The Centers for Disease Control and Prevention's decision to no longer recommend that infants receive a dose of the hepatitis B vaccine within 24 hours of birth could lead to hundreds of additional infections, worse health outcomes, and millions of dollars in increased healthcare costs, according to a new study published Monday in JAMA Pediatrics.
The CDC approved the change in December following a vote by the vaccine advisory panel under Health Secretary Robert F. Kennedy Jr. The agency now advises mothers who test negative for the virus to consult their healthcare providers about whether their newborns should receive the first dose within 24 hours. Those mothers are recommended to delay the initial dose until at least two months of age.
The shift has drawn sharp criticism from the medical community, which argues it undermines three decades of established guidance. Doctors and infectious disease experts say there is no evidence to support delaying the vaccine and worry it could lead to a resurgence of the virus. The United States has safely administered the hepatitis B vaccine at birth since 1991, a practice credited with nearly eliminating the disease among young children. Cases of hepatitis B infection in children have dropped by 99 percent.
Researchers used economic models to estimate the impact of the policy change. They found that the longer the delay, the higher the costs in human life and healthcare spending, ranging from $16 million to $370 million depending on the age of first vaccination and adherence to schedules. One analysis showed that delaying the hepatitis B series by two months among children born in a single year to parents who tested negative would increase lifetime healthcare costs by $16.4 million. A seven-month delay would add $19.8 million.
The researchers noted that their estimates were conservative because they assumed perfect adherence to the three-dose vaccine series. They also did not account for the rising risk of children contracting hepatitis B from household members or the community, which could increase if the number of people with HBV infections grows. Hepatitis B can be transmitted from mother to child during delivery, and not all pregnant women are screened. There is no cure.
All projections indicated that in unvaccinated groups, more individuals would progress to chronic infection or serious complications such as cirrhosis and liver cancer. The advisory committee's recommendation came after a discussion that included misinformation and cherry-picked data promoted by individuals with a history of vaccine skepticism, according to the study. The recommendation was partly based on low infection rates, but experts note that low incidence is a direct result of successful vaccination programs.
An editorial accompanying the study noted that birth-dose hepatitis B vaccination rates in the U.S. were already declining before the panel voted. Rates peaked at 83.5 percent in February 2023 but dropped to 73.2 percent by August 2025. The editorial said that the models would typically have been presented to the Advisory Committee on Immunization Practices (ACIP) to quantify the anticipated impact of changing the vaccine recommendation. However, the committee “did not consider the harms of delaying vaccination,” focusing instead “solely on theoretical safety concerns for infants, despite the absence of safety signals with more than 1 billion doses given worldwide since 1982.”
This development comes amid broader debates over vaccine policy. For instance, the Pentagon's optional vaccine policy has raised concerns about force readiness, as a former general warned of potential risks. Meanwhile, acting CDC chief Robert F. Kennedy Jr. has faced political firestorm for blocking a COVID vaccine study, underscoring the contentious landscape of public health decisions.
