The CDC, RFK Jr., And Childhood Vaccine Schedules

0:07On Friday, the Centers for Disease Control and Prevention's Vaccine Advisory Panel voted to end a recommendation that all newborns be immunized at birth against hepatitis B. That guidance had been in place for more than 30 years. Hepatitis B is a highly infectious virus that can cause severe liver damage, including cirrhosis and cancer. The new members of the Advisory Committee on Immunization Practices, also called ACIP, were handpicked by Health and Human Services Secretary Robert F. Kennedy Jr. That's after Secretary Kennedy, in June abruptly fired all 17 members who were serving on the panel when he took over HHS.

0:43That led top officials at the CDC to resign in protest. His new members have publicly stated they want to revisit the entire childhood vaccine schedule. After the panel's Friday meeting, President Donald Trump expressed support for such a review, instructing Kennedy to study how U.S. childhood vaccine policy differs from, quote, peer-developed countries. So how might this recommendation to end the hepatitis B shot for newborns affect public health? And what's next for childhood vaccinations? We get to those questions and so much more after this short break. I'm Jen White. You're listening to the 1A Podcast.

1:17Back with more in just a moment. Stay with us.

1:24Here to guide us through all of it is Michael Osterholm. He's a professor at the University of Minnesota School of Public Health, where he directs the Center for Infectious Disease Research and Policy. Michael, welcome back to the program. Thank you. Also joining us from Saskatoon in Canada is Angela Rasmussen. She's a virologist at the University of Saskatchewan and co-editor-in-chief of the journal Vaccine. Angie, welcome back. Thanks for having me, Jen. So Michael, just tell us a little bit more about this new recommendation made by ASIP regarding the hepatitis B vaccine and how it differs from the recommended practice of the last 30 plus years.

1:58I think it's very important to emphasize the fact, number one, that the overall review of this vaccine did not change from what it was prior to this meeting. Our center, which has an activity called the Vaccine Integrity Project, actually did an extensive review of more than 400 studies and showed that the birth dose is highly effective and has a very strong safety profile. And a point to emphasize, it remains available to protect your newborn. So you can still get it. Now you have to do that in consultation with your physician or nurse practitioner. And I think it's really important that parents should make sure they ask for it if it's not offered.

2:40And I know that hospitals and clinicians are going to continue to recommend it. But what they did with the recommendations, instead of making it that where a parent could say, is this vaccine recommended? You could say, yes, you should get it. Now you can't say that. You have to say, well, it's recommended later, but not now. And I think that's the challenge is we've put something in place, a solution looking for a problem just that confuses parents even more. Angie, what are the risks associated with the hepatitis B virus? So hepatitis B virus is a really durable virus. I'm going to say that right up front.

3:16Unlike many of the RNA viruses like COVID, SARS-2 that we're familiar with, hepatitis B virus is a DNA virus. And so it can actually stick around in the environment and remain infectious for quite a long period of time. And historically, this has actually made it very difficult to prevent transmission in a household setting. So one thing that Secretary Kennedy and members of the ACIP have said recently is that hepatitis B is only transmitted by sexual contact and drug use. And that's just simply not true. What happens is you get infected with hepatitis B. In a large proportion of people who do get infected, they develop a chronic infection that can last for years.

3:57And years or even sometimes decades later, that can develop into liver cancer. One of the things that I think is most insidious about hepatitis B virus is that during that period when you're chronically infected, many people don't have symptoms. So they actually may not know if they're infected. And this actually creates a pretty significant risk for anybody who is not vaccinated, who lives in a household with an infected person. We got this message from Matt in Silver Spring, Maryland. As a progressive, I've been very disappointed in the reaction of the medical community to the recent decision to make changes to the vaccination recommendation.

4:31The truth is that this immediate vaccination is only necessary for children who are born to mothers who are hep B positive. If nobody in the home has the disease, it's perfectly safe to wait until the infant has a regular checkup with their pediatrician. The insistence that all babies be vaccinated immediately after their birth has never been supported by any medical science, and the knee-jerk reaction against this common sense policy update just undermines the scientific community. I'd love to hear both of your reactions to that, Michael. Yeah, well, let me just say right out front that the listener is wrong, just plain wrong.

5:02And what I mean by that is that we have made an attempt, dating back to the 1980s, to interrupt transmission from that infected mom to that yet unborn child and have been unsuccessful because there are so many cracks in our health care system and the safety net that's there. So in fact, if you look at what has happened over time is that up to 18 % of women are never tested ever before they deliver a child because that's what they're presenting often for the first time for medical care at the delivery. We have seen over and over again individuals who, even when they had the data available to say that the mom was or wasn't infected, it was not used.

5:43And so what happened was by 1991, after having been unsuccessful in driving down the numbers of individuals who were infected because of this mode of transmission, the decision was actually made to then just blanket it, just like you do seatbelts. You don't have a discussion every morning when you buckle your child into their car seat and seatbelt and say, well, today might be the day, but today isn't. I haven't had an accident in years, so why do I need to do that? You need to be ready all the time. And so because this is such a safe vaccine, as Angela will tell you, this is one of the very safest vaccines we have, even for minor reactions.

6:19And so there's not really a downside to vaccinating the child, even if the mother, in fact, is not infected. And in fact, it starts the protection that will be there for later in life when the other modes of transmission that are so frequently talked about might occur when you're 18 or 20 or 25. And so I think the bottom line message we have to get across is that we have tried all these other methods, and we have only seen a 95 percent reduction in transmission from an infected mom to their baby by using this approach that we just described. Well, we reached out to the CDC for comment about the panel's recommendation, and they pointed us to their press release.

6:57It described ACIP's recommendation as, quote, individual-based decision-making, which means, quote, parents and health care providers should consider vaccine benefits, vaccine risks, and infection risks, and that parents consult with their health care provider and decide when or if their child will begin the hepatitis B vaccine series, end quote. Angie, we'll talk a little bit more about the committee members in a bit. But in the discussion about the hepatitis B vaccine, members of the panel pointed to Denmark as a counterpoint to current U.S. policy. There, they don't give the shot at birth. They wait until babies are a bit older.

7:30Denmark has national health care. They also have higher rates of prenatal screening for hep B. So what do you think of using Denmark's model as a basis for making public health recommendations in the U.S.? Well, I think that using Denmark or any other country really to set U.S. vaccine policy is really a mistake. While there may be other countries that are peers in the sense that they are wealthy, developed nations with health care systems and with robust economies, Denmark is a very different country than the U.S. And the U.S. is a very large country geographically. It has a very large population.

8:07It has a different population than other countries, including Denmark. So it's really not comparable because there will be different levels of vaccine uptake. As Mike just pointed out, there is not universal prenatal screening for infection in mothers. So a country like Denmark that does have a national socialized medicine health care system, they are able to offer that screening universally. So the risk to infants is actually much different than it is here in the U.S. The other issue is that in different countries with different population sizes and different levels of immigration, different people, people doing different things, doing different occupations, things like that, people will have different prevalences of certain diseases, including HBV.

8:52And so the recommendations for Denmark are not necessarily going to apply for the U.S. because we have different patterns of disease prevalence here in the U.S., as well as different levels of vaccine uptake. The countries are not really comparable and we shouldn't be making U.S. policy based on what happens in other countries and what's right for them. We should be making policies based on the U.S. and what is right for the American people. Let's go back to our voice bill box. Here's a message we got from one of you. When my son was born in 1999, I questioned why he needed a hepatitis vaccine so soon after birth.

9:26I believe the immune system should be allowed a chance to develop on its own. I do support vaccines, but I think they should be given with thought. Michael, we heard from several people questioning whether a newborn's system can handle a vaccine or whether it might be better to wait. What can you tell us? Well, in fact, this is a very important question. Thank you for asking it. Do you remember that this child is being overwhelmed at birth if, in fact, the mother is infected with the virus and the actual exposure of the birthing process? So what this vaccine is really doing is competing and trying to rev up the immune system in a faster time period than the virus that might be transmitted from the mom so that it can actually prevent that infection from taking hold.

10:11So from the very moment we're born, we start being exposed to antigens or different kinds of chemical that could, in fact, cause an immune response. And it does not take the body's time from an immune system standpoint for it to adjust for things like the virus or the vaccine for hepatitis B. Angie, from a public health perspective, what do you make of this individual-based decision-making approach recommended by ASAP? Well, you know, I don't think that it's actually intended to support public health. You know, the discussion always comes down to this individual decision making or sometimes what's called shared clinical decision making, which is the idea that somebody sits down with their doctor and decides if it's right for them.

11:00The fact is, people can already do that. ASAP makes recommendations. They don't make mandates. And so people already are capable of doing this individual decision making. They already will have to provide informed consent before receiving any vaccines or before agreeing to have their children be vaccinated. So this was already in place. I think that what framing this as individual decision-making does is it really disguises the fact that the ACIP is discouraging people from getting the birth dose of hepatitis B. And if you read the recommendation closely, it recommends delaying the birth dose at least two months.

11:38So they actually say that you could potentially delay it even longer. That would put those children at risk for infection for an even longer period of time. And that is really the part of the recommendation that I think is really detrimental to public health because it's actively discouraging people from getting a vaccine that would protect them. We got this question from Mo in Baltimore. How do we move forward with adhering to recommendations from these oversight committees and government agencies? These were created to help create guidelines for the masses so that they themselves do not have to sift through dozens of studies and information to know how to properly care for themselves and their loved ones.

12:16Michael, any advice? Well, I think at this time, you know, we are bombarded with information that's coming down from so many different sources. And one of the things I just wanted to add in context here is an issue that we just mentioned when you said the CDC made a statement. I think it's really important for the public to understand at this moment, you can no longer trust the U.S. federal government with any information around public health issues across the board and specifically vaccines. And what leads you to that conclusion? Because that's a strong statement to make, Michael. It's a very strong statement.

12:53And let me remind you, I've been in this business 51 years, and I have been one of the strongest supporters of CDC over that time period and believe that it has been an invaluable organization. But right now, it is not the CDC it once was. It is an organization that's led largely by ideologically driven individuals. Much of the scientific expertise that was at CDC has been let go. And while there are still many very talented, committed individuals who work there, they do not represent the messaging that is coming from CDC or the ACIP. And the ACIP is in the same position. We had a very talented, highly skilled ACIP that was fired last spring and replaced with people who are ideologues.

13:38And so we have to let the public know you can't trust any of the information coming from CDC today on vaccines. And that, I think, is the consensus of all of my colleagues, too. Very hard to hear. I agree with that. Well, that leads me to this fact. The American Academy of Pediatrics states that whether or not the CDC adopts the change, again, ACIP made a recommendation. The American Academy of Pediatrics will continue to recommend that newborns receive the hepatitis B vaccine. Insurance companies also say they will continue to cover that shot. Some state public health agencies say their recommendation won't change.

14:15So Angie, what is the significance of this vote by the panel? So I think the significance of this vote by the panel is it really is part of the ongoing effort by this administration. And we see this in President Trump's presidential memorandum that came out immediately after the meeting ended to re-examine the entire childhood vaccine schedule. That is the goal of what the ACIP is doing. They, while state, local public health departments and organizations like AAP are going to make their recommendations, they still are fragmented. You know, there's this new economy, I guess, of these public health organizations making other recommendations.

14:59And that's wonderful because I agree with those recommendations being evidence-based. But at the end of the day, people have historically looked to the CDC. And ASIP was previously, until June, a model for the rest of the world in terms of how to decide vaccine policy and make recommendations. So a lot of people will still continue to look to the CDC, even though, as Mike said, the CDC is politically compromised. They are not providing information that is based on evidence or science. They are providing information that advances their political agenda and people cannot trust that. But unfortunately, because of their history of trust and their history of excellence, people will continue to do so.

15:43And that I think is really, really dangerous. If doctors across the country stop looking to bodies like ACIP, Michael, where are they in their medical organizations turning to get information about vaccines and recommendations about when and which to give? Well, that's one of the things that we're really working out right now, you might say. First of all, keep looking to your medical associations, to the societies. They are, in fact, I think, acting with a great deal of thoughtfulness and care around this issue. And so, as we just talked about the American Academy of Pediatrics, they have continued to make the kind of recommendations that are in keeping with the best science.

16:20Our Center of Vaccine Integrity Project has worked hard to deliver a very comprehensive review of these different vaccines so that when the societies do make decisions, they have before them a body of information. We did that with the hepatitis B effort recently and trying to help the medical societies come up with the kind of recommendations that we should continue to listen to and follow. Let's take a quick pause here. We'll be back with more of the conversation in just a moment.

16:53Let's get back into the discussion with this message we got from Keith. I did a two-year pediatric residency at Rancho Los Amigos Hospital in Downey, California. It was originally built as a destination to house victims of polio. And as you walk through the halls, you would see all these pictures of vast gymnasium-sized rooms. filled with people in iron lungs. Vaccines are the greatest innovation of our lifetime. People who don't want to vaccinate their kids really need to talk to their grandparents and older people to understand what it was like when polio or diphtheria came to town and the entire population stopped going to work, stopped going to church, stopped going to theaters, because they were afraid to be with people.

17:52Thanks for that message. Now, by all accounts, the last two meetings of the Vaccine Advisory Panel have been chaotic. Votes have been delayed. Members have been asked to vote without knowing exactly what they're voting on. There's been a great deal of sniping. Here's a clip of an exchange from last Thursday between Dr. Joseph Hibbel and Dr. Robert Malone, who was chairing the meeting, and they were discussing how to evaluate the science. If we don't have a scientific framework, They are susceptible. And we have heard we have heard your comments. And please understand that there that there is a process in place.

18:25Please do not interrupt me. Angie, tell us more about the members of this panel and what experience they bring. Yeah. So in June, the members of the ACIP who had been appointed prior to Trump, assuming the presidency, were all fired by Secretary Kennedy. And they were replaced with eight people, many of whom are openly anti-vaccine. They're not just anti-vaccine skeptics. They are actually anti-vaccine. They are opposed to vaccination. Several other members have no history of vaccine skepticism, but they are relatively unexperienced or they have no experience essentially in studying vaccines, in studying immunology and studying infectious diseases or making vaccine policy or public health policy.

19:14So the overall composition of the ACIP, there's several new members have been added since then that also have similar beliefs, is largely composed of people who are at the very least skeptical of vaccines and in some cases are outright hostile towards them. Dr. Malone, who was in that clip that you just played, is very hostile towards vaccines. He believes that mRNA vaccines are toxic and the spike protein is toxic and that it kills people essentially, which is not true. What happened in that exchange, what was reflected there is that Dr. Hibblen, who is a retired captain in the public health service, he's a psychiatrist and specializes in diseases of the brain.

19:58He was referring to the old framework that ACIP used to use. So ACIP had different types of frameworks for going through the evidence and evaluating it in a standardized and objective way, and then using that to make recommendations that could be voted on and turned into policy. Dr. Hibblen was objecting to the fact that Dr. Malone and his consort on the ACIP have essentially thrown those frameworks out. So they are making decisions now without using these standardized methods to evaluate the evidence. They're essentially making decisions based on their own opinion of the evidence, which is historically not how vaccine decisions have been made.

20:38They have been made with these standardized frameworks to ensure that there's consistency and also that there is fairness. And these vaccines are evaluated in a completely objective, scientific way rather than based on ideological beliefs. We got this question from one of you. Has the committee ever said no to a vaccine? Michael, As you said, you've been doing this work for over 50 years. Has a vaccine ever not been recommended? In fact, there have been a number of examples where vaccines were altered in the recommended approach that was being taken at the time, a decision made to change the approach.

21:17And so that has happened. And it's always happened within that spirit, though, of the scientific data. You know, that is what drives the discussion. And so, yes, that body is hardly a rubber stamp body. It's one that reflects the expertise of all the different members that are on there. They're chosen for that. In addition, ACIP has put together a series of work groups that involve many, many individuals from the scientific world, from the community, from the professional organizations that spend many, many, many hours poring over these data, bringing a final conclusion to the table. What you saw at this recent ACIP meeting was conjecture, was basically flying by the seat of your pants kind of statements and conclusions.

22:03I mean, for example, one of the things they've recommended is now to get a blood draw, to actually test the child after vaccination to see how their antibodies do. Well, there's no data to support that that has any real meaningful impact on the child's health because what are the levels you're trying to look for? What are the means of having to come back in for additional visits? That was all suggested on the fly. The old ACIP, that would never have been acceptable, ever. And I think that's what the public has to remember, is that, in fact, there has been a standard that's worked. And it's worked very well to not only protect their children, but also to make sure that the vaccines they got were safe.

22:41Well, we got this comment from Zach in Georgia, who writes, I was a clinical epidemiologist at CDC until I was let go in September of 2025. I would like to second Michael's point. The current iteration of the CDC is ideologically driven. Although I was not in vaccine policy specifically, I was told that I could not research quote-unquote ideological topics like environmental exposures, social determinants of health, or gender and health. Although the career civil servants at the CDC are doing their best to provide the best information for the American people, many recommendations are incomplete, out of context, or a distortion of existing evidence.

23:18We also got this comment from Margaret in Virginia who writes, my only complaint about Hep B vaccine is the adjuvant aluminum. It is repeated twice and with other aluminum-containing vaccines likely has a cumulative effect. It is a known neurotoxin. Angie, I'd love for you to respond to that. Yeah, so this is a really good point. And I'm so glad that you raised this because there seems to be a lot of confusion between what is an aluminum salt and what is elemental aluminum or aluminum metal. So the vaccines contain aluminum salts and aluminum salts are essentially just like table salts, except instead of being made with sodium, they're made with the element or an ion from aluminum.

24:00These salts dissolve in liquid, just like table salt does. We actually consume large amounts of these salts in salt, actually if you use natural salt, in food and in drinking water. So we are actually exposed to these aluminum salts quite frequently. When they are injected with the antigen, which is the target of the immune system in a vaccine, they actually stimulate your immune system to respond more strongly, more robustly to that antigen. So you end up having more protective immune responses. You end up having more durable immune responses because the adjuvants are often used to induce immune memory.

24:39So the purpose of these aluminum salt adjuvants is really to make these inactivated vaccines like the hepatitis B vaccine work better. But they are very small quantities. They are tiny compared to the amount of aluminum salts that you would normally consume in your lifetime. and they do not accumulate. They do not result in little pieces of aluminum metal throughout your body. And I think that the discussion about aluminum salts and particularly a presentation that was given by ACIP member, Dr. Evelyn Griffin, really misled, I think, the public to think that people are actually accumulating large amounts of heavy metals in their body from these vaccines, when in reality, it's a chemical that is actually more like table salt and that does not stick around.

25:26We got this question from Janice who says, it would be useful to hear from your experts about the impact ACIP recommendations have on pricing and availability of vaccines, such as the Hep B vaccine. If companies cannot rely on a public health-driven population that will routinely get the vaccine, isn't it possible that companies will simply decide to no longer manufacture or at least to charge much more for the vaccine? Michael? Yeah, well, this is a very important point And we are very concerned about the fact that we have a very limited number of manufacturers of the routine childhood vaccines in this country.