The question of whether parents should vaccinate their newborns against hepatitis B is threatening to split the Republican Party between traditional conservatives and the Make America Healthy Again contingent.  

The hepatitis B vaccine has been a touchstone for the anti-vaccine movement since the universal birth dose of the vaccine was recommended in 1991, but it has come into new focus with the shifting of vaccine policy under Health and Human Services Secretary Robert F. Kennedy Jr.

Recommended Stories

• Thune dismisses Democrats demand to reach Obamacare subsidies deal before shutdown
• Wisconsin Planned Parenthood to stop abortions next week to avoid funding cuts
• Florida surgeon general defends Trump’s Tylenol warning, suggests similar state guidance coming

Medical professionals within the GOP, particularly in the Senate, are sharply divided on vaccinating newborns for hepatitis B, a virus that, in the long term, causes chronic liver disease and cancer.

Kennedy’s leadership at HHS and direction over the Centers for Disease Control and Prevention’s vaccine advisory panel raise the stakes of the internal party disagreement in part because the panel’s decisions could alter insurance coverage for the vaccine, an issue that might, in the long term, have political implications for voters, especially for parents of young children.

Kennedy selected the members of the CDC’s Advisory Committee on Immunization Practices this summer. They met in mid-September to reevaluate the hepatitis B recommendations. However, the committee postponed its vote indefinitely following several hours of intense debate and sharp disagreement.

Any changes in recommendations for the childhood vaccine schedule made by the ACIP and subsequently approved by the CDC director, including the infant dose of the hepatitis B vaccine, will alter insurance coverage through private and public plans.

An HHS spokesperson told the Washington Examiner that “it has not been determined yet” whether hepatitis B will be discussed at the next ACIP meeting, which is currently scheduled for late October.

Meanwhile, the leader of the GOP has weighed in squarely against vaccinating newborns for hepatitis B.

During a press event on the causes of autism on Monday, President Donald Trump praised ACIP’s re-evaluation of the hepatitis B vaccine and told parents to wait to vaccinate their child against hepatitis B.

“Hepatitis B is sexually transmitted. There’s no reason to give a baby that’s almost just born hepatitis B,” Trump said Monday.

Trump reiterated the point Friday morning, posting on Truth Social that children should “TAKE HEPATITAS B SHOT AT 12 YEARS OLD, OR OLDER, AND, IMPORTANTLY, TAKE VACCINE IN 5 SEPARATE MEDICAL VISITS.”

Infants most at risk for developing chronic hepatitis B

Bodily fluids exchanged from a hepatitis B-positive mother to her child during labor and delivery are a primary vehicle for children to be infected with the virus. Infants born to mothers who are hepatitis B-positive are most at risk for developing chronic hepatitis B. 

While only 2% to 6% of adults who contract acute hepatitis B will go on to develop a chronic infection, 90% of infants who contract the disease will have the disease their entire lives. About a quarter of those who contract chronic hepatitis B at birth will die from liver damage or liver cancer, according to the CDC. 

About 70% of the estimated 1.89 million people in the United States living with chronic hepatitis B were born overseas, mostly in Asia and Africa. Still, an estimated 25,000 infants are born to hepatitis B-positive mothers each year in the U.S. 

Although those most at risk for contracting acute hepatitis B are those who use intravenous drugs and homosexual males, the disease can also be spread through more casual contact, including through seemingly innocuous objects, such as shared toothbrushes and piercing or tattooing needles. 

Sen. Bill Cassidy (R-LA), chairman of the Senate health committee, has been one of the most vocal supporters of the universal infant dose of the hepatitis B vaccine because of his experience as a gastroenterologist specializing in liver disease.

During the height of the AIDS epidemic, Cassidy started a hepatitis B vaccination program for low-income patients at the facility he co-founded, the Greater Baton Rouge Community Clinic in Louisiana, which has highly influenced his position on the vaccine.

Earlier this month, Cassidy posted on X pictures of patients with cirrhosis from liver disease, saying that the hepatitis B shot is “about preventing illnesses like this.” 

“I have the experience of treating patients infected with hepatitis B at birth, who end up terribly ill like this,” said Cassidy. “Why would anyone want someone to end up like this?

MAHA pushes skepticism of Hepatitis B vaccine 

Several leading Republicans in the MAHA movement have questioned the need for vaccinating all infants on their first day of life and instead have suggested that only those born to hepatitis B-positive mothers should be vaccinated and treated within 24 hours of birth.   

Sen. Roger Marshall (R-KS) has championed this position, citing his 25 years as an OB-GYN physician. 

Marshall told CNN’s Jake Tapper earlier this month that testing for hepatitis is part of routine prenatal care and that physicians ought to get to know whether their patient has risk factors for the disease.

“There are people that need the Hepatitis vaccine. I’m just saying, not a one-day-old, and not every baby does,” Marshall said. If we don’t know the Hepatitis status of the mom, if it’s a patient that hasn’t got prenatal care, it’s a person that’s doing drugs, of course, that baby needs the Hepatitis vaccine.

Sen. Rand Paul (R-KY), an ophthalmologist who earned his medical degree from Duke University,  has also been an outspoken critic of the hepatitis B vaccine for newborns, arguing since at least 2015 that infants need not be inoculated against a sexually transmitted infection.

Over Labor Day weekend, Paul and Cassidy engaged in a heated back-and-forth on X regarding whether the vaccine is necessary if a mother delivering in the hospital tests negative. 

Paul posted during the debate that the “only logical reason moms would not be tested is malpractice” if they were to deliver in a hospital setting, adding that Cassidy “seems to claim the doctors are incompetent to do Hep B testing of moms, but perfectly able to perform universal vaccination.”

Vaccinating newborns for an STI

Trump, Paul, and other detractors of the infant hepatitis B vaccine argue that it is not necessary to vaccinate newborns for a sexually transmitted infection, appealing to common sense. 

This isn’t new. Critics of the hepatitis B vaccine have made similar points since the CDC recommended universal vaccination in the early 1990s, when most states required the inoculation for children to attend daycare or school.

Elena Conis, professor of journalism at the University of California, Berkeley, and historian on the portrayal of vaccines in the media, contends that this line of critique was at least in part influenced by the role of media coverage of the hepatitis B vaccine in the 1980s at the peak of the AIDS crisis. 

The first iteration of the vaccine went to market in 1981, and an even safer version was released in 1986, making it possible for the first time to start a mass vaccination campaign against hepatitis B. 

Journalists and scientists in the late 1980s, attempting to raise public awareness, emphasized how those most at risk for hepatitis B, homosexual men and intravenous drug users, were the same as those most at risk for contracting HIV. 

Media reports highlighted the hepatitis B vaccine as a “beacon of hope in a time of fear,” Conis argued in her 2011 paper on the history of the hepatitis B vaccine. This style of reporting eventually created the perception among non-medical professionals that hepatitis B is primarily an STI.

But by the early 1990s, the CDC recognized that it was practically impossible to target adults most at risk of contracting hepatitis B before they had been exposed to the virus. Their solution, outlined in a 1991 Morbidity and Mortality Weekly Report, was to vaccinate all newborns, regardless of maternal hepatitis B status. 

Cases of hepatitis B have precipitously dropped since the start of the universal vaccination policy. Still, Conis argues the association between hepatitis B and HIV stuck in the public consciousness and ultimately heightened skepticism of the vaccine among parents.

“Critics looked to early scientific representations of hepatitis B as a sexually-transmitted disease affecting specific strata of the adult population as evidence in support of their position,” wrote Conis.

GOP supporters of Hepatitis B vaccine raise alarm bells 

Although Cassidy has been the loudest proponent of the infant hepatitis B vaccine, other Republicans in the Senate have expressed frustration with Kennedy and Trump’s direction on vaccine policy, including hepatitis B.

Majority Whip John Barrasso (R-WY), an orthopedic surgeon by training, has said that he has become “increasingly concerned” about Kennedy’s leadership on vaccines since the measles outbreak in West Texas earlier this year, which claimed the lives of two children in an undervaccinated Mennonite community. 

Barrasso told Kennedy that “vaccines work” during a hearing before the Senate Finance Committee the week before the ACIP meeting.

“I’ve been hearing from many of my medical colleagues, people I know from medical school residency and when I practice medicine in Wyoming, and their real concerns that safe, proven vaccines like measles and hepatitis B and others could be in jeopardy, and that would put Americans at risk and reverse decades of progress,” Barrasso said.

Barrasso’s office declined to provide updated comments since his statements earlier this month, in light of the delayed decision from ACIP and Trump’s recommendation to delay the shot until puberty. 

Sens. Susan Collins (R-ME) and Lisa Murkowski (R-AK), both senior members of the Senate health committee, have also said that they are concerned by Trump’s remarks on vaccine policy and his recommendation that pregnant women not take Tylenol due to potential autism risks. 

Hepatitis B vaccine uptake still relatively high

Regardless of the controversy surrounding the infant dose of the Hepatitis B vaccine, comparatively few parents are choosing to skip or delay the inoculation.

According to a sweeping survey on vaccine policy from KFF and the Washington Post earlier this month, only about 16% of parents have delayed or skipped some childhood vaccines, excluding seasonal ones such as the flu and COVID vaccines.

Roughly two in 10 Republican parents say they have skipped or delayed recommended childhood vaccines. That increases to approximately a quarter of MAGA-identified Republicans and only 17% of non-MAGA supporters. 

But only a small percentage of parents, regardless of political affiliation, are declining the Hepatitis B vaccine despite the controversy. Only 5% of parents told KFF that they entirely skipped the Hepatitis B shot, while only 4% said they delayed the vaccination. 

Parents who identified as MAGA Republicans were more likely to say they have skipped or delayed the Hepatitis B vaccine compared to non-MAGA parents, at 16% and 9% respectively.

Issue polling data released in early September from Fabrizio Ward, a pollster heralded by Trump in the past, indicates that support for the Hepatitis B vaccine has overwhelming bipartisan support. 

Roughly 69% of Trump 2024 voters indicated that it was important to receive the Hepatitis B vaccine, compared to 79% of swing voters and 90% of those who voted for former Vice President Kamala Harris.