan centradas en el paciente, pero en la práctica no son equitativas. Dejan fuera justamente a las familias que más necesitan protección”, dijo Wang. Es decir, a aquellas que probablemente no acceden a atención prenatal ni a pruebas, que tienen infecciones no detectadas o adquiridas después de las pruebas, así como a bebés que pueden estar expuestos a cuidadores u otros miembros del hogar.

Con frecuencia, se trata de familias inmigrantes, incluyendo comunidades asiáticas y de las islas del Pacífico, donde la hepatitis B sigue siendo endémica. “Ya diagnosticamos y tratamos poco a estas poblaciones”, dijo Wang. “Este cambio solo profundizaría esa brecha”.

Estados Unidos es ahora el único país que ha abandonado la recomendación de una dosis universal al nacer contra la hepatitis B. Aunque tomará décadas reunir datos sobre los resultados, predicen que retrasar la primera dosis hasta los 2 meses podría resultar en más de 1.400 infecciones evitables y unos 300 casos de cáncer de hígado por año.

“No elegimos lo que heredamos”, dijo Wang. “Pero sí podemos elegir lo que dejamos a las próximas generaciones”.

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“I was 18, healthy, in college,” she said. “And suddenly I had a chronic illness I didn’t even know about.”

Born in Florida in 1975, Wang grew up before the hepatitis B vaccine was routinely given to newborns. For years, she assumed she had been infected by her mother, only to discover later that both her parents were negative. “It turns out my grandparents, who cared for me after birth, probably passed it to me,” she said. “That’s how easy this virus spreads 鈥� not from some exotic risk factor, just family.”

Today, Wang is the medical director for viral hepatitis programs at RWJBarnabas Health in New Jersey. Her story now sits at the center of a historic turning point in public health.

On Dec. 5, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted to end the universal U.S. recommendation for the newborn dose of the hepatitis B vaccine, instead adopting a policy urging individual-based decision-making.

Under the new approach, only infants born to mothers who test positive for hepatitis B will automatically receive a dose of the vaccine and hepatitis B antibodies shortly after birth. For everyone else, if the parents choose to vaccinate, the birth dose can be delayed until 2 months of age.

All the committee members were appointed by Health and Human Services Secretary Robert F. Kennedy Jr., a longtime anti-vaccine activist. In an 8-to-3 vote, the panel decided that since most pregnant women now receive hepatitis B testing, administering the vaccine at birth should be reserved for infants whose mothers test positive. They framed the shift as a way to reduce interventions deemed unnecessary, align vaccination with test results, and give parents more control over timing. Supporters of the decision described it as a move toward parental choice rather than a reflection of changing epidemiology.

But to many clinicians and epidemiologists, the change represents a dangerous rollback that could reverse three decades of progress toward eliminating a disease that still infects as many as 2.4 million Americans and kills tens of thousands each year. They see echoes of the 1980s, when risk-based vaccination left entire generations unprotected, and worry the country is about to repeat that mistake.

Moreover, the panel’s move on hepatitis B 鈥� in the face of overwhelming data that shows the birth dose is effective and safe 鈥� portends further upheaval for the nation’s childhood vaccine schedule, a cornerstone of public health.

“They’re not just trying to change one vaccine,” said Angela Rasmussen, a virologist and an editor of the scientific journal Vaccine. “They’re trying to dismantle how vaccine policy is made.”听

Department of Health and Human Services spokesperson Emily Hilliard responded: “ACIP reviews all evidence presented and issues recommendations based on evidence and sound judgment to best protect America’s children.”

The authors of a by the Vaccine Integrity Project, which evaluated more than 400 studies and reports, warned in a that delaying the birth dose “would reduce protection for infants and increase the risk of avoidable HBV infections, undermining decades of progress” toward eliminating the hepatitis B virus. The review was led by researchers at the University of Minnesota’s Center for Infectious Disease Research and Policy, which created the Vaccine Integrity Project in response to what it regards as Trump administration actions that “,” and it was vetted by outside experts.

“We fought hard for that universal birth dose because targeted approaches missed too many babies,” Wang said. “We know what happens when you wait.”

What’s unfolding now is not just a technical policy update but a fundamental test of the systems meant to protect the most vulnerable. The debate turns on a few critical questions 鈥� whether testing is reliable enough to replace universal safeguards, how infectious hepatitis B truly is, why past strategies failed, and what the CDC’s internal shake-ups mean for vaccine policy writ large.

The Limits of Testing

Hepatitis B testing sits at the center of the new ACIP recommendation, but even the CDC acknowledges that testing alone can’t guarantee protection. Pregnant women may test negative if the virus was acquired late in pregnancy or during the “window period,” before hepatitis B surface antigens become detectable. False negatives happen. No testing system, no matter how well designed, can catch every infection. That’s why universal vaccination was created in the first place.

If a mother’s status is unknown at delivery, hospitals are supposed to give the newborn a hepatitis B vaccine within 12 hours, adding hepatitis B antibodies for premature infants or if the mother later tests positive. But in real clinical settings, these safeguards routinely break down. Results take time. Nurses miss or misread labs. Pharmacies delay deliveries. Documentation gets lost.

“Every step you add increases the chance that something falls through the cracks,” Wang said. “Delaying the vaccine just adds another.”

ACIP’s vote shows how that logic is being challenged.

Some committee members suggested dropping the third hepatitis B shot if antibody levels look high after the second.听

But Brian McMahon, a liver disease specialist who has spent decades treating hepatitis B, told the panelists that the data doesn’t support that idea. “Only maybe 20% to 30%” of infants have an adequate antibody level after the first dose, he said.

“You need two doses to really reach a high level of protection,” he said, with the third shot giving a stronger, longer-lasting response.

He said the overall message coming from the committee seemed designed to “discourage the birth dose.”

“They’re making it more and more difficult,” McMahon said.

In a second vote, ACIP also encouraged parents and clinicians to order post-vaccine serology tests 鈥� blood tests that measure protective antibody levels 鈥� after the second or third dose. The tests, ACIP said, should be covered by insurance.

More Infectious Than HIV or Hepatitis C

Hepatitis B can survive on toothbrushes, razors, and household surfaces for a week. It spreads not just from mother to child but also through ordinary family contact: shared items, open sores, small blood exposures. In the 1980s, researchers found that about half of infections in American children came not from mothers but from other household members.

That’s why state health departments continue to insist that every newborn be vaccinated within 24 hours of delivery, regardless of maternal status. “Delaying vaccination misses a crucial period of potential exposure,” warned this year. The vaccine, it noted, is 80% to 100% effective when given on time.

The Vaccine Integrity Project report underscores the stakes. Since the universal birth dose was introduced in 1991, pediatric hepatitis B infections in the U.S. have dropped by more than 99%. A estimated that the current schedule has prevented more than 6 million hepatitis B infections and nearly 1 million hospitalizations.

The benefits are lifelong. Infants vaccinated at birth are shielded not just from hepatitis B but also from the liver failure and cancer it can cause decades later. Yet because the disease unfolds slowly, the consequences of policy shifts may not surface for 20 or 30 years.

Trieu Pham, a California physician, doesn’t need to imagine those consequences. Born in Vietnam in 1976, he probably contracted the virus at birth. “If the vaccine had existed then, I wouldn’t have gone through what I did,” he said. Diagnosed in his 20s, he developed cirrhosis by 40. At 47, he was coughing blood from ruptured esophageal veins. Eventually, he required a liver transplant to survive.

“You live with this constant fatigue and fear,” he said. “And the saddest part is it was preventable.”

His three children, all vaccinated within hours of birth, are free of hepatitis B. “That’s the difference a day can make,” Pham said.

A Lesson Already Learned

In 1982, ACIP recommended the new hepatitis B vaccine only for adults at high risk: health care workers, injection drug users, and men who have sex with men. But by the late 1980s, it was clear that risk-based vaccination couldn’t contain transmission. Many newly infected adults didn’t fit any defined risk group. Identifying high-risk people proved imperfect, stigmatizing, and ultimately ineffective.

Meanwhile, infants infected during or shortly after birth had a of developing chronic infection, compared with in adults. Yet public health officials repeated the same targeted strategy, this time with newborns. In 1988, the CDC recommended universal prenatal screening and linked an infant’s vaccination to the mother’s test result, again basing protection on a risk marker instead of vaccinating all infants.

As before, it failed. Many infected mothers weren’t correctly identified. Some were never tested, some were tested too early, and others had results that were misread or never communicated. Too many infants slipped through the cracks, proof that another targeted approach couldn’t reliably protect them.

In 1991, the CDC issued its landmark guidance recommending that all infants, regardless of their mother’s infection status, receive a hepatitis B vaccine at birth, followed by two additional doses in infancy. By 2005, the policy was fully embedded in the routine immunization schedule, then reaffirmed in 2018. This evolution was based on data showing that a universal strategy, rather than a targeted one, was the most effective in preventing infections.

A Matter of Trust

The CDC’s new hepatitis B policy rests on the premise that moving the decision to parents will strengthen trust in the vaccine system. Supporters frame it as an empowerment shift 鈥� a way to give families more control.

In 1999, when it was last recommended to postpone the first dose of hepatitis B vaccine for infants born to uninfected mothers, vaccination rates among infants born to those who were infected.

“Opt-in policies sound patient-centered,” Wang said, “but in practice they’re inequitable. They leave behind the very families who need protection most” 鈥� the ones most likely to miss prenatal care and testing, have infections that go undetected or arise after testing, or slip through gaps in hospital care, as well as infants who can be exposed and infected by other caregivers and household members.

Those are often immigrant families, including from Asian and Pacific Islander communities in which hepatitis B remains endemic. “We already underdiagnose and undertreat these populations,” Wang said. “This change would deepen that gap.”

The United States is now the only country to abandon a universal hepatitis B birth dose recommendation. Though it will take decades to gather outcomes data, predict that delaying the first dose of hepatitis B vaccine to 2 months of age could result in over 1,400 preventable infections and about 300 cases of liver cancer per year.

“We don’t get to choose what we inherit,” Wang said. “But we do get to choose what we pass on.”

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Congress is running out of time to avert a huge increase in health care premium payments for millions of Americans who buy insurance through the Affordable Care Act marketplaces. Dec. 15 is the deadline to sign up for coverage that begins Jan. 1, and some consumers are waiting to see whether the credits will be extended, enabling them to afford coverage next year.

Meanwhile, a federal vaccine advisory panel handpicked by Health and Human Services Secretary Robert F. Kennedy Jr. voted last week to end the universal recommendation for a hepatitis B vaccine dose at birth. It’s just the start of what are expected to be major changes in childhood vaccine recommendations overall.

This week’s panelists are Julie Rovner of 麻豆女优 Health News, Anna Edney of Bloomberg News, Maya Goldman of Axios, and Sheryl Gay Stolberg of The New York Times.

Panelists

Among the takeaways from this week’s episode:

• As of Thursday morning, the Senate was preparing to vote on competing health proposals, neither of which was expected to pass: one, from Democrats, that would extend the enhanced ACA premium tax credits and a second, from Republicans, that would instead add money to health savings accounts for some ACA enrollees. With the credits set to expire and time running out to sign up for plans, it is likely that coverage will be unaffordable for some Americans, leaving them uninsured.
• The Advisory Committee on Immunization Practices’ decision to end its recommendation that newborns be immunized against hepatitis B is a major development in the federal government’s shift away from promoting vaccines. While the panel coalesced around the claim that babies are most likely to contract hepatitis B from their mothers, the reality is that the virus can live on household items, posing a threat of chronic disease and death to unvaccinated children.
• In reproductive health news, House Speaker Mike Johnson removed insurance coverage of fertility treatment for service members from the National Defense Authorization Act before the legislation’s passage, and anti-abortion groups are calling for the firing of Food and Drug Administration head Marty Makary over reports he is slow-walking policy changes on medication abortion.

Also this week, Rovner interviews Georgetown University professor Linda Blumberg about what the GOP’s health plans have in common.

Plus, for “extra credit” the panelists suggest health policy stories they read (or wrote) this week that they think you should read, too:听

Julie Rovner: The Washington Post’s “,” by David Ovalle.听听

Anna Edney: Bloomberg News’ “,” by Anna Edney.听听

Sheryl Gay Stolberg: The New York Times’ “,” by Katie J.M. Baker.

Maya Goldman: ProPublica’s “,” by Aliyya Swaby.

Also mentioned in this week’s podcast:

• Politico’s “,” by Alice Miranda Ollstein, Ruth Reader, and Liz Crampton.
• The New York Times’ “,” by Sheryl Gay Stolberg and Christina Jewett.
• Bloomberg News’ “,” by Charles Gorrivan, Riley Griffin, and Rachel Cohrs Zhang.
• The Associated Press’ “,” by Ali Swenson and Nicky Forster.

[Editor’s note:听This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]听

Julie Rovner:听Hello from 麻豆女优 Health News and WAMU Public Radio in Washington, D.C.听Welcome to听What the Health?听I’m听Julie Rovner, chief Washington correspondent for 麻豆女优 Health News, and听I’m听joined by some of the best and smartest health reporters in Washington.听We’re听taping this week on Thursday,听Dec.听11,听at 10听a.m. As always, news happens fast,听and things might have changed by the time you hear this. So here we go. Today, we are joined via video conference by听Anna听Edney听of Bloomberg News.听

Anna听Edney:听Hi,听Julie.听

Rovner:听Maya Goldman of Axios News.听

Goldman:听Great to be here.听

Rovner:听And听I’m听pleased to welcome to the podcast panel my friend and longtime health reporting colleague, Sheryl Gay Stolberg听of听The New York Times. Sheryl, so glad to have you听join听us.听

Stolberg:听I’m听so glad to be here, Julie.听

Rovner:听So,听later in this episode,听we’ll听have my interview with Linda Blumberg of Georgetown University. Linda has spent years analyzing Republican proposals to fix health听care and has some interesting observations to share. But first, this week’s news.听

We will start again with the continuing saga of the expiring enhanced tax credits for the Affordable Care Act.听Starting Jan.听1, millions of people who get their insurance from the Obamacare marketplaces will face huge increases in what they have to pay in premiums.听Some will find those increases so big听they’ll听have no choice but to drop their insurance altogether. And next Monday, Dec.听15,听is the deadline for people to sign up for coverage that starts in January. So,听the Senate is set to vote today on two different options. The first, backed by all the听chamber’s Democrats, calls for a straight,听three-year extension of the enhanced payments that were first implemented in 2021.听Those extra payments made insurance so much more affordable that enrollment听basically doubled听from about听12 million people听in the听marketplaces to about 24 million. That bill,听though,听is unlikely to achieve the 60-vote majority it would need to advance. The Senate is also scheduled to consider a Republican alternative,听sponsored by Finance Committee听Chairman听Mike Crapo of Idaho and Health Committee Chair Bill Cassidy听of Louisiana. It听wouldn’t听extend the enhanced tax credits at all. Instead, it would provide either $1,000 or $1,500 for a tax-preferred health savings account that individuals could听use for听routine health expenses to be coupled with听a high-deductible insurance听policy.听“High-deductible”听meaning听many thousands of dollars.听It’s听not听expected to achieve 60 votes either.听So,听assuming听both of these听plans fail to听muster听the听needed 60 votes, where does that leave us?听

Edney:听I think that听leaves us looking for what the next turn of the key will be. I mean, will they be able to come to some听agreement on extending the tax credits听鈥斕齦ikely听鈥斕齩r the subsidies听鈥斕齦ikely after.听Like you said, enrollment has been underway,听and people are enrolling even though they听don’t听really know what the fate of these will be. So,听it’ll听be interesting to see how the marketplace reacts given what happens.听But I don’t think there’s a听really clear听idea yet, except that everyone thinks that something might start moving once these votes are dispensed with.听

Stolberg:听I think what听happens is that a lot of Americans are going to lose their health insurance.听We know that the number of Americans insured on the Obamacare听exchange is more than double after the enactment of these extended tax credits in 2021.听I think there听were 11 million;听now there are 24 million. And people, as you said in the outset,听have to听decide now. And听maybe they’ll听sign up now.听But if they lose these credits,听I think that a lot of folks听are going to suddenly find themselves without insurance coverage. And I think politically for Republicans, that is going to be a big problem going into next year’s midterms.听They know this, and that’s why they’re scrambling to come up with some kind of alternative that does not have Obamacare in its name.听But we also know that the alternatives that听they’re听proposing听won’t听go听very far听in terms of offsetting听out-of-pocket听costs for people who are struggling to pay for health听care.听

Rovner:听Things are starting to bubble up in the听House,听too. I mean,听we’ve听seen this.听鈥� We knew we were going to have this Senate vote, which is everybody protected by everyone to be a show vote, but now Republicans in the House are getting skittish as well.听

Goldman:听Yeah, absolutely. And听we’ve听seen a听couple听different听proposals in the House. So,听there are some moderates that are Republican moderates that are proposing听a听straight,听two-year extension. I think, like Anna said,听we’ll听see what happens after the Senate votes today,听if听that brings people to the table or not. I think one thing that struck me this week is听The Associated Press reported that听听are听actually slightly听ahead of where they were at this time last year.听But of course, that听doesn’t听mean that听that’s听going to result in more overall enrollment. There听is still a lot that needs to be ironed out there.听One thing that听I’m听wondering is:听Is health coverage just something that people are听biting听the bullet听on at this point? And they’re like,听Well, I know it’s听really expensive, but I still need to have health insurance.听And is that going to听鈥μ齟ven if people do drop off,听we’re听so far away, politically speaking, from the November elections, that,听is that听actually going听to resonate still? I听don’t听know.听

Rovner:听Yeah. I mean, one of the things that听鈥� I saw that AP story,听too,听that enrollment is听actually higher听than it was last year at this time.听But you听have to听worry if听there’s听going to be what they call the death spiral,听where only the people who need insurance the most sign up. You听have to听wonder whether these are the people who would sign up no matter what. And听it’s听the healthier people for whom听it’s听a bigger question mark听鈥斕齱hether they听actually need听the health听insurance at this much higher price听鈥斕齱ho are听probably waiting听right now. If听you’re听sick,听you’re听probably going听to sign up no matter what. So,听in some ways, I wondered if that was more of a warning signal than anything else.听

Goldman:听That’s听a great point.听

Stolberg:听I think the death spiral听is a real concern, especially with the plan that Cassidy and Crapo are putting forward. It would drive people into either catastrophic plans or听“bronze”听plans, which are lower costs, but听high-deductible. And the people who are going to get into those plans are healthy people. That is going to deprive the听risk听pools for sick people of the听healthy. And we know what happens when the听risk听pools become imbalanced like that.听Then insurance costs really skyrocket for the people who need it most.听

Rovner:听Yeah. Now, even if Republicans do decide they want to sue for peace, if you will, there are a lot of other obstacles to a bipartisan deal.听We’ve听talked听about abortion.听But it looks听like there are other things that Republicans want to do that Democrats are not going to want to accept.听

Stolberg:听Such as ending support for IVF听[in vitro fertilization]听coverage like they did in the听defense听bill听this week?听

Rovner:听Yeah, which听we’ll听get to in a little while.听

Stolberg:听OK.听

Rovner:听Yeah. I mean, I could see a bipartisan deal.听I’m听just dubious partly听鈥斕齛nd听we’ve听said this, I think, every week for the last five or six weeks听鈥斕齮hat Republicans听won’t听vote for an extension without permanent abortion restrictions,听and Democrats听won’t听vote for an extension with permanent abortion restrictions. But I know that some of these Republican bills also would deprive legal immigrants. There are anti-fraud provisions, some of which might be supported by Democrats, some of which might be seen as so onerous that they would prevent legitimate people from legitimately signing up.听Does anybody听actually see听a bipartisan deal happening?听I guess how scared do Republicans听have to听get before听they’re听willing to do something that the Democrats would agree to?听

Stolberg:听I听don’t听see a bipartisan bill happening in time. I mean, Cassidy said at this hearing last week, literally pleading with his听colleagues saying,听We听can talk about grand plans,听Bernie听[Sanders, I-Vermont]听can talk about听“Medicare for All,”听and we can talk about this, but we got to do something in three weeks.听Well, now听it’s听two weeks,听and听they’re听not going to come to some compromise, especially not one involving abortion or undocumented immigrants by Christmas.听It’s听not going to happen.听

Rovner:听Yeah. Congress loves to give itself deadlines and then not meet them.听

Goldman:听Absolutely. And听I think we听have Republicans with their grand plans,听and you听can’t听implement a full HSA听[health savings account]听expansion in the time that听they’ve听allotted.听That’s听just not听practicable.听

Rovner:听Yeah.听I think this听is a war of talking points at this point. All right. Well, the ACA may be this week’s news, but I听don’t听want to听miss out on听the vaccine news from late last week after we taped. As听predicted, HHS Secretary RFK Jr.’s听[Health and Human Services Secretary Robert F. Kennedy Jr.]听handpicked CDC听[Centers for Disease Control and Prevention]听advisory committee on vaccine practices voted to roll back the universal recommendation for a first dose of the hepatitis B vaccine for infants,听right after birth. Instead, the panel recommended making the vaccine the subject of听“individual-based听decision-making.”听What’s听the difference between that and听actually recommending听the vaccine?听Is this a really big change?听Anna, Sheryl,听you guys听have been watching this closely.听

Edney:听Yeah, I think that听it’s听a big change听in the sense that it can be听pretty confusing听for parents.听And it injects this idea of the vaccine听possibly being听harmful听鈥斕齛lthough听that’s听not something听that’s听seen in the data听鈥斕齛nd also听that听maybe it’s听just not that big of a deal, which is the problem of the success of the vaccine is the vaccine works. Hepatitis B cases in newborns go down,听and people think,听Oh, well, we听don’t听really have to worry about this anymore.听But听that’s just听not the case. Obviously, as听we’ve听seen with other diseases of late, these things can come back.听

And听so听I think听it’s听not going to change听at the moment, at least, necessarily insurance coverage for having the vaccine, but it does leave open this door that,听Well,听maybe you听should talk to your doctor, see if听it’s听really the best thing.听And听there’s听just a lot coming at you as a new parent or a parent with a new child on the way,听and a lot of medical advice to wade through,听and things like that. So,听this adds an extra piece to that for which a lot of the medical societies and doctors, Sen.听Cassidy included, have said,听This听isn’t听something that听we’ve听had a big question mark on.听It’s been听actually really,听really helpful听in the health of children.听

Rovner:听Yeah. Hepatitis B cases in children and teens have gone down 99%.听

Stolberg:听That’s听right,听since 1991.听I was going to say, I think this is a听really big听deal.听And it’s a听really big听deal for a couple of reasons.听One,听it’s听not听science-based.听There’s听no evidence that delaying the vaccine makes it any safer for children.听Two, it’s a听really big听deal because of the debate that Kennedy and his allies have created around what was once not given any thought.听And听it’s听also a big deal because,听as doctors will tell you, in theory, one could argue, as Kennedy and his group do, that this is a disease听that’s听transmitted sexually,听or听it’s听transmitted through intravenous drug use. And for infants, the real risk is mother-to-child transmission. Well,听first of all,听that’s听not entirely true. The virus can last and live on household items like听scissors,听or听tables,听or whatever. We know that newborns are the ones that are most at risk.听

And we also know that the best time to capture or vaccinate a newborn is when听they’re听there in the hospital,听and they have access to medical professionals who can administer the vaccine. And unlike countries like Denmark, which follow听up their babies, our babies听don’t听get that kind of follow-up. And听so听the likelihood is that kids will not get vaccinated when听they’re听older. Parents will forget about it,听and they will have missed that critical opportunity to be protected against an infection that can cause chronic liver disease and death.听

Goldman:听Yeah. And there was a lot of discussion during the meeting on,听Oh, well, we need to do a better job of screening the mothers for hepatitis B,听and you should still get the newborn vaccine if you test positive, et cetera, et cetera.听But that’s not ACIP’s听[Advisory Committee on Immunization Practices]听job to say that we should be screening mothers,听so they听don’t听have any authority there to enforce that. And a CDC staff member said,听We’re听working on that.听But,听like Sheryl said, we听don’t听have the same听kind of system that they have in other countries,听where you can get those follow-up appointments,听and get women in for prenatal care that they need.听And听so听I agree,听it’s听going to be a huge, huge issue.听

Rovner:听Yeah. Well, speaking of those other countries,听later on听Friday after the meeting,听in news that some might have missed, President听[Donald]听Trump issued an executive order basically telling RFK Jr. that he can do anything he wants with the childhood vaccine schedule because he should compare it to our听“peer听nations.”听Sheryl, you had a big story last week about听. What are they?听

Stolberg:听Well, what I reported with my colleague Christina Jewett is that Kennedy has been on this two-decade crusade to really upend American vaccine policy.听Ultimately,听he听would like to end all mandates for childhood vaccination.听That’s听not within his purview.听That’s听in the purview of the states.听But he wants to revisit the entire childhood vaccine schedule. And you can听see in听what he has done by installing his allies, some of whom presented at this ACIP meeting last听week,听he’s听put them in key places. People like Mark听Blaxill, who is a parent of a child with autism, who was a founder of a group called Safe Minds, which was an advocacy group. Mark听Blaxill听now works for听the CDC.听He’s听a smart,听Harvard-educated听businessman, not a doctor, but he presented on hepatitis B. We saw Aaron Siri, Kennedy’s lawyer,听presenting on the childhood vaccine schedule.听

This is a committee that is supposed to be听comprised听of medical experts听鈥斕齪eople who are physicians听who’ve听administered care. And what we are seeing is Kennedy installing these people and others,听sprinkling them throughout the department,听or bringing them in,听to carry out his vision. And he was听very clear听about that vision in an interview with me. I mean, he听firmly believes, as he said听鈥斕齢e was careful听鈥斕齢e said that autism has gone up over these past decades,听and听it’s听the same time as the childhood vaccines have become听鈥μ齱e’ve听had more widespread use of vaccines.听We’ve听also had more widespread drinking of pumpkin spice lattes,听as Kennedy’s critics note, but Kennedy has said听vaccines must be a potential culprit.听I thought听that听was听very interesting听that he put that word in听鈥斕齪otential. It was a wiggle word. But frankly, what he thinks is that vaccines are responsible,听and he has said as much in other interviews.听

Rovner:听And yet, while this is going on at this听very high听level,听we’re听now having a huge and growing measles outbreak in South Carolina,听in addition to the one that听we’ve听already had in Texas.听This is really having an impact on parents’听willingness to have their children vaccinated. I mean, that,听I think at this point,听cannot be denied just by听the evidence.听

Edney:听Yeah. Fewer parents are getting their kids vaccinated for school.听They’re听getting more waivers and things like that,听too. So,听we do see that this is听definitely giving听parents who听maybe had听concerns,听or听have felt some kinship with the MAHA听[Make America Healthy Again]听movement as听it’s听grown, the听ability to do what they feel is right, less so following听the science.听

Stolberg:听Peter Hotez, who is at Baylor University, told me that he was not surprised when there was a听measles outbreak in Texas, and听in particular in听that part of West Texas, because vaccination rates in that corner of the state had been dropping precipitously in the years prior to the outbreak. And he said he could see it coming.听

Goldman:听I think听it’s听also,听it’s听not just people that are very in line with the MAHA movement at this point. I think if听you’re听not paying as close of attention as we are, the messages that听you’re听seeing are,听Vaccines are bad. We need to听look into听vaccines. I听don’t听know, should I get a vaccine? Should I give my children vaccines?听And I think听that’s听really taking hold.听

Rovner:听Another story that听we’re听going to follow听into听2026. All听right,听we’re听going to take a quick break. We will be right back.听听

Turning to reproductive health, the last big bill Congress is trying to finish before leaving for the year is the National Defense Authorization听[Act]. And for the second year in a row, House Speaker Mike Johnson has ordered the removal of a provision passed by both the House and the Senate that would provide military听personnel听the same fertility coverage that other federal employees and members of Congress get. Right now, fertility treatments like IVF are only covered for those in the military who have service-related injuries or illnesses. I thought this was a priority for President Trump. At least he keeps saying that it is.听

Stolberg:听I think this听is daylight between Trump and Mike Johnson,听clearly.听

Rovner:听I have to say, I was surprised.听Since when听can the speaker just take something out of a bill that was passed by both the House and the Senate?听

Stolberg:听Also, not to mention that members of Congress have this coverage.听

Rovner:听That’s right, which they only got听fairly recently.听I’m听surprised that there’s, I would say, less听pushback. There obviously is听pushback. There听are people who are听really furious听about this, but听in the manner of how things work in听Congress,听this is听literally the听second time听he’s听done it. And his spokespeople admit that he did it. And he says,听Well, I only want this if听it’s听done ethically.听And a reminder,听he’s听from Louisiana, which is the state that has current restrictions on the destruction of excess embryos from IVF听that’s听made IVF difficult to obtain in that state.听It’s听one person exerting his will over the rest of the Congress.听

Stolberg:听Yeah. I think听that’s听the most interesting thing about it is the daylight between Johnson and Trump听and also听Kennedy on this听issue.听Because while Trump and Kennedy profess to be anti-abortion,听it’s听not really a top-of-mind issue for either one of them.听But it is for Johnson. And I guess I听can’t听imagine Trump vetoing the听defense bill, so听I guess this听is going to go through.听

Rovner:听Yeah, without it. Again.听Well, speaking of who it’s a priority for, much听[to]听the frustration and anger of the anti-abortion movement, a new report finds that the percentage of medication abortions using telehealth continues to grow, including those from states with shield laws that protect prescribers to states that have abortion bans, to patients in those states that have abortion bans, which听underlines a story from your colleagues at Bloomberg, Anna,听suggesting that FDA commissioner Marty Makary is听听of the abortion pill that was promised to anti-abortion lawmakers, that he’s apparently slow walking that until perhaps after the midterms.听

I hasten to add that HHS听spokesman听Andrew Nixon denies the studies being deliberately delayed. But just the story has angered anti-abortion forces so much听[that]听they’re听now calling for Makary’s firing. And Missouri Republican Sen.听Josh Hawley,听who’s听been at the forefront of the fight against the abortion听pill, and I believe the person who got the promise for this study,听has called the allegations unacceptable and is demanding answers by this Monday. Combined with听what’s听going on with the carousel of center directors at the FDA, how much longer can Makary last under this continuing onslaught?听

Edney:听Yeah, what I was thinking of when you were talking about this story is this is just one in a tiny slice of all the things that听seem to be听coming at Makary and going听wrong,听and听calling into question his ability to manage the FDA. I think specifically听鈥斕齳ou were just mentioning this with abortion, Sheryl听鈥斕齮hat听it’s听not top of mind for Trump or RFK. So,听I’m听not sure that this is the thing that does him in unless Sen.听Hawley or something breaks on that end.听Maybe there听are some senators who will be upset enough as more, or听if,听more details come out.听

I think that听definitely Makary听appears to be fighting for his job.听I think there have been some听great stories听in听The Washington Post and听The Wall Street Journal talking about these discussions at the White House every few weeks,听where听should we keep doing this? Do we need to think of听maybe putting听someone different in leadership?听He’s听still there.听And so,听it seems that RFK is backing him听pretty publicly.听Obviously,听that can change at a moment’s notice.听So,听something to keep a听really close听eye on.听

Goldman:听Something that we’ve been talking about on my team related to that is that it’s going to be听really hard听to get anyone else approved through the Senate for any of these positions.听And they can install an acting director, but there are limits to how long that can last. And听so听I think that that is maybe partially helping with some job security for a lot of these people at these high levels.听

Stolberg:听I think it would be听very hard听to get someone else installed given the broken promises that Kennedy has made to Cassidy.听They’re听going to be very wary.听And also, Makary is in the arc,听or the spectrum,听of people who could fill that job.听He’s听actually听kind听of听moderate, if you will.听And I talked to someone close to Kennedy who said that Kennedy still has confidence in him. So,听his ouster,听I think,听would require the White听House bigfooting听Kennedy. And听I’m听not sure听that听that would happen.听

Rovner:听And they have, as听we’ve听noticed, other things to deal with right now.听Finally听this week, remember that听$50 billion听Congress听included for听rural health in last summer’s big budget bill to offset the听nearly听$1 trillion听in cuts to Medicaid?听Well, now the Trump administration is effectively telling states that if they want to claim a share of that money, they need to make changes that align with other听听鈥斕齮hings like barring people from using food stamps for junk food,听or legalizing听short-term听insurance plans that many states worry could destabilize the individual insurance market. Now, I听wouldn’t听call this outright coercion, but I remember that the Supreme Court听basically did听just that when they ruled that the ACA’s Medicaid expansion had to be voluntary. Is this really going to fly,听that the Trump administration could say,听You听can’t听have this money unless you do other things that we want you to do?听

Goldman:听If听I’m听remembering correctly, all states that have all听right听to听applications will get a baseline of money,听and states can get more money for certain things that they apply for. And听so听I think that听maybe that听makes this a little different. But I think states will be听very upset听if they听don’t听get the money that they听want,听that they are asking for. And听it’ll听be interesting to see if there is legal action on the back听end,听too.听

Rovner:听Yeah. I mean, clearly this听$50 billion听for rural health is not enough to even begin to make up for the cuts that are coming to Medicaid. So,听we’re听talking about听small amounts听of money.听It’s听just,听I听don’t听remember seeing conditions that were quite this blatant. And听you’re听right, Maya, it’s听not听all of听the money, but it is some segment of the money. But for them to just literally come out and say,听We’re听going to give you money if you do what we want.听I would think at some point Congress gets to say,听Hey, not what we had in mind.听

Stolberg:听But Congress听won’t听say it. Not this Congress.听

Rovner:听Yeah, not this Congress. So听maybe a听future Congress. All right. Well, that is this week’s news. Now, we will play my interview with Linda Blumberg of Georgetown University, and then we will come back and do our extra credits.听听

I am pleased to听welcome to听the podcast Linda Blumberg.听Linda is a research professor at Georgetown University and an institute fellow in the Health Policy Division of the Urban Institute, and one of my go-to people whenever I have a听really complicated听question about health policy.听Linda, welcome to听What听the Health?听

Linda听Blumberg:听Thanks so much for having me here.听

Rovner:听So,听to the unpracticed eye, it looks like Republicans in the House and Senate are just now听coming up with听all these new and different health plans. But,听in fact, most of them are variations on what Republicans have been pushing, not just for years, but for decades in some cases.听Is there anything听really new,听or is this just a long list of golden oldies?听

Blumberg:听I think this听is听basically a听list of things that have been brought out before. Now, they听have to听present them and talk about them in the context of the Affordable Care Act, which they听didn’t听have to do many years ago.听They’re听working around in terms of what听they’re听impacting on听the Affordable Care Act,听and how these other pieces would fit in with what they want to do there. But听they’re听essentially the听same things听they’ve听been talking about for a long time.听

Rovner:听So,听you’ve听been analyzing these plans for years now.听And while they may look different on the surface, you say they all have one thing in common:听that they work to segment rather than pool risk. Can you explain that in听layman’s terms?听

Blumberg:听Sure. When I talk about segmenting health听care risk, what I’m talking about is policies,听or strategies that place more of the financial responsibility of paying for medical care on the people who need that care when they need it, or on those who are most likely to need medical care.听That is the opposite of pooling risk more broadly, which听actually takes听health听care costs and spreads them to a greater extent across people, both healthy and sick.听

Rovner:听So basically,听protecting听sick people, which is the idea of health insurance in general, right?听

Blumberg:听Well, from my perspective, yes. The situation is because there is听鈥斕齱hat we in economics call听鈥� a听very skewed distribution of health听care spending, that means that in any particular year, at any听particular moment in time, most people are pretty healthy and don’t use much medical care,听and the great bulk of health听care spending falls on a small percentage of the population. And so,听when听you’re听only looking in the short term, when听you’re听not looking broadly across time,听or across somebody’s life, then people who, when you segment health听care risk, you听can create savings for people when听they’re听super healthy. The problem is that it increases the cost even more when they are not healthy,听and none of us are healthy forever.听

Rovner:听And just to be clear, the percentage of people who use听the majority of听health听care is really,听really tiny, isn’t it?听

Blumberg:听Yeah. So,听for example, there is a rule of thumb that around the top 5% of health听care spenders account for听basically half听of all health听care spending, and the bottom half of spenders account for less than 3% of health听care spending. But that is at a particular moment in time,听again. And听I think the problem听is when we think about health听care spending as听Who’s听going to听win?听Who’s听going to lose?听in terms of money,听right now,听at a particular moment in time.听Instead of thinking about what happens to us over the course of our lifetime, which is,听then,听when we spread the costs much more broadly,听we’re听more protected. We have access to adequate affordable health听care under broad-based pooling of health听care听risk. When we segment it,听we’re听really making people much more听vulnerable听to not being able to get the care they need when they need it.听

Rovner:听And how do things like health savings accounts,听and giving consumers more power to go out and negotiate on their own, how do those听actually segment听risk?听

Blumberg:听So,听the more you take the dollars that are being spent on health听care and remove it from the health insurance pool听鈥斕齮he amount of money that is going to pay for claims through health insurance,听听whether it’s public or private insurance听鈥斕齮he more you take it out of the insurance pool and you put it on the individuals, the more we’re separating the risks and putting heavier costs on people when they need care. So,听a health savings account gives us some听cash,听or听allows us to put some cash into an account to use when听we’re needing听care. But it also comes with health insurance plans that are much听higher听deductibles and much larger out-of-pocket costs.听

And听so听what we see in practice is that the people who have these听accounts, they听tend to not听鈥μ鼺irst of all, they tend to be much wealthier people听because听they’re听tax advantages听for wealthy people, not for people who are听[of]听much more modest means. And when they go to get care,听there’s听usually not that much money in the account to help them pay for these much larger deductibles and out-of-pocket costs. And听so听they’re听paying for听a lot more when they need听the care. The insurance kicks in at a much higher level of听spend. And听so听the听financial burden, even though听they’ve听paid lower premiums when they need听the care, the financial hit is on the individual.听

Rovner:听So why shouldn’t we put higher-risk people in a different pool? Since, as you point out, most people are healthy most of the time. That would reduce costs for more people than it would raise costs for.听Right?听

Blumberg:听Well, it would,听at a particular moment in time, but the problem is we don’t stay healthy听all of听the time.听And so,听I’m听not born with a stamp on my head that says,听You’re听going to be a low spender,听and so听you’re听going to be better off over here.听All I need is a broken leg. All I need is somebody in my family to develop diabetes. God听forbid,听a kid gets hit by a听car,听or听develops a brain tumor. Stuff happens from听out of the blue. And then,听if听that’s听the case, if听I’m听in a situation that could really make it so that I听can’t听access,听or my loved ones听can’t听access,听the care that they need when they need it.听And by the way, as听we age, everybody tends to use听more and more听care.听

So,听you can save money at a moment of time by segmenting risk in these ways, but if you do it,听you’re听putting so many people at risk for not being able to get adequate care when they need it. And because of that skewed distribution of health听care spending,听it’s听a situation where what you save when听you’re听healthy from segmenting risk is听really pretty听small compared听to the extra amount you听have to听spend for pooling risk. Because if you take these dollars,听and you spread them over everybody, then the increment that you听have to听spend听in order to听make sure听you’re听protected,听and everybody else is protected when they need medical care,听is not that big.听

Rovner:听Is there some ideological听reason why听Republicans听seem to be听coalescing around these risk-segmentation ideas?听

Blumberg:听I’m听not a psychologist, so the motivation escapes me.听Because I do think people are better off over the course of their lifetimes when we spread risk broadly.听I think part of the issue听is the other philosophical difference between conservatives and more progressive policymakers is the idea of income distribution. And the truth of the matter is that听really wealthy听people, if they get sick and have a high-deductible plan,听or they have a much听more narrow听set of benefits that are being offered to them, they have wealth that can take them a long way to get to buy medical care. They can pay for the broken limb.听They can pay for听various different听medications.听

If they have听a very serious听illness,听or injury听that’s听longer lasting, they may not听鈥斕齟ven wealthy people听鈥斕齧ay not be able to cover the costs,听or it may really have听a big impact听on them.听But by and large, wealthy听people听are able to听insulate听themselves to some degree, even听with very听pared-down coverage. Whereas somebody听who’s听middle-income, who’s听lower-income,听who’s听not super wealthy, is not going to be able to access that care. So,听if your focus is on protecting the assets of those with a lot of wealth, this is听a positive听in that regard.听

Rovner:听So how does this ongoing debate about these enhanced premium subsidies play into this whole thing?听

Blumberg:听When听we’re听talking about the enhanced premium tax credits, which seem to be,听by the end of this week,听will听be going by the听wayside,听those are听actually pooling听mechanisms,听too. And I think it’s important for people to understand that financial assistance for lower-听and middle-income people, one of the great things that it does听鈥斕齛s a secondary effect of just giving those people insurance coverage听鈥斕齣s it brings a lot more healthier people into the pool. People who are healthy, young, who听wouldn’t听have been able to afford health insurance coverage before,听and so would have听remained听uninsured and did before these credits were in place. It brings them into the pool. It lowers the average medical expenses听of people insured.听And by pooling risk in that way, it听actually lowers听the premium.听Because as the average cost of the individuals enrolled goes down, the premiums go down,听too.听

And so one of the things besides these other strategies,听which would tend to segment risk further, as we talked about, the strategy that they are denying听鈥斕齱hich is continuing these enhanced subsidies听鈥斕齣s also going to further segment risk because it’s going to push healthier people out of the pool that can’t afford it anymore. Same with, by the way, the听people who are immigrants but are residing here legally, who are no longer going to be able to access assistance to buy coverage in the marketplaces as they have been for the last number of years, they also tend to be people who use less medical care on average. And so those immigrants being in our insurance pools are听actually helping听to subsidize American citizens who are less healthy. And听so听by saying,听Listen,听we’re听not going to let you in.听We’re听not going to give you subsidies to make it affordable for you to come in.听We’re听actually pushing听the average cost of the health insurance coverage upward for no good reason, honestly.听

Rovner:听Linda Blumberg, thanks very much.听

Blumberg:听My pleasure. Good to see you.听

Rovner:听OK,听we’re听back.听It’s听time for our听extra-credit听segment.听That’s听where we each recognize the story we read this听week听we think you should read,听too.听Don’t听worry听if you miss it;听we will put the links in our show notes on your phone or other mobile device. Anna, you have a story written by you this week. Why don’t you go first?听

Edney:听Yeah, thank you. I had a听story听just published today.听It’s听in Bloomberg:听“.”听And I took a deep look at this issue of preterm infant听formula.听So,听for听preemies听that are born听really early, there’s this big debate right now on whether formula is harming them,听or whether it’s something else that’s causing one a day,听essentially,听to die from this awful disease, necrotizing enterocolitis.听And听so听Abbott is struggling because they don’t make a lot of money听off of听this formula, but they’re being sued for billions and billions of dollars.听So听they really want Congress, any agency, the White House, whoever, to intervene in some way.听

They’re听throwing everything at the wall to see what can stick. And I’ll just say one tidbit that I听found that听was听really interesting.听There’s听a lot of debate. There was an NIH听[National Institutes of Health]听report on this disease recently that moved in Abbott’s favor a little bit. I did learn through my reporting that the report was ghostwritten by a company that does a lot of work with听Abbott,听and听lists them as a client. So听that’s听an interesting conflict of interest there,听maybe a听hook to get听you guys听to go read it. Thanks.听

Rovner:听Oops.听I’m听definitely going听to go read it.听Maya, why don’t you go next?听

Goldman:听Yeah,听I’m听excited to read that, Anna.听

Edney:听Thank you.听

Goldman:听My extra credit this week is from ProPublica.听It’s听by Aliyya Swaby and听it’s听called听“”听There are a lot of details in the story, but听I think the headline听tells you the gist of it. But what stuck out to me about this is I think in health journalism and health policy, we听often talk about the safety net as if听it’s听magic and going to catch everyone, or at least I find myself slipping into that mindset sometimes. And I think听it’s听really important听to听look into听how people on the ground are听actually experiencing听these services. And听it’s听also a reminder, unfortunately, that there are bad actors everywhere.听

Rovner:听Alas. Sheryl.听

Stolberg:听So,听my extra credit this week is听actually more听of a science听policy story than a health听policy story, but it is a fascinating yarn.听It’s听titled听“.”听It’s听in The New York Times by my colleague Katie J.M. Baker. And this is the story of two Chinese virologists who were married,听and the woman came to believe that听covid听was a bioweapon created in a lab,听and that the Chinese government had purposefully grown this virus and released it to set off the pandemic. And this doctor fell under the sway of people like Steve Bannon, Trump’s ally, and an exiled听Chinese billionaire who had reason to want to blame the Chinese government,听and who brought her to the United States, placed her in a series of safe houses once she arrived,听and arranged for her to meet some of Trump’s top advisers.听

And she has now gone underground,听and her husband听actually moved听to the United States to try to find her. And听she’s听basically in听hiding.听She’s听cut off contact with her family.听And it’s heartbreaking,听and poignant,听and also,听from my perspective, revelatory about just the politics that have come to define our debates around science and health in the wake of the pandemic.听

Rovner:听Yeah, it is quite the story. All right. My extra credit this week is from听The Washington Post.听It’s听called听听by David Ovalle. And听we’ve听talked about this issue before. These fees were听mainly aimed听at tech companies,听who are the biggest users of the H1B visa program, but this new $100,000 fee is already preventing particularly rural practitioners from bringing medical professionals to places in the United States that Americans just听don’t听want to practice. This story centers on an overworked kidney disease practice in North Carolina听that’s听still waiting on a U.S.-trained doctor that it hired months ago,听who is stuck in India.听We’ve听already talked about how the Medicaid cuts are going to hit rural areas particularly hard. This fee to bring in international medical professionals sounds like听it’s听making that even worse.听听

OK, that is this week’s show.听Thanks to our editor, Emmarie Huetteman,听and our producer-engineer,听Taylor Cook. A听reminder:听What听the Health?听is now available on WAMU platforms, the NPR app, and wherever you get your podcast, as well as,听of course,听kffhealthnews.org. Also, as always, you can email听us听your comments or questions.听We’re听at whatthehealth@kff.org, or you can find me still on X听听or on Bluesky听. Where are you folks hanging these days, Maya?听

Goldman:听I am on X听听and on LinkedIn under my name.听

Rovner:听Anna?听

Edney:听听or听听@AnnaEdney,and听LinkedIn as well.听

Rovner:听Sheryl.听

Stolberg:听And听I’m听on听听and听听@sherylnyt,听and LinkedIn under my own name.听

Rovner:听We will be back in your feed next week. Until then, be healthy.听

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But in the upside-down world of Health and Human Services Secretary Robert F. Kennedy Jr., vaccines are on the ropes. A vaccine committee dominated by skeptics he chose for the panel voted 8-to-3 Friday to end a 34-year recommendation to inoculate newborns against hepatitis B, a practice that helped reduce childhood infections of the virus by 99%, from around 16,000 in 1991 to only seven in 2023.

While the committee went about its deliberations, the peril of abandoning vaccines was plain to see. The country’s worst year since 1992 for measles 鈥� an entirely vaccine-preventable illness 鈥� continued with flare-ups in Utah, Arizona, and South Carolina. A two-year outbreak of whooping cough, which vaccines can also check, has caused about 60,000 reported cases 鈥� including at least six infant deaths.

But neither of those diseases was discussed on the first day of the meeting by members of the Advisory Committee on Immunization Practices. The panel’s chartered purpose is to determine vaccination policies to counter such risks, but under Kennedy, it has focused on responding to doubts from vaccine skeptics and opponents.

Like previous gatherings of the committee, which was handpicked by Kennedy after he fired the panel’s 17 incumbent experts in June, the session was chaotically at odds with past practices of the Centers for Disease Control and Prevention. Kennedy has described the agency as a “cesspool of corruption.”

The committee’s chair, epidemiologist Martin Kulldorff, left three days before the meeting and was named to a senior HHS position. His successor, Kirk Milhoan, a pediatric cardiologist who that the mRNA technology used to make covid vaccines is “the biggest threat to humanity,” was on a plane or in Asia for most of the meeting, leaving Vice Chair Robert Malone holding the reins. Malone opposes vaccine mandates and became a darling of the anti-vaccine movement when he told podcast host Joe Rogan in 2021 that Americans were “basically being hypnotized” into taking the covid vaccine.

Typically, slides and data for the panel’s meetings are posted on the CDC’s website several days beforehand. This time they weren’t posted at all.

The committee’s working group that studied hepatitis B vaccines did not include recognized hepatitis experts. When a few panel members expressed reservations during the ACIP meeting, CDC hepatitis specialist Adam Langer was brought in to answer questions. He frowned on the proposed changes.

Surprising Choice of Experts

At 8 a.m. Dec. 4, the CDC finally listed the names of the meeting’s presenters. Aaron Siri, one of Kennedy’s former lawyers and a strident legal foe of vaccination, was set to headline Friday’s discussion of the pediatric immunization schedule.

Sen. Bill Cassidy, a Louisiana Republican and physician who cast a deciding vote for Kennedy to win confirmation to his job, said on the social platform X: “Aaron Siri is a trial attorney who makes his living suing vaccine manufacturers. He is presenting as if an expert on childhood vaccines. The ACIP is totally discredited. They are not protecting children.”

In replies to his post, some people demanded to know what Cassidy planned to do about it. While he has publicly criticized some of Kennedy’s moves on vaccines, the senator has made no visible effort to reverse them.

As the meeting began, Malone revealed that Vicky Pebsworth, a senior officer at the National Vaccine Information Center, a four-decade-old cornerstone of vaccine skepticism, was chairing a committee that is reviewing the entire childhood vaccine schedule. That’s the repository of ACIP recommendations that protect American children from measles, pertussis, influenza, tetanus, chickenpox, meningitis, and a host of other diseases.

Typically, seasoned CDC and FDA experts on vaccines and infectious disease present data about a disease and the options for its prevention before ACIP votes on a policy. Instead, Pebsworth, vaccine-skeptical climate scientist , and businessperson Mark Blaxill, who helped lead another anti-vaccine group, presented the case 鈥� a negative one 鈥� on the hepatitis B vaccine on Dec. 4.

Sports medicine doctor Tracy Beth Høeg, who parlayed a year working with University of California-San Francisco epidemiologist Vinay Prasad, now the FDA’s vaccine chief, into a leading role at the agency, frequently chimed in. Nevison and Blaxill were co-authors of a 2021 autism study retracted for data misrepresentation and other problems.

Unsurprisingly, the picture they painted Dec. 4 suggested that the hepatitis B birth dose wasn’t necessary, and might be dangerous, notwithstanding years of scientific consensus to the contrary.

The presentations stunned Cody Meissner, an infectious disease specialist and one of the only vaccinologists on the CDC panel. “There were so many statements that I don’t agree with that it’s hard to be succinct,” he said.

Yvonne Maldonado, a Stanford University infectious disease specialist and one of the former ACIP members ejected in June, said she found it horrifying to watch unvetted presentations by nonexpert nonphysicians.

“Almost every statement made by this committee was misinformation, disinformation, or outright lies,” she said. “They are cherry-picking data, pulling up fringe papers, misunderstanding good papers. They are not the right people to be making decisions.”

Pebsworth said the committee was taking up the birth dose issue because of “pressure coming from stakeholder groups” 鈥� presumably including Kennedy and his allies. The U.S. is an “outlier” in its universal recommendation, she erroneously said.

In fact, the birth dose of the hepatitis B vaccine is given in 115 countries and is recommended by the World Health Organization. Many Western European countries limit the birth dose to targeted groups, however.

Arguments for the Birth Dose

Nevison said targeted measures to stop the virus in the 1980s, including promoting safer sex, increasing blood screening, and vaccinating the babies of hepatitis B-positive mothers, had achieved most of the reduction in cases since then. But most experts say the birth dose played a key role. And the virus remains a threat, with an in the U.S.

The birth dose “is a safety net,” Meissner said. “It’s really for chronically infected mothers who for one reason or another do not get tested.”

“Where is the evidence of harm?” asked another panelist, psychiatrist Joseph Hibbeln.

In the years since the birth dose of hepatitis B vaccine was recommended, it has caused vanishingly few confirmed major side effects.

Blaxill, who 25 years ago helped advance the since-disproven theory that traces of mercury in vaccines were causing an epidemic of autism, said that hepatitis B vaccines were inadequately studied. He pointed to a study that showed high fevers in some children after the shot, which he said suggested brain inflammation.

Maldonado said that’s wrong. “I’ve seen thousands of children with fevers,” she said. “It’s not the same as encephalitis.”

Nevison said that a small number of vaccine court awards proved at least some harm by hepatitis B vaccinations. Reed Grimes, director of the Division of Injury Compensation Programs at the Health Resources and Services Administration, explained that an award does not necessarily signify proof of injury, but rather that the government decided not to contest a claim.

Speculation bloomed. Panelist Evelyn Griffin, an obstetrician, posited that rising cases of inflammatory bowel disease might be related to a medium 鈥� brewer’s yeast 鈥� used in the production of the hepatitis B vaccine. She did not cite a source for the idea.

Babies born with hepatitis B infections have a 90% chance of chronic liver infection later in life, and 25% of those with a chronic infection will die prematurely with chronic liver disease.

Panel members pushing to end the universal birth dose argued that blood tests of pregnant women should show who needs the shot. But only 35% of women who test positive receive all recommended follow-up care, and the virus can spread easily through contacts as common as a toothbrush or a bath towel. Ending the birth dose could result in nearly 500 deaths a year, according to a recent study.

The meeting was preceded by a heavy round of briefings for journalists and from established medical experts who view the new ACIP as a sounding board for anti-vaccine views 鈥� “inflating speculative risks while downplaying well-established vaccine benefits,” as three recent .

They noted that the hepatitis B birth dose is already optional, although doctors strongly recommend it. But recommending that it be a shared decision based on individual choice, as the ACIP voted Dec. 5, could add paperwork for doctors and introduce doubts in parents’ minds.

ACIP recommendations aren’t binding but have been used by health insurers in the past to establish coverage decisions. Federal agencies and private insurers will in most cases continue to pay for the hepatitis B vaccination if parents want it, said Andrew Johnson, who represented the Centers for Medicare & Medicaid Services during the meeting. But studies have shown that ambiguous advice leads to lower vaccination rates, said Kathryn Edwards, a Vanderbilt University vaccinologist.

Anti-vaccine activists have long targeted the hepatitis B birth dose. At one time they baselessly claimed it caused sudden infant death syndrome.

But within a decade of the universal dose implementation, the rate of SIDS had . That was thanks to an HHS-American Academy of Pediatrics’ “back to sleep” campaign, which urged parents to avoid suffocation risk by not letting their babies go to sleep on their stomachs.

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Una de sus pacientes tenía 17 años cuando la examinó por dolor estomacal. McMahon descubrió que había desarrollado cáncer de hígado causado por hepatitis B, apenas unas semanas antes de graduarse de la secundaria como la mejor estudiante.

Murió antes de la ceremonia.

McMahon también recuerda a un niño de 8 años que no mostraba signos de enfermedad hasta que se quejó de dolor: resultó ser un tumor de rápido crecimiento en el hígado. Aún puede escuchar su voz.

“Gemía de dolor diciendo: 鈥楽é que voy a morir pronto’”, recordó. “Todos estábamos llorando”. El niño murió en casa una semana después.

El virus de la hepatitis B se transmite a través de la sangre y otros fluidos corporales, incluso en cantidades microscópicas, y puede sobrevivir en superficies durante una semana. Como muchos de sus pacientes, McMahon explicó que ambos niños contrajeron hepatitis B al nacer o en la infancia temprana.

Ese desenlace hoy se puede prevenir.

Una dosis de la vacuna al nacer, recomendada para recién nacidos desde 1991, es hasta para prevenir la infección transmitida por la madre si se administra en las primeras 24 horas de vida. Si los bebés reciben las tres dosis, el contra este virus incurable, con una protección que .

En las comunidades del oeste de Alaska, años de pruebas dirigidas y campañas amplias de vacunación lograron que los casos .

“El cáncer de hígado ha desaparecido en los niños”, dijo McMahon. “No hemos visto un solo caso desde 1995. Tampoco tenemos, que sepamos, nadie menor de 30 años que se haya infectado”.

Le preocupa que estos avances obtenidos con mucho esfuerzo puedan retroceder.

驴Retrasar la dosis?

Un comité asesor sobre vacunas de los Centros para el Control y 听Prevención de Enfermedades (CDC, por su siglas en inglés), nombrado por el secretario de Salud y Servicios Humanos Robert F. Kennedy Jr., tiene previsto discutir y votar el 4 de diciembre si se mantiene la recomendación de administrar la dosis de hepatitis B al nacer.

La medida podría limitar el acceso de los niños a la vacuna.

En el podcast de Tucker Carlson en junio, Kennedy afirmó falsamente que la dosis de hepatitis B al nacer es una “causa probable” de autismo.

También dijo que el virus de la hepatitis B no es “casualmente contagioso”. Pero demuestran que el virus puede transmitirse por contacto indirecto, cuando restos de fluidos infectados, como la sangre, entran al cuerpo al compartir objetos personales como rasuradoras o cepillos de dientes.

Las recomendaciones de este comité tienen gran influencia. La mayoría de los seguros privados están obligados a cubrir las vacunas que el Comité Asesor sobre Prácticas de Inmunización (ACIP, por sus siglas en inglés) aprueba, y muchas políticas estatales de vacunación se basan directamente en esas guías.

Pero ni el ACIP ni los CDC tienen funciones regulatorias: no pueden imponer vacunas obligatorias. Esa responsabilidad . Sin embargo, mantener la recomendación de administrar la vacuna al nacer permite que las familias tengan la mayor cantidad de opciones: pueden elegir vacunar desde el nacimiento, esperar hasta más adelante o no vacunar. Y el seguro continuará cubriendo el costo de la vacuna mientras siga estando aprobada por la Administración de Alimentos y Medicamentos (FDA, por sus siglas en inglés).

Dos altos funcionarios de la FDA 鈥攅l comisionado Marty Makary y el principal regulador de vacunas Vinay Prasad鈥� sugirieron a finales de noviembre que podrían en el proceso de aprobación de vacunas. Todas las vacunas deben estar aprobadas por la FDA para ser administradas en Estados Unidos.

En obtenidos por y , Prasad cuestionó la práctica rutinaria de “aplicar múltiples vacunas al mismo tiempo”.

No está claro si se refería a las vacunas combinadas, que protegen contra varias enfermedades en una sola dosis. Tres de las nueve vacunas contra la hepatitis B actualmente aprobadas por la FDA son combinadas. Sin embargo, la se aplica solamente como una vacuna individual.

“Sembrando desconfianza”

Aunque los seguros privados continúen cubriendo esta vacuna, la desinformación que surja de esa reunión podría llevar a que algunas familias crean erróneamente que puede hacerle daño a sus bebés, advirtió , presidente del Comité de Enfermedades Infecciosas de la Academia Americana de Pediatría (American Academy of Pediatrics) y profesor asistente en la Escuela de Medicina de la Universidad de Colorado.

“Lo que salga de este desastre de reunión en diciembre estará principalmente diseñado para sembrar desconfianza y esparcir miedo”, expresó.

El presidente Donald Trump, Kennedy y algunos de los nuevos miembros del ACIP han distorsionado cómo se transmite esta enfermedad hepática, ignorando o minimizando el riesgo del contagio indirecto.

El virus de la hepatitis B es . Las personas no vacunadas, incluidos los niños, pueden infectarse con cantidades microscópicas de sangre en una mesa o un juguete, incluso si la persona infectada no presenta síntomas.

McMahon ha atendido a niños que dieron negativo al nacer y luego se infectaron por contacto indirecto. En de la década de 1970, casi un tercio de esos niños desarrolló hepatitis B crónica sin mostrar síntomas, explicó.

“Es un virus muy contagioso”, dijo McMahon. “Por eso dar la dosis al nacer a todos es la mejor manera de prevenirlo”.

Los CDC recomiendan que todas las personas embarazadas se hagan la prueba de hepatitis B, pero estiman que hasta un 16% no se la realiza y queda fuera de los registros. O’Leary y otros expertos dicen que hacer pruebas justo antes o después del parto no es factible, ya que la mayoría de los hospitales no tiene el personal ni los recursos suficientes.

La vacuna de tres dosis tiene . Numerosos estudios demuestran que no está asociada con un mayor riesgo de , , ni . Las reacciones graves son poco comunes.

“Tenemos un perfil de seguridad excelente”, dijo O’Leary. “Nadie espera chocar en auto, 驴cierto? Pero igual todos usamos el cinturón de seguridad. Esto es similar”.

Los CDC estiman que 2,4 millones de personas en el país tienen hepatitis B, y que . La enfermedad puede ir desde una infección aguda hasta una crónica, . Si no se trata, puede provocar cirrosis, insuficiencia hepática y cáncer de hígado. No tiene cura.

Recomendación para padres: hablar con su doctor

, profesor de medicina preventiva en la Escuela de Medicina de la Universidad de Vanderbilt y ex miembro con voto del ACIP, dijo que algunos padres tienen dificultad para entender por qué un recién nacido sano necesita una vacuna tan pronto, especialmente contra un virus que están convencidos de no tener y que a menudo asocian solo con conductas de riesgo. Esa percepción, señaló, se mezcla con la creciente desconfianza en la salud pública y el escepticismo hacia las vacunas.

Su consejo para futuros padres que están indecisos es hablar con su médico sobre las vacunas. Incluso si la embarazada dio negativo en la prueba, dijo, sigue siendo importante administrar la dosis al nacer, ya que pueden ocurrir falsos negativos y el virus se puede propagar fácilmente a través del contacto con superficies.

Los bebés que reciben la serie completa de vacunas desde el nacimiento tienen de desarrollar cáncer de hígado.

“Si uno espera un mes y la madre resulta ser positiva, o el bebé se contagia de un cuidador, para entonces la infección ya está establecida en el hígado del bebé”, explicó Schaffner. “Ya es demasiado tarde para prevenirla”.

Agregó que, si menos personas se vacunan, la hepatitis B circulará más en las comunidades estadounidenses y el riesgo de infección aumentará para quienes no se vacunen.

Y más casos de hepatitis B también podrían significar mayores costos tanto para los pacientes como para el sistema de salud.

Los CDC calculan que tratar a una persona con una forma menos grave de la enfermedad cuesta entre $25.000 y $94.000 al año. Para quienes necesitan un trasplante de hígado, los gastos médicos anuales pueden superar los $320.000, dependiendo del tratamiento.

Durante los últimos 30 años, los que han reportado los padres tras la aplicación de la dosis al nacer han sido llanto e irritabilidad, síntomas que desaparecen rápidamente. Schaffner dijo que eso demuestra un perfil de seguridad muy sólido para una vacuna en recién nacidos que protege contra una enfermedad incurable.

“Los datos son clarísimos sobre esto”, agregó. “Ahora hay toda una serie de países que han iniciado este programa. Lo han tomado como modelo del nuestro”.

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Working out of a in Anchorage, Alaska, liver specialist Brian McMahon has spent decades treating the long shadow of hepatitis B. Before a vaccine became available in the 1980s, he saw the virus claim young lives in western Alaskan communities with stunning speed.

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

McMahon thinks often 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 tumor on his liver.

McMahon can still hear his voice.

“He was moaning in pain, saying, 鈥業 know I am going to die soon,’” he recalled. “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 a week. Like many of his patients, McMahon said, both children contracted hepatitis B at birth or in early childhood.

That outcome is now preventable. A birth dose of the vaccine, recommended for newborns since 1991, is up to in preventing infection from the mother if given in the first 24 hours of life. If babies receive all three doses, have immunity from the incurable virus, with the protection lasting at least .

In the communities of western Alaska, years of targeted testing and widespread vaccination efforts led to .

“Liver cancer has disappeared in children,” McMahon said. “We haven’t seen a case since 1995. Nor do we have any children under 30 that have gotten infected that we know of.”

He worries those hard-won gains could soon be rolled back.

Pushing Back the Dose?

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

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

He also said the hepatitis B virus is not “casually contagious.” But shows 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 the vaccines the Advisory Committee on Immunization Practices endorses, and many state vaccination policies are directly linked to its guidelines.

Neither ACIP nor the CDC is regulatory. They cannot mandate immunizations. It’s to do that. But keeping the recommendation for a hepatitis B vaccine at birth preserves the widest range of options for families. They can choose to vaccinate at birth, wait until later in childhood, or not vaccinate at all, and insurance will continue to cover the cost of the shot as long as it remains approved by the Food and Drug Administration.

Two senior FDA officials 鈥� Commissioner Marty Makary and top vaccine regulator Vinay Prasad 鈥� suggested at the end of November that the vaccine approval process may be coming. Vaccines must be approved by the FDA to be administered in the United States.

In obtained by and , Prasad questioned the routine practice of “giving multiple vaccines at the same time.” It’s not clear whether he was referring to combination vaccines that offer immunity against multiple diseases with a single shot. Three of the nine hepatitis B vaccines currently approved by the FDA are combination vaccines. The of the hepatitis B vaccine is given only as a stand-alone vaccine.

Contacted for comment, Health and Human Services spokesperson Emily Hilliard said in a statement that “ACIP will review the evidence at its meeting this week and issue recommendations based on gold standard, evidence-based science and common sense.”

鈥楽owing Distrust’

If private insurers opt to still cover the shot, misinformation from the meeting still could lead families to falsely believe the vaccine could harm their babies, said , chair of the Committee on Infectious Diseases for the American Academy of Pediatrics and an assistant professor of pediatrics at the University of Colorado School of Medicine.

“Whatever comes out of this disaster of a meeting in December is going to be mainly designed around sowing distrust and spreading fear,” he said.

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

McMahon has cared for children who tested negative at birth and later became infected through indirect contact. In a , nearly a third of such children went on to develop chronic hepatitis B without ever showing symptoms, he said.

“It’s a very infectious virus,” McMahon said. “That’s why giving everybody the birth dose is the best way to prevent it.”

The CDC recommends that all pregnant people 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 testing mothers for the virus shortly before or after delivery is unfeasible, because most hospitals lack the staff and resources.

The three-dose vaccine has a of safety. Numerous studies show it is not associated with an increased risk of , , , or , and severe reactions are rare.

“We have an incredible safety profile,” O’Leary said. “No one expects to get in a car wreck, right? And yet we all put our seat belts on. This is similar.”

The CDC estimates that 2.4 million people in the U.S. have hepatitis B and that half they are infected. The disease can range from an acute infection to a chronic one, often with . If the disease is left untreated, it can lead to serious conditions such as cirrhosis, liver failure, and liver cancer. There is no cure.

Expert’s Advice to Parents: Talk to a Doctor

, a professor of preventative medicine at the Vanderbilt University School of Medicine and a former voting member of ACIP, said some parents struggle to understand why a healthy newborn needs a vaccine so soon after birth, especially for a virus they feel certain they don’t have and often wrongly associate only with risky behaviors. Those perceptions, he said, mix with declining trust in public health and rising skepticism about vaccines.

His advice to expectant parents who are on the fence is to talk to their doctor about the shots. Even if the pregnant woman has tested negative, he said, it’s still important to give the baby the birth dose, because false negatives are possible and because the virus can spread so easily from surface contact. Babies who receive the full vaccine series starting from birth have their chance of .

“If you wait a month and if the mom happens to be positive, or the baby picks it up from a caregiver, by that time the infection is established in that baby’s liver,” Schaffner said. “It’s too late to prevent that infection.”

He said that if fewer people get vaccinated, hepatitis B will circulate at higher rates in American communities and the risk of contracting the virus will rise for everyone who doesn’t get the shots.

And more hepatitis B cases could mean higher costs for patients and the broader health care system. The CDC estimates treating someone with a less severe form of the disease costs $25,000 to $94,000 per year. For patients who require a liver transplant, annual medical expenses can climb above $320,000, depending on their treatment.

Over the past 30 years, the parents have reported from their babies receiving the birth dose have been fussiness and crying, both of which pass quickly. Schaffner said that’s a very strong safety profile 鈥� for a newborn vaccine with a track record of protecting babies from an incurable disease.

“The data are so clear about this,” Schaffner said. “A whole array now of other countries have initiated this program. They’ve modeled it on us.”

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Both President Donald Trump and some newly appointed ACIP members have mischaracterized how the liver disease spreads, according to medical experts, including those working at the CDC. The ACIP panel’s recommendations can determine insurance coverage for immunizations.

At a White House press conference on Sept. 22, Trump, in advocating for delaying the newborn vaccine dose, falsely claimed that hepatitis B is solely a sexually transmitted infection.

“Hepatitis B is sexually transmitted. There’s no reason to give a baby that’s almost just born hepatitis B. So I would say wait till the baby is 12 years old and formed and take hepatitis B,” Trump said.

Hepatitis B is a highly infectious virus that attacks the liver and is transmitted through contact with infected bodily fluids, including blood. It can also be passed from mother to baby.

A reporter asked if Trump had spoken with Health and Human Services Secretary Robert F. Kennedy Jr., who oversees the CDC, about making the change, and Trump said he had, as Kennedy looked on.

Although hepatitis B is often associated with high-risk behaviors such as injection drug use or having multiple sexual partners, , including career CDC scientists, note that the virus can be transmitted in ordinary situations too, including among young children.

At the latest ACIP meeting, held Sept. 18 and 19, members debated postponing the hepatitis B newborn dose until 1 month of age.

CDC scientist outlined research showing incidences of unvaccinated children born in the U.S. to mothers who tested negative, later becoming infected with hepatitis B. Langer serves as acting principal deputy director for the National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention.

Langer told the vaccine advisory panel that the virus can survive for outside the body on surfaces. During that time, contact with even microscopic traces of infected blood on a is enough for a child to be infected. This means unvaccinated children not considered at high risk can still be exposed in everyday environments, or by an infected caregiver.

“We do have data that says that it can happen and that it is likely to happen,” he said. Though the exact cause of infection may not be clear in documented cases of children of hepatitis B-negative mothers becoming infected, “I can tell you that it didn’t come from the mother and it didn’t come from injection drug use and it didn’t come from sexual contact, so that means that it had to have been some kind of casual contact,” Langer said.

Yet during the debate, some members gave little credence to the risk of transmission to children through household contact.

“This is a very, very important vaccine that should be given to the high-risk populations,” said ACIP voting member , a professor of operations management at the MIT Sloan School of Management. “The high-risk populations seem to be babies born to hep B-positive mothers, drug addicts, and other populations at high risk,” he said, despite Langer’s presentation highlighting other avenues of possible transmission.

Contrary to research that was presented, Levi later said the risk of not vaccinating children of hepatitis B-negative mothers was “probably close to zero” in the first few years of life.

The CDC estimates 2.4 million people in the U.S. have hepatitis B and half they are infected. The disease can range from an acute, mild infection to a chronic infection, often with . The disease has no cure and, if left untreated, can lead to serious conditions like cirrhosis, liver failure, and liver cancer later in life.

During debate on the vote to delay the newborn dose, ACIP member said that the proposed one-month gap would leave some children vulnerable to the virus, even if their mothers test negative for hepatitis B.

“This assumes implicitly that all the infections are coming from moms,” Hibbeln said. “You can’t decide on that simply by the mother’s status. You would have to look at the entire household’s status.”

ACIP member Evelyn Griffin, an obstetrician and gynecologist, asserted that doctors could ascertain an entire household’s hepatitis B status by asking the mother.

“How are they going to know?” Hibbeln said. “If 50% of people don’t know that they are hepatitis B-positive, you can ask all you want, and nobody knows.”

The committee members, all handpicked by Kennedy, ultimately decided to table the vote on whether to delay the newborn dose after Hibbeln brought up inconsistencies in the wording of the text of the resolution.

“The notion that hepatitis B is only confined to transmission for prostitutes, drug users, etc. is such an ignorant and uninformed way of approaching infectious disease,” internist , the president of the American College of Physicians and its liaison to ACIP, said when reached after the meeting.

“The virus does not care what your behavior or lifestyle is. The virus goes from person to person through bodily fluids,” Goldman said. It can be transmitted when an unvaccinated person touches infected bodily fluids on common surfaces and then accidentally touches the eyes or mouth. “What if someone was in a car accident and got exposed to blood?”

“It is not only mother-to-fetus transmission, it is not only certain risk groups,” he said. “This is why it’s universal; everyone should get this for their protection, and it is unfortunate that it is being politicized into a sexually transmitted disease and that’s it. That’s not an appropriate way to evaluate science.”

Pediatric vaccination recommendations are widely credited with nearly eliminating the virus in American-born children.

Babies infected at birth have a 90% chance of developing chronic hepatitis B, and a quarter of those children go on to have severe complications, like liver cancer, or to die from the disease.

In 1991, federal health officials determined newborns should receive their first dose of a hepatitis B vaccine within , which can block the virus from taking hold if transmitted during delivery. From 1990 to 2022, case rates of hepatitis B declined by more than 99%. While parents may opt out of the shots, many day care centers and school districts of hepatitis B vaccination for enrollment.

The next meeting of the ACIP is scheduled to begin Oct. 22. Agendas are usually posted weeks in advance, but so far, no information on the substance of the upcoming meeting has appeared on the CDC’s website. The agenda for the September meeting was posted less than a week before the meeting’s start.

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As in earlier hearings concerning Robert F. Kennedy’s performance as secretary of the Department of Health and Human Services, the focus was on Sen. Bill Cassidy (R-La.), who cast the deciding vote as HELP Committee chair to confirm Kennedy early this year. Since that vote, Cassidy has repeatedly expressed skepticism about Kennedy’s leadership.

Cassidy noted that when Kennedy swore in Monarez on July 31, he extolled her “unimpeachable scientific credentials.” Less than a month later, she was fired. “What happened?” Cassidy said. “Turmoil at the top of the nation’s top public health agency is not good for the health of the American people.”

Monarez said she came into the job aligned with Kennedy’s goals of improving America’s health and was open to changing the policies and structures at the CDC. She wasn’t ready to compromise her scientific judgment, however.

“I could have kept the office, the title, but I would have lost the one thing that cannot be replaced: my integrity,” she said.

Monarez said that at an Aug. 25 meeting, Kennedy demanded she fire senior scientists and agree to approve all changes in vaccine policy put forward by the new members of the Advisory Committee on Immunization Practices. In June, Kennedy fired its members and replaced them with a smaller group that includes leading opponents of the U.S. vaccination program.

When Monarez refused both requests, she said, Kennedy told her to resign. She refused, and the White House fired her, she said.

Kennedy, in testimony this month, denied he’d made the ultimatums and said Monarez had lied. Republican senators repeated that claim at Wednesday’s hearing. Markwayne Mullin of Oklahoma said a recording of the Aug. 25 meeting contradicted Monarez’s account. But later in the hearing, Cassidy said that Mullin had retracted his statement, saying there was no such recording.

The hearing appeared to confirm reports that Kennedy intends to change the childhood vaccine schedule, moving initially against recommending a hepatitis B vaccination shortly after birth, a practice the CDC has supported for more than three decades.

The that children be vaccinated against 16 pathogens with about 25 shots, sprays, or oral vaccinations in their first two years of life. The vaccines protect kids against such diseases as influenza, measles, whooping cough, meningitis, diarrhea, chickenpox, cancer, and pneumonia. It’s up to states to decide which vaccinations are required for schoolchildren.

Sen. Lisa Blunt Rochester (D-Del.) noted that for decades universal vaccination of newborns for hepatitis B has reduced case rates of the disease among young people by 99%, as reported by 麻豆女优 Health News. Sens. Ashley Moody (R-Fla.), Ed Markey (D-Mass.), and Cassidy (R-La.) asked about plans, first reported by 麻豆女优 Health News, for ACIP to vote to recommend pushing the first dose of the hepatitis B vaccine from the hours after birth to age 4.

Cassidy, in closing the hearing, spoke gravely of the dangers of ending the hepatitis B dose for newborns. He noted that before 1991 as many as 20,000 babies would become infected with hepatitis B, often leading to liver disease and sometimes death. Today, fewer than 20 babies a year contract the virus from their mothers, he said.

“That is an accomplishment to make America healthy again, and we should stand up and salute the people that made that decision,” he said.

Asked by reporters after the hearing whether the American public should have confidence in the advisory committee if it votes to delay the hepatitis B dose for newborns, he replied, “No.”

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“There is going to likely be a discussion about hepatitis B vaccine, very specifically trying to dislodge the birth dose of hepatitis B vaccine and to push it later in life,” said Demetre Daskalakis, of the National Center for Immunization and Respiratory Diseases. “Apparently this is a priority of the secretary’s.”

The vote was expected to take place during the next meeting of the CDC’s Advisory Committee on Immunization Practices, scheduled for Sept. 18-19.

For more than 30 years, the first of three shots of hepatitis B vaccine has been recommended for infants shortly after birth. In that time, the potentially fatal disease has been virtually eradicated among American children. Pediatricians warn that waiting four years for the vaccine opens the door to more children contracting the virus.

“Age 4 makes zero sense,” pediatrician Eric Ball said. “We recommend a universal approach to prevent those cases where a test might be incorrect or a mother might have unknowingly contracted hepatitis. It’s really the best way to keep our entire population healthy.”

In addition to the hepatitis B vaccine, the panel and vote on recommendations for the combined measles, mumps, rubella, and varicella vaccine and covid-19 vaccines. Pediatricians worry changes to the schedules of these vaccines will limit access for many families, leaving them vulnerable to vaccine-preventable diseases.

Typically, ACIP would undertake an analysis of the data before recommending a change to vaccine guidelines. As of the end of August, this process had not begun for the hepatitis B vaccines, Daskalakis and another former official said.

“This is an atypical situation. There’s been no work group to discuss it,” Daskalakis said.

The second former senior official spoke to NPR and 麻豆女优 Health News on the condition of anonymity.

In response to questions from 麻豆女优 Health News, HHS spokesperson Andrew Nixon wrote, “ACIP exists to ensure that vaccine policy is guided by the best available evidence and open scientific deliberation. Any updates to recommendations will be made transparently with gold standard science.”

The draft agenda for the upcoming ACIP meeting was released to the public less than a week before it is scheduled to begin.

At the last ACIP meeting, in June, Martin Kulldorff, the chair and one of seven new members handpicked by Kennedy, questioned the need to vaccinate every newborn, citing only two of the many ways the virus can spread. Kulldorff is a former Harvard Medical School professor who became known for during the pandemic.

“Unless the mother is hepatitis B positive, an argument could be made to delay the vaccine for this infection, which is primarily spread by sexual activity and intravenous drug use,” he said.

The virus spreads via direct exposure to an infected bodily fluid like blood or semen. The disease has no cure and can lead to serious conditions like cirrhosis and liver cancer later in life. The CDC advisory panel may maintain the recommendation to inoculate newborns whose mothers have hepatitis B or are considered at high risk of the disease, the former officials said.

Protection From Birth

In 1991, federal health officials determined it was advisable for newborns to receive their first dose of the hepatitis B vaccine within , which blocks the virus from taking hold if transmitted during delivery. While parents may opt out of the shots, many day care centers and school districts of hepatitis B vaccination for enrollment.

The prospect of ACIP’s altering the recommendation has left some people living with the virus deeply unsettled.

“I am goddamn frustrated,” said Wendy Lo, who has lived with the liver disease, likely since birth. Years of navigating the psychological, monetary, medical, and social aspects of chronic hepatitis B has touched almost every aspect of her life.

“I would not want anyone to have to experience that if it can be prevented,” she said. Lo learned she had the disease due to a routine screening to study abroad in college.

Lo credits the vaccines with protecting her close family members from infection.

“I shared with my partner, 鈥業f you get vaccinated, we can be together,’” she said. He got the vaccine, which protects him from infection, “so I’m grateful for that,” she said.

The CDC estimates half of people with hepatitis B they are infected. It can range from an acute, mild infection to a chronic infection, often with . Most people with chronic hepatitis B were born outside of the U.S., and Asians and Pacific Islanders Black people have the highest rates of newly reported chronic infections.

When her children were born, Lo was adamant that they receive the newborn dose, a decision she says prevented them from contracting the virus.

The earlier an infection occurs, , according to the CDC. When contracted in infancy or early childhood, hepatitis B is far more likely to become a chronic infection, silently damaging the liver over decades.

Those who become chronic carriers can also unknowingly spread the virus to others and face an increased risk of long-term complications including cirrhosis and liver cancer, which may not become evident until much later in life.

“Now I’m in my 50s, one of my big concerns is liver cancer. The vaccine is safe and effective, it’s lifesaving, and it protects you against cancer. How many vaccines do that?” Lo said.

Thirty Years of Universal Vaccination

Treatments like the antivirals Lo now takes weren’t available until the 1990s. Decades of the virus’s replicating unchecked damaged her liver. Every six months she gets scared of what her blood tests may reveal.

After a vaccine was approved in the 1980s, public health officials initially focused vaccination efforts on people thought to be at highest risk of infection.

“I, and every other doctor, had been trained in medical school to think of hepatitis B as an infection you acquired as an adult. It was the pimps, the prostitutes, the prisoners, and the health care practitioners who got hepatitis B infection. But we’ve learned so much more,” said , a professor of infectious diseases at the Vanderbilt University School of Medicine and a former voting member of ACIP.

As hepatitis B rates remained stubbornly high in the 1980s, scientists realized an entire vulnerable group was missing from the vaccination regime 鈥� newborns. The virus is from an infected mother to baby in late pregnancy or during birth.

“We may soon hear, 鈥楲et’s just do a blood test on all pregnant women.’ We tried that. That doesn’t work perfectly either,” Schaffner said.

Some doctors didn’t test, he said, and some pregnant women falsely tested negative while others acquired hepatitis B after they had been tested earlier in their pregnancies.

In 1991, Schaffner was a liaison representative to ACIP when it voted to for hepatitis B before an infant leaves the hospital.

“We want no babies infected. Therefore, we’ll just vaccinate every mom and every baby at birth. Problem solved. It has been brilliantly successful in virtually eliminating hepatitis B in children,” he said.

In 1990, there were 3.03 cases of hepatitis B per 100,000 people 19 years old or under in the U.S., according to the CDC.

Since the federal recommendation to vaccinate all infants, cases have dramatically decreased. shows that in 2022 the rate among those 19 or under was less than 0.1 per 100,000.

While hepatitis B is often associated with high-risk behaviors such as injection drug use or having multiple sexual partners, note that it is possible for the virus to be transmitted in ordinary situations too, including among young children.

The virus can survive for outside the body. During that time, even microscopic traces of infected blood on a can pose a risk. If the virus comes into contact with an open wound or the mucous membranes of the eyes, an infection can occur. This means that unvaccinated children not considered at high risk can still be exposed in everyday environments.

Future Access Uncertain

If the CDC significantly alters its recommendation, health insurers would no longer be required to cover the cost of the shots. That could leave parents to pay out-of-pocket for a vaccine that has long been provided at no charge. Children who get immunizations through the federal program would lose free access to the shot as soon as any new ACIP recommendations get approved by the acting CDC director.

The two former CDC officials said that plans were underway to push back the official recommendation for the vaccine as of August, when they both left the agency, but may have changed.

Schaffner is still an alternate liaison member of ACIP, and hopes to express his support for universal newborn vaccination at the next meeting.

“The liaisons have now been excluded from the vaccine work groups. They are still permitted to attend the full meetings,” he said.

Schaffner is worried about the next generation of babies and the doctors who care for them.

“We’ll see cases of hepatitis B once again occur. We’ll see transmission into the next generation,” he said, “and the next generation of people who wear white coats will have to deal with hepatitis B, when we could have cut it off at the pass.”

We’d like to speak with current and former personnel from the Department of Health and Human Services or its component agencies who believe the public should understand the impact of what’s happening within the federal health bureaucracy. Please message 麻豆女优 Health News on Signal at (415) 519-8778 or .

麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

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