When a baby is born in a hospital in the United States, one of the first things that happens – usually within 24 hours – is the hepatitis B shot, which prevents the virus that can cause liver cancer. Newborn shots have been standard practice across the country since 1991, after initial efforts to prevent them from missing the mark. In the decades that followed, most parents didn’t think twice about it.
But over the past two years, more and more parents have started saying no. Because the prenatal test is given inside the hospital, before the family returns home, there are no appointments to miss, no possibility of mixing schedules – ways that other childhood vaccines can be missed. If the infant did not get this picture, most of the time, someone rejected it or delayed it.
A study published on February 23 at JAMA it sets the number clear on that turn. Researchers tracked 12.4 million newborns — about one-third of all U.S. births — at all hospitals in all 50 states that use Epic, one of the largest electronic health record systems in the country. Using years of previous data, the researchers modeled where vaccination rates should be heading, and compared those estimates to what was actually happening.
The study found that between 2023 and mid-2025, the proportion of infants receiving a birth dose of hepatitis B decreased from 83.5 percent to 73.2 percent. That translates to about “400,000 or more children a year missing or delaying hepatitis B vaccination (at birth),” said Joshua Rothman, a pediatrician at the UC San Diego School of Medicine and lead author of the study. For context, that’s roughly the same as all Minneapolis residents who miss or delay taking photos each year.
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All of this happened before Robert F. Kennedy Jr. took control of the nation’s health agencies. Now, he has turned skepticism into policy. In January, the Centers for Disease Control and Prevention stopped recommending to all hepatitis B birth test – plus five other childhood vaccines. Parents were already walking away from birth control, and now the government too.
The easiest vaccine to attack
The roots of this go back to the Covid pandemic, which changed the way millions of Americans think about all vaccines – not just the Covid shot.
“This is a good example of what we in the literature have come to refer to as the Covid-19 vaccine effect,” said Matt Motta, a public health researcher at Boston University who studies vaccine hesitancy. Researchers have documented disbelief in Covid stricken bleeding total doubts of the flu vaccine, childhood MMR shots, even vaccinations for pets. Polls sent combination a sign about whether that doubt changes behavior – but research like this captures what parents do, not what they tell the analyst.
Growing skepticism has not reached every vaccine equally, and hepatitis B has made an easy political target. Because the virus spreads through blood and sex, skeptics have a ready argument: Why vaccinate a newborn for an STD? “It is one of the vaccines that is suitable for political opposition,” Motta said. Both Kennedy and Meaning of CaseyPresident Donald Trump’s nominee for surgeon general, have made this case public. The scientific answer – that hepatitis B can also be spread at birth and through close household contact in childhood – is true, but it is more difficult to fit on a sticker.
None of this is entirely new. Americans have been arguing about vaccines since George Washingtonday, when they called it vaccination. But historically, that doubt existed outside of federal agencies. What’s different now is that “the leading US government health agencies have people who are very skeptical about vaccines,” Motta said. “There is, in my mind, no example of this.”
In January, The CDC made it official: The agency reduced the number of vaccines it recommends worldwide for children from 17 to 11, moving hepatitis B and five others to what it calls “shared clinical decisions” — essentially a case-by-case decision made by parents and doctors. The US has tried these versions before, and there’s a reason we gave up.
In The 1980sdoctors tested only high-risk pregnant women for hepatitis B. But up to half of infections are asymptomaticso they continued to miss the case. In 1988, the country switched to testing every mother. That helped, though 50 to 100 infants were still infected each year – the result of mothers with false negatives, babies exposed after birth, and families that fell through the cracks. So in 1991The US started vaccinating every newborn, and it worked. Annual infant infections have decreased less than 20.
The new proposal takes us back to the 80s.
Without a uniform federal standard, the vaccines a child receives will be influenced less by scientific consensus than by the politics of the state in which they are born.
Supporters of the change, including Kennedy, have pointed to countries like Denmark that do not vaccinate infants around the world for hepatitis B. But Motta said the comparison misses a big difference: Denmark has tax-funded health care for all for all residents, national immunization registryand inspection infrastructure to find a case the vaccine would prevent otherwise. (The United States does neither of these reliably enough to do the same.)
“If you had told me that the United States would make the kind of investment that Denmark has in its health infrastructure,” Motta said, “then I would say, well, let’s reconsider. But that’s not the reality we live in.”
That’s because in the United States, vaccines have long been used as an alternative form of safety – what David Wallace-Wells, writing in the New York Timeshe has named a way to “prevent the evil consequences of all the notable failings of our country.” Hepatitis B at birth means it doesn’t matter if a family member carries the virus unknowingly. The MMR vaccine means that measles is not dangerous even for a child who is malnourished or far from a doctor.
And those limitations are real. More than 27 million Americans were uninsured sometime in 2024, and even within the CDC’s perinatal hepatitis B prevention program, only 65 percent of exposed infants received the recommended blood monitoring test. Screening strategies only work when the system catches everyone. The American system does not.
A reading published in December estimated that the CDC’s changes could lead to hundreds of additional infant hepatitis infections each year — and even that, the authors cautioned, is probably an understatement. Their model could not account for increased vaccine reluctance, or the fact that children who miss the first dose are less likely to receive the full vaccine.
And hepatitis B is just one of six childhood vaccines that the CDC removed from the recommended list, along with rotavirus, influenza, and hepatitis A, among others.
The results of these changes will not be the same. The American Academy of Pediatrics (AAP) has broken by the CDC and published its vaccination scheduleto establish a hepatitis B birth test for each newborn. Several states, including Massachusetts and New Yorkhave said they will follow AAP’s recommendations instead of the revised federal schedule. Others will follow the federal lead.
The poll suggests parents would follow. In a February survey by the Annenberg Center for Public Policy of the University of Pennsylvania, 42 percent of Americans said they would trust the AAP over the CDC on whether infants should get the hepatitis B shot — only 11 percent said the CDC. A third were undecided – the exact group that a clear federal proposal could reach.
In just the first two months of this year, the United States has recorded more than 1,000 cases of measles. The whole year of 2024 they had 285. And now, liver cancer B could see such an increase. Every state with a Democratic governor has defied CDC guidelines and maintained the original hepatitis B vaccine recommendation, while many Republican-led states have not. Without a uniform federal standard, the vaccines a child receives will be influenced less by scientific consensus than by the politics of the state in which they are born.
