In a significant shift, vaccine advisers for the US Centers for Disease Control and Prevention (CDC) voted on Friday to restrict the administration of hepatitis B vaccines for newborns. This decision reflects a controversial approach by the Trump administration towards vaccines that have been safely administered for decades. The panel, appointed by Health Secretary Robert F Kennedy Jr, opted to remove the longstanding recommendation that all newborns in the US receive the hepatitis B vaccine. Instead, they have recommended that parents of infants born to mothers who test negative for hepatitis decide when, or if, their child should receive the vaccine series, in consultation with a healthcare professional. Experts have expressed concerns that this change could lead to confusion regarding routine vaccinations and create access issues, particularly for lower-income families. While the advisers' recommendations are non-binding, they often influence official policy and affect how private and federal insurance providers cover vaccines. Donald Trump has welcomed the removal of the recommendation, signing a memo to review child immunisation guidelines in line with practices from other developed countries. However, Michaela Jackson, program director of prevention policy at the Hepatitis B Foundation, warned, "This is going to lead to an increase in preventable infections among children." She added that the changes could create barriers to access and erode parental trust in healthcare providers. The advisers clarified that hepatitis B vaccines will still be recommended for children whose mothers test positive for the virus. The new approach, termed "shared clinical decision-making," was approved by an 8-3 vote, although this term is often associated with non-routine vaccines and is poorly defined. Cody Meissner, a professor of pediatrics at the Geisel School of Medicine at Dartmouth College, opposed the change, stating, "We have heard ‘do no harm’ is a moral imperative. We are doing harm by changing this wording." Natasha Bagdasarian, an infectious disease physician, echoed these concerns, suggesting that the new language could be interpreted by healthcare providers as indicating that the vaccine is controversial. The advisers also suggested that if a parent cannot get their child vaccinated at birth, they should wait at least two months. Judy Shlay, a liaison for the National Association of County and City Health Officials, remarked, "We should not restrict that." The recommendations will be forwarded to Jim O’Neill, acting director of the CDC, who will consider altering the official US policy on hepatitis B vaccines. Independent medical organisations, including the American Academy of Pediatrics, continue to advocate for all infants to receive the vaccine within 24 hours of birth. Additionally, the advisers proposed blood tests for infants after their first vaccination to determine if further shots are necessary. This approach has not been studied, raising questions about its efficacy. Delaying the vaccine from birth to two months could result in at least 1,400 infections, 300 cases of liver cancer, and 480 deaths annually, according to recent modelling. Hepatitis B can be transmitted in various settings, and many individuals infected with the virus are unaware of their status. The Vaccines for Children programme, which covers vaccinations for 52% of US children, will be impacted by these changes, making it harder for families to access the shots. The second day of the advisory committee meeting was marked by tension, with members expressing frustration over the lack of data supporting the proposed changes. Joseph Hibbeln, a neurologist and adviser, stated, "There has been no data presented that this plan would actually work." Meissner countered claims that the hepatitis B vaccine is a remedy for systemic healthcare flaws, asserting, "We’re giving it to protect the infant against a potentially fatal disease. We know it’s safe and we know it’s very effective." He cautioned that the proposed changes could lead to increased infections among children and adults alike.