Opinion: Rolling back hepatitis B protections risks disaster

Back in 2011, the Centers for Disease Control and Prevention (CDC) issued a report identifying 10 great public health achievements and their benefits in the first decade of the 21st century.

Topping the list: vaccine-preventable diseases.

From 2001 to 2010, new vaccines emerged to treat everything from herpes to diphtheria to human papillomavirus (HPV), the cause of multiple types of cancer. They joined a list of 17 diseases that were effectively targeted, managed and even prevented by immunization.

We live in different times. Now, a panel that advises the federal government on vaccination policy is considering overturning a 30-year-old recommendation that all babies born in the United States immediately receive one of the most demonstrably effective vaccines: hepatitis B.

It is part of a larger effort by the anti-vaccine movement, headlined by Robert F. Kennedy Jr., the U.S. secretary of Health and Human Services. Kennedy and vaccine skeptics contend disease risk is low and say the HBV vaccine is no longer necessary because the universal vaccination strategy has worked. They say parents should decide if and when their children are vaccinated.

Hepatitis B is the most common serious liver infection in the world. At least 2 billion people in the world have been infected by its causative virus, with roughly 300 million living with a chronic disease, whose symptoms range from fatigue, jaundice and joint pain to inflammation and scarring of the liver, resulting in cirrhosis or cancer. Often, these symptoms do not become apparent until the disease is well-advanced.

The CDC estimates more than 640,000 adults in the U.S. have chronic hepatitis B. Fifteen to 25% of persons who develop the chronic condition will die from the disease. There are treatments to manage the symptoms of hepatitis B and slow its progression, but there is no cure beyond a liver transplant.

The best course of action is to avoid getting the disease altogether, which is transmitted through direct contact with infected blood or certain bodily fluids. Newborns are particularly at risk of infection through the birthing process when mothers may not even know they carry the virus or through close contact with other family members.

The immature immune system of newborns is ill-prepared to fight the virus, and up to 90% of infants infected with hepatitis B in their first year of life will develop a chronic condition that can lead to liver failure and death. In 1991, when all infants in the U.S. began to universally receive the HBV vaccine at birth, infection rates dropped dramatically, from roughly 5% of children infected to less than 1% in some populations.

“We used to have 18,000 or 20,000 kids a year being born with this, a quarter of them going on to have liver cancer,” James Campbell, a pediatric infectious disease doctor at the University of Maryland, told PolitiFact. “We now have almost none.”

The HBV vaccine is remarkably enduring. I remember receiving an experimental HBV vaccine in 1982 while I was a new postdoctoral fellow at the National Institutes of Health. Four decades later, a routine blood test showed that my antibody resistance to the virus remains robust. That puts the HBV vaccine in rare company with those for smallpox, polio, yellow fever, HPV, chickenpox and measles/mumps/rubella (MMR), all of which confer long, even lifelong, protection.

Contrast that with my visit to Maputo Central Hospital in Mozambique, where the HBV vaccine was not available. There, an entire ward of young men were dying of liver cancer. The underlying cause in every case was HBV.

Current efforts to reduce or eliminate vaccination requirements are momentously short-sighted and empirically errant. There are decades of data showing the HBV vaccine (and others) to be effective. They treat disease by preventing it — the best of all outcomes.

We are already seeing unprecedented outbreaks of measles across the country, mostly in regions where once-mandated MMR vaccinations are now voluntary. The number of measles cases in 2025 is the highest since the disease was declared eliminated in the U.S. in 2000.

The consequences of purposefully putting babies at greater risk of HBV infection will not be so quickly apparent. Most will grow up unaware of their condition until their symptoms become serious, chronic and life-threatening.

They won’t thank us.

Brenner is a physician-scientist and president and chief executive of Sanford Burnham Prebys Medical Discovery Institute in La Jolla.