A recent federal decision to change how newborns receive the hepatitis B vaccine has raised concerns among Missouri health leaders, who warn the shift could put Black and low-income babies at higher risk of infection.
The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted to end its long-standing recommendation that all newborns receive the hepatitis B vaccine at birth. Under the new guidance, babies born to mothers who test negative during pregnancy may wait until at least 2 months old to receive the first dose.
The U.S. Department of Health and Human Services says the change gives parents more choice and aligns the United States with vaccination practices in other developed countries. HHS Secretary Robert F. Kennedy Jr., who has long questioned the safety and effectiveness of some vaccines, has emphasized potential risks since taking office in early 2025 — a focus public health experts say departs from long-standing immunization practices.
According to “The Conversation,” a nonprofit news organization dedicated to unlocking knowledge for the public good, before the United States began vaccinating all infants at birth with the hepatitis B vaccine in 1991, around 18,000 children every year contracted the virus before their 10th birthday– about half of them at birth. Today, fewer than 1,000 U. S. children or adolescents contract the virus every year – a 95% drop. Fewer than 20 babies are reported infected at birth.
Doctors and public health officials in Missouri say the new approach depends too heavily on early and consistent prenatal care — something many families do not always receive.
More than 40% of births in Missouri are covered by Medicaid, according to the Missouri Department of Social Services. Many pregnant patients rely on community clinics or safety-net health centers, where delays in care and gaps in insurance coverage are common, increasing the likelihood that hepatitis infections go undetected before birth.
Health care providers say removing the universal birth dose eliminates a simple and proven layer of protection for newborns, particularly those born into families already facing barriers to care.
Dr. Kendra Holmes, president and CEO of Affinia Healthcare, said the policy replaces a clear safeguard with a system that assumes testing and prenatal care will occur on time.
“For 30 years the CDC has recommended this universal Hep B vaccine at birth,” Holmes said. “So, now they’re changing that to more of a risk stratification model that limits vaccinations to children born to moms who have tested positive for hepatitis B or have an unknown status.
“What this does is remove a crucial safety net that disproportionately endangers Black and Brown babies because we are the ones who experience more delays in prenatal care and more disruptions in Medicaid coverage.”
Missouri law requires pregnant patients to be tested for hepatitis B, hepatitis C and syphilis at their first prenatal visit, typically in the first trimester. But about 25% of pregnant women in the state do not begin prenatal care until after the first trimester, according to the March of Dimes. State health data also show Missouri lags the national average in adequate prenatal care.
“If you have delayed care, you’re not going to be tested properly and in a timely way for hepatitis,” Holmes said. “If you don’t have Medicaid coverage — and of course they’re working to roll that back — that’s going to disrupt your ability to have prenatal care.”
Holmes said testing alone does not always protect newborns because some infections do not immediately appear.
“You can be infected with hepatitis B, but you may not get a positive result for up to six to eight weeks,” she said.
Dr. Kanika Cunningham, director of the St. Louis County Department of Public Health, said the policy change could undo years of progress in preventing hepatitis B transmission at birth.
“Hearing this news that they want to undo what has been a well-researched practice … that can really set families back,” Cunningham told the Missouri Independent. “I’m really concerned about the impact on the most vulnerable, our babies, contracting it.”
Doctors nationwide have raised similar concerns. Susan Kressly, president of the American Academy of Pediatrics, called the guidance “irresponsible and purposefully misleading” and warned it could lead to more infections, while reaffirming support for vaccination at birth.
Hepatitis B attacks the liver. Babies infected at birth have a 90% chance of developing chronic hepatitis B, Holmes said — a condition that can lead to liver failure, liver cancer and death.
At a recent press conference, Dr. Ronald G. Nahass, president of the Infectious Diseases Society of America, criticized the decision as a rejection of decades of scientific evidence.
“This will result in more disease, more suffering, more confusion and yes, less trust,” Nahass said.
Holmes said the hepatitis B policy change reflects broader federal health priorities that often overlook communities facing the greatest risks. She pointed to recent efforts to expand testing and treatment for Lyme disease.
Lyme disease affects White Americans at much higher rates than Black Americans, according to CDC data, and more than half of reported cases occur in males.
“These health policies impact the health of Black and Brown babies,” Holmes said. “It’s very clear — if people are paying attention — that these health policy changes and priorities are increasing racial disparities in health care for Black and Brown people.”
Sylvester Brown Jr. is the Deaconess Foundation Community Advocacy Fellow.