CDC Advisers Postpone Vote on Infant Hepatitis B Vaccine Recommendation
Advisers to the Centers for Disease Control and Prevention (CDC) postponed scheduled votes on Thursday concerning proposed changes to the recommendation for universal immunization of newborns against hepatitis B. The Advisory Committee on Immunization Practices (ACIP) rescheduled the votes for Friday, citing confusion and disagreement over the proposed language.
Committee Proceedings
The committee meeting included significant discussion and debate among members. Dr. Joseph Hibbeln, a voting member, stated that the committee had received "the third version of the questions... in 72 hours" and expressed a protest regarding the description that ACIP members had been consulted in developing these questions.
The intended vote aimed to address the long-standing recommendation to vaccinate all healthy newborns against hepatitis B, irrespective of the mother's viral status. The language of the vote was modified during the day, leading some members to request additional time for written review.
Current Policy and Disease Information
The existing recommendation seeks to ensure protection for all U.S. children against the hepatitis B virus, which can cause severe health issues. This policy has been a key component of efforts to eliminate hepatitis B in the United States over several decades.
Hepatitis B can transmit from mothers to infants during childbirth and through contact with infected body fluids in infancy. The virus affects the liver, and chronic infection can result in liver cancer, cirrhosis, and mortality. Infants infected with the virus face significantly higher risks of these outcomes. There is no known cure for hepatitis B.
Divergent Views on Policy Change
Discussion on Thursday revealed differing perspectives among attendees regarding a change to the recommendation.
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Support for Policy Change: Dr. Tracy Beth Høeg, representing the Food and Drug Administration (FDA), questioned the necessity of the universal policy. She remarked that for "babies who are born without high risk factors," the "potential for benefit is so low." She further noted that "high income nations throughout the world are not" making such a universal recommendation.
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Defense of Current Policy: Dr. Cody Meissner, a professor of pediatrics at Dartmouth's Geisel School of Medicine and a current ACIP member with previous service, defended the existing policy. He stated that the disease had decreased in the United States due to the current immunization program's effectiveness. When challenged by adviser Robert Malone to qualify this statement as opinion, Dr. Meissner responded, "These are facts, Robert."
Concerns from Medical Professional Groups
Nonvoting liaisons from medical professional organizations voiced concerns regarding the committee's process, noting it deviated from standard ACIP procedures. Dr. Jason Goldman, a liaison for the American College of Physicians, expressed concerns that the committee's actions promoted an "anti-vaccine agenda" without sufficient data and evidence, potentially failing ethical obligations.
Broader Context and Future Agenda
The postponement has resulted in a condensed agenda for Friday. In addition to the hepatitis B policy vote, the committee is scheduled to discuss the U.S. vaccine schedule compared to international practices and the potential links between aluminum adjuvants, used in some vaccines to enhance effectiveness, and asthma. The consensus among many medical professionals is that there is insufficient evidence to suggest aluminum adjuvants are unsafe, and ample evidence indicating no significant concern.
Public health experts have expressed concerns that recent operational adjustments within the committee could affect vaccine access in the U.S. ACIP's recommendations hold significant influence, guiding medical professionals and determining insurance coverage for vaccinations. Since new members were appointed in June, there have been observations regarding reduced collaboration between the committee and mainstream medical groups, as well as less reliance on the expertise of CDC specialists.