A federal advisory panel has proposed a significant alteration to the longstanding hepatitis B vaccination guidelines for newborns. This week, the Advisory Committee on Immunization Practices (ACIP) voted to recommend that most parents delay the first dose of the vaccine until their child reaches two months of age.

In an 8–3 decision, the committee’s vote marks a notable revision to a policy that has been in place for over 30 years.

This recommendation specifically pertains to infants born to mothers who test negative for hepatitis B during pregnancy. For newborns whose mothers are infected or whose hepatitis B status is unknown, the current protocol, which requires a dose within 12 to 24 hours of birth, will remain unchanged.

The revised guidance encourages parents to consult with their healthcare providers about the timing of the vaccination and whether to administer it at birth or delay it. Additionally, a second vote, passed by a 6–4 margin with one abstention, advises parents who opt for vaccination to consider testing their child after the initial dose to determine the necessity of further doses.

Before this change can be implemented, it requires approval from acting CDC Director Jim O’Neill or Health Secretary Robert F. Kennedy Jr. If the Health Secretary endorses this recommendation, it would represent one of his most significant actions on vaccine policy since assuming office. Notably, the Health Secretary founded the anti-vaccine organization Children’s Health Defense and has previously replaced all ACIP members, appointing several vaccine skeptics to the panel.

Medical experts who spoke at the meeting opposed altering the decades-old recommendation. Former ACIP chair José Romero criticized the shift, calling it “… an historic departure from the role ACIP has played in shaping vaccine policy in the United States, when we could expect science to inform decisions, experts to debate evidence, and consensus to drive shared, clear recommendations.”

“Rather than advance sound vaccine policy, this ACIP sowed doubt in the vaccines themselves,” he said.

Public health officials warn that postponing the birth dose could have long-term consequences. A new modeling analysis suggests that delaying vaccination until 2 months could result in more than 1,400 newborns becoming chronically infected within the first year, potentially leading to hundreds of future cases of liver cancer and hepatitis B–related deaths.

The current birth-dose policy, introduced in 1991, led to infections in infants dropping from hundreds annually to fewer than two dozen. Panel experts note that the revision was driven by parental concerns, comparisons to European vaccine schedules, and the amount of time since the last evaluation.

An ACIP working group is now reassessing the entire childhood vaccine schedule.