AILSA CHANG, HOST:
Health Secretary Robert F. Kennedy Jr. has packed the Advisory Committee on Immunization Practices with his own appointees. And when the ACIP meets on Thursday, two former CDC officials told NPR that the committee will push to change when children get their first hepatitis B vaccine. The new recommendation would be after age 4 instead of right after birth. A Health and Human Services spokesman said any changes will use, quote, "gold standard science." But as Jackie Fortier with KFF Health News reports, infectious disease experts are worried.
JACKIE FORTIER: When William Schaffner was in medical school in the early 1960s, doctors were taught that the people who got hepatitis B fell into four groups.
WILLIAM SCHAFFNER: The pimps, the prostitutes, the prisoners and the health care practitioners - the four Ps - got hepatitis B infection. But we've learned so much more.
FORTIER: Schaffner is now a professor of infectious diseases at the Vanderbilt University School of Medicine. The hepatitis B virus is spread through contact with infected bodily fluids like blood and can lead to deadly liver cancer. When an adult vaccine was approved in 1982, public health focused on getting those high-risk groups the shot, but hepatitis B cases kept climbing.
SCHAFFNER: Why? Well, first of all, everybody doesn't go to a doctor. Number two, when they go to a doctor and the doctor asks them about intravenous drug use and needle sharing, sexual behavior, people are reluctant to tell their doctors.
FORTIER: Researchers also found out the hepatitis B virus is tough and spreads in other ways. Traces of infected blood on surfaces can infect unvaccinated kids and adults. Scientists also realized an entire vulnerable group was missing from the vaccination regime - newborns. If a mother has the virus, it can spread to her baby.
SCHAFFNER: That's the way the virus gets to the next generation.
FORTIER: So doctors tried vaccinating only babies born to pregnant women who tested positive for hepatitis B. It didn't work, Schaffner says, because some of the doctors didn't test or there were false negatives, and some women became infected later in their pregnancy after they tested negative. Throughout the '80s, hepatitis B cases remained stubbornly high. So the ACIP made what Schaffner calls a very American decision.
SCHAFFNER: It was bold. It covered the whole problem. We want no babies infected. Therefore, we'll just vaccinate every baby at birth - problem solved. We did this in 1991.
FORTIER: Since then, cases of hepatitis B have plummeted in the U.S.
SCHAFFNER: I know that there are discussions that are about to take place about the appropriateness of this. This works. Don't go back to the bad old days.
FORTIER: Wendy Lo, who lives in the San Francisco area, also remembers the bad old days back when there was no vaccine, and for people like her living with the disease, no treatment. Years of navigating the psychological, monetary, medical and social aspects of chronic hepatitis B has impacted almost every aspect of her life.
WENDY LO: I would not want anyone to have to experience that if it can be prevented.
FORTIER: She credits the vaccines for protecting her husband and later her children from contracting the virus. So the idea of pushing back the newborn dose to a later age and leaving children vulnerable to a lifelong infection with no cure is incomprehensible to her.
LO: I am d*** frustrated. You have something that is safe and effective and it protects you against cancer. How many vaccines also does that?
FORTIER: Both Lo and Schaffner hope to speak at Thursday's ACIP meeting in favor of keeping the birth dose recommendation.
CHANG: That was reporter Jackie Fortier with our partner, KFF Health News.
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