Delaying the Hep B Vaccine Will Hurt Our Health (and Our Wallets)

The Advisory Committee on Immunization Practices (ACIP), the group that advises the Centers for Disease Control and Prevention (CDC) on vaccine policy and creates vaccine recommendations, is meeting again tomorrow and Friday.

This week’s meeting is happening over an interesting backdrop. Over the weekend, an internal FDA memo was leaked which claimed that the COVID-19 vaccine was linked to 10 deaths in children (without providing data).

Officials also announced on Monday that ACIP would be changing leadership. The new committee chair, Kirk Milhoan, MD, is a pediatric cardiologist who has long been critical of COVID-19 vaccines.

On the ACIP Agenda

According to the most recent draft agenda posted to the CDC website on Monday, the committee will discuss:

• The hepatitis B vaccine
• The childhood and adolescent immunization schedule
• Vaccine adjuvants (additives that help make vaccines more effective)
• Vaccine risk monitoring and evaluation

The committee is also expected to vote on delaying the hepatitis B vaccine birth dose after delaying the vote in September.

The Hepatitis B Birth Dose

The U.S. started vaccinating babies for hepatitis B on their first day of life in 1991, and in 10 years infections in young children had dropped by 80%. Infants infected with hepatitis B under 1 year old have a 90% chance of the disease becoming chronic, which can lead to liver disease, cirrhosis, and liver cancer.

At the September meeting, ACIP heard presentations on the vaccine’s safety and effectiveness from experts within CDC. It seems that the committee is not seeking the same sort of expertise for tomorrow’s meeting.

One expert who has previously provided vaccine modeling data to ACIP is Heather Bradley, PhD, an associate professor of epidemiology at Emory's Rollins School of Public Health. She and colleagues developed a model looking at the health and economic impacts of delaying the hepatitis B birth dose. The findings are published as a pre-print in advance of tomorrow’s ACIP meeting.

“There were no data presented in the September meeting on the potential health impacts or cost-effectiveness of delaying the birth dose. This was the impetus for our team to quickly create the model by leveraging our previous work. We hope the findings will reach members of the committee through public comment and other channels and will be used in the decision-making process,” says Bradley.

By the numbers:

Bradley and team estimate that a single year of delaying the hepatitis B vaccination to 2 months could lead to:

• 1,437 preventable infections
• 300 cases of liver cancer
• 480 deaths
• Over $222 million in excess health care costs

Further delays later into childhood could increase those numbers.

“It is important to understand these costs accumulate for each year the new recommendation is in place,” says Bradley. “These avoidable health care costs should be weighed against a vaccine for which we have decades of safety and effectiveness data. There is no evidence to support delaying the birth dose and plenty of evidence to support maintaining the current recommendation, including from our model.”