December 16, 2025 • 15 mins
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Summary: I walk you through the proposed shift away from universal newborn hepatitis B vaccination at birth, why it matters, what the evidence shows, and how parents can make a calm, informed choice—without reigniting every vaccine debate.
Episode highlights
- I explain why hepatitis B is uniquely risky for babies: if infected early, up to 90% develop lifelong infection with later risks of cirrhosis and liver cancer. I also clarify that exposures aren’t only from mom at delivery—household contact and tiny blood exposures matter.
- We review what happened after the U.S. moved to a universal newborn dose in 1991: childhood hepatitis B plunged dramatically, with no new safety concerns emerging from hundreds of millions of doses.
- I outline the new proposal: keep the birth dose for babies of mothers who are positive or whose status is unknown; consider delaying to two months when mom tests negative—via shared decision-making with the pediatrician.
- I describe why many pediatric and public health experts still favor the birth dose: it protects against documentation errors and early exposures, and it avoids added “friction” that can reduce on-time vaccination.
- I address autism concerns with empathy and evidence: large studies and reviews have not found a link between vaccines—including hepatitis B—and autism.
- My take: I would keep the universal birth dose because it’s safe, simple, and highly effective. But if parents delay, they should commit to the 2-month visit and rely on their clinician—not social media.
Key takeaways
- The risk window is small but meaningful. Early-life infection can have lifelong consequences; the birth dose is a safety net.
- Process vs. evidence matters. Policy shifts should be driven by strong data, not ideology or committee turnover.
- If you delay, have a plan. Put the two-month appointment on the calendar now and follow through.
- Know your status. Make sure maternal hepatitis B testing is done and documented correctly.
Resources mentioned (for deeper reading)
- Hepatitis B clinical overview and long-term risks (CDC): cdc.gov/hepatitis-b/hcp/clinical-overview
- U.S. policy history and early childhood burden pre-1991: PubMed 11694691
- Impact of infant hepatitis B vaccination (MMWR): mmwrhtml/mm5125a3.htm
CTA: If this episode helped, share it with an expecting parent or grandparent. To get my weekly note on practical, evidence-supported longevity and preventive health, join me at DrBobbyLiveLongAndWell.com.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:00):
Imagine this.
(00:01):
You've just had a baby, you'rebarely sure what day it is,
you're holding this tiny newhuman, and a nurse walks in and
says, All right, time for thehepatitis B vaccine.
For over 30 years, that's beenstandard for almost every
newborn in America.
But now a major federalcommittee says, hmm, maybe we
(00:25):
don't need to do that anymore.
Some doctors are alarmed, somepatients and parents are
relieved, some are confused, anda few are wondering whether
we're about to restart everyvaccine debate of the last
decade.
So today we're going to walkthrough this calmly.
What's the actual risk?
(00:46):
What does the evidence say?
Why did the recommendationchange?
And yes, we'll talk about autismconcerns because they always
come up, and parents deservereal answers.
Hi, I'm Dr.
Bobby Du Bois, and welcome toLive Long and Well, a podcast
(01:11):
where we will talk about whatyou can do to live as long as
possible and with as much energyand figure that you wish.
Together we will explore whatpractical and evidence-supported
steps you can take.
Come join me on this veryimportant journey, and I hope
(01:32):
that you feel empowered alongthe way.
I'm a physician, Iron Mantriathlete, and have published
several hundred scientificstudies.
I'm honored to be your guide.
Welcome, my dear listeners, tothe hepatitis B vaccine
(01:52):
controversy.
My take.
Well, before we get started, Iwanted to share something.
I've avoided diving into publiccontroversies, especially when
they have political overtones.
That's not what this podcast isabout.
But in this case, the discussionaround the hepatitis B vaccine
(02:13):
has quickly drifted away fromthe actual evidence.
And I've heard from manylisteners who feel confused or
overwhelmed by the headlines.
So I decided to do this episodebecause there are real data
points, real scientific insightsthat can help clarify what's
(02:34):
going on.
And I genuinely love yourfeedback.
Do you want me to tackle topicslike this when they surface?
Should I weigh in when healthissues become politicized, but
still have a strong evidencebase?
If so, what other topics wouldyou like me to cover?
Your input really shapes thedirection of this show, so
(02:56):
please let me know.
Okay, now for the beginning.
So for today, we will have eightparts to our discussion.
Part one, why hepatitis Bmatters for babies.
Part two, what happened afternewborn HEP B vaccination began?
(03:22):
Part three, what's changing now?
Part four, how this decisionhappened, part five, how babies
get hepatitis B.
Part six, the two concerns aboutdelaying until two months of
age.
Part seven, autism concerns, whythey come up and what we know.
(03:45):
Part eight, Who's Right,supporters versus critics, and
part nine, my take.
So let's begin with part one.
Why hepatitis B matters forbabies.
Hepatitis B is a virus thatattacks the liver.
In adults, most people clear it,but infants, completely
(04:06):
different story.
If a baby gets hepatitis B atbirth or in the first few months
of life, the chance ofdeveloping lifelong chronic
infection is extremely high, upto 90%.
Chronic hepatitis B can lead tocirrhosis and liver failure and
liver cancer decades later.
(04:28):
Before the vaccine wasintroduced for babies in 1991,
about 18,000 U.S.
children became infected everyyear.
That's a huge number for adisease that's so preventable
today.
That's where universal newbornvaccination came in.
(04:48):
Well, part two, well, whathappened after newborn HEP B
vaccination began?
And that is now the topic forus.
In the early 1990s, the U.S.
recommended that all newbornsget the hepatitis B vaccine
before leaving the hospital.
(05:09):
The result?
Childhood hepatitis B plummeted.
Within 10 years, infectionsdropped by roughly two-thirds.
Today they're down over 95 to99% from where we started.
And importantly, after hundredsof millions of doses worldwide,
(05:29):
there really have been no newsafety concerns associated with
giving newborns the hepatitis Bvaccine.
So why change anything?
Let's look at the new proposedguidance.
Part three, what's changing now?
Recently, a federal vaccineadvisory committee, ACIP, voted
(05:51):
to change the guidance.
The proposal is (05:52):
if the mother is hepatitis B positive, baby
still gets the birth dose.
If the mother's status isunknown, baby still gets the
birth dose.
If the mother tests negative,the baby may wait until two
months for the first dose andhave a shared decision-making
(06:14):
discussion with her doctor.
This is a major shift away fromall newborn babies get it while
in the hospital.
Now, it's not final until theCDC director approves it.
Keep in mind that otherorganizations may still
recommend the birth dose.
The American Academy ofPediatrics has already said they
(06:35):
plan to keep recommending thebirth dose for all newborns.
Why the difference?
Well, that takes us to theprocess.
Part four, how this decisionhappened.
This review committee cycle wasdifferent.
The committee was reconstituted,meaning many long-standing
(06:56):
expert members were removed.
Several new members, includingindividuals who really didn't
have medical or scientificbackgrounds, were at it.
Some participants in the actualmeeting were known for vaccine
skepticism, and theirpresentations did not always
reflect the scientificconsensus.
Crucial, there was no new safetyconcerns, no new adverse event
(07:21):
signals, and no new evidenceshowing harm from giving
newborns the vaccine.
Instead, the arguments forchanging the policy centered on,
well, the current low rate ofhepatitis B in U.S.
infants, parental autonomy, thebelief that maternal testing is
(07:41):
reliable enough to skipuniversal birth dosing.
Meanwhile, CDC scientists,pediatric infectious disease
experts, and public healthorganizations strongly disagreed
with altering the universalapproach, warning that reducing
coverage, even a little, couldlead to preventable infections.
(08:05):
The process itself raised someconcerns among professionals.
Policy changes should be drivenby robust evidence, not by
shifts in committee membershipor ideology.
Well, let's step back and lookat how babies actually get
hepatitis B.
Part 5.
How babies get hepatitis B.
(08:27):
And let's begin there.
Some might be thinking, well,hepatitis B is a sexually
transmitted disease, so Ishouldn't have to worry about my
baby.
Others might think, well,hepatitis B in babies comes only
from mother-to-childtransmission during birth.
Well, that is the biggest risk,but it's not the only one.
(08:51):
Young children can be exposedthrough bites that break the
skin, open sores, contact withtiny amounts of infected blood,
shared household items,toothbrushes, razors, nail
clippers.
The point is, exposures canhappen.
And you may not know who in yourbroader family or childcare
(09:12):
circle has chronic hepatitis B.
The birthdose was designed toprotect infants from all of
these uncertainties.
All right, part six.
Dr.
Bobby's two concerns aboutdelaying two months.
Let's break down the two mainworries.
(09:33):
Concern number one, infection inthe first two months.
It is a short window.
The risk is low, but if a babydoes get infected early, the
consequences are lifelong.
The dose of the hospitalprotects against the unexpected,
a misrecorded maternal test, amissed test, an unrecognized
(09:57):
household exposure.
These things happen more oftenthan we'd like.
Concern number two (10:04):
will babies actually get vaccinated at two
months?
This is the big one.
Right now, the birth doseensures nearly universal
coverage because the baby'sliterally right there.
The healthcare team is present,there's minimal friction.
(10:24):
If the first dose happens at twomonths, you introduce friction,
missed appointments, parents whoare hesitant, logistical
challenges, mixed messages fromsocial media.
Maybe we'll wait, becoming maybewe won't.
Even today, about 9% of parentsdelay or skip the hepatitis B
(10:46):
vaccine.
A policy that makes delay thedefault almost certainly
increases the number ofunvaccinated children.
All right, part seven.
Autism concerns.
Why they come up and what weknow.
The full autism discussion needsan episode or many to fully
(11:08):
explore.
But we need to at least touch onsome of the issues.
First, empathy.
Parents want to keep theirchildren safe.
Autism diagnoses have increased.
It's understandable that peopleare looking for causes.
Well, let's go to the evidence.
In my opinion, vaccines don'tcause autism.
(11:30):
This view is backed by lots ofstudies, tens and hundreds of
thousands of children, reviewsby major scientific bodies,
research on the MMR vaccine, thestuff in it like thimerosol,
aluminum, and total vaccineexposure all show no association
between vaccines and autism.
(11:51):
So why are autism diagnosesrising?
Again, for another day.
But most likely reasons?
Broader diagnostic criteria,better awareness, better
screening, environmental factorsnot related to vaccines, things
in our food, pollutants, orfactors we just don't know yet.
(12:12):
Autism is complex, but vaccineshave been studied a lot and
consistently shown not to be thecause.
And there's no evidence thatspecifically links hepatitis B
vaccines to autism.
All right, part A.
Eight.
So who's right?
Supporters.
(12:32):
Part eight.
Who's right?
Supporters of the new guidancesay hepatitis B is now rare in
infants.
If mom is negative, the risk isvery low.
Parents should have more controlover newborn decisions.
All reasonable points.
Critics say, though, even rareinfant infections can be
(12:55):
serious.
Testing moms isn't perfect.
Household exposure happens.
Vaccine hesitancy is rising.
So adding friction may reducekids getting vaccines.
The policy process wasinfluenced by non-experts.
Both sides raise legitimatepoints.
(13:15):
So where do I land?
Part nine, my take.
If I were designing nationalpolicy, I would keep the
universal birth dose.
Why?
It's safe.
There's no new evidence to saythat it isn't true.
The vaccine worksextraordinarily well.
It protects against real-worldgaps.
(13:36):
The proof is in the pudding.
Infant hepatitis B infectionsare rare because the system is
simple.
But I also want to be clear: this change is not catastrophic. (13:43):
undefined
Parents can still choose thebirth dose.
Hospitals can still offer it.
Pediatricians can stillrecommend it.
And most babies whose mothersare hepatitis B negative remain
at very low risk.
My advice for parents (14:03):
know your own hepatitis B status, make
sure it's documented correctly.
Strongly consider the birthdose, even if you test negative.
If you delay, commit to thetwo-month appointment.
Rely on your doctor, not socialmedia.
Public health works best whendecisions are evidence-based.
(14:26):
All right, our closing.
So that's my take.
Balanced, calm, and grounded inthe evidence.
The hepatitis B birthdose is oneof our most successful public
health interventions.
I believe maintaining universalnewborn vaccination is the
safest choice.
But even if the recommendationshifts, parents still have
(14:49):
strong options and the situationis manageable.
If this episode helped clarifythings for you, please share it
with expecting parents,grandparents, or anyone confused
by the headlines.
I'm Dr.
Bobby Du Bois, and this is LiveLong and Well.
Stay curious, stay thoughtful,and I will see you next time.
(15:14):
Thanks so much for listening toLive Long and Well with Dr.
Bobby.
If you like this episode, pleaseprovide a review on Apple or
Spotify or wherever you listen.
If you want to continue thisjourney or want to receive my
newsletter on practical andscientific ways to improve your
(15:34):
health and longevity, pleasevisit me at Dr.
Bobby Livelongandwell.com.
That's doctor as the dr bobbylivelongandwell.com.
Imagine this.
(00:01):
You've just had a baby, you'rebarely sure what day it is,
you're holding this tiny newhuman, and a nurse walks in and
says, All right, time for thehepatitis B vaccine.
For over 30 years, that's beenstandard for almost every
newborn in America.
But now a major federalcommittee says, hmm, maybe we
(00:25):
don't need to do that anymore.
Some doctors are alarmed, somepatients and parents are
relieved, some are confused, anda few are wondering whether
we're about to restart everyvaccine debate of the last
decade.
So today we're going to walkthrough this calmly.
What's the actual risk?
(00:46):
What does the evidence say?
Why did the recommendationchange?
And yes, we'll talk about autismconcerns because they always
come up, and parents deservereal answers.
Hi, I'm Dr.
Bobby Du Bois, and welcome toLive Long and Well, a podcast
(01:11):
where we will talk about whatyou can do to live as long as
possible and with as much energyand figure that you wish.
Together we will explore whatpractical and evidence-supported
steps you can take.
Come join me on this veryimportant journey, and I hope
(01:32):
that you feel empowered alongthe way.
I'm a physician, Iron Mantriathlete, and have published
several hundred scientificstudies.
I'm honored to be your guide.
Welcome, my dear listeners, tothe hepatitis B vaccine
(01:52):
controversy.
My take.
Well, before we get started, Iwanted to share something.
I've avoided diving into publiccontroversies, especially when
they have political overtones.
That's not what this podcast isabout.
But in this case, the discussionaround the hepatitis B vaccine
(02:13):
has quickly drifted away fromthe actual evidence.
And I've heard from manylisteners who feel confused or
overwhelmed by the headlines.
So I decided to do this episodebecause there are real data
points, real scientific insightsthat can help clarify what's
(02:34):
going on.
And I genuinely love yourfeedback.
Do you want me to tackle topicslike this when they surface?
Should I weigh in when healthissues become politicized, but
still have a strong evidencebase?
If so, what other topics wouldyou like me to cover?
Your input really shapes thedirection of this show, so
(02:56):
please let me know.
Okay, now for the beginning.
So for today, we will have eightparts to our discussion.
Part one, why hepatitis Bmatters for babies.
Part two, what happened afternewborn HEP B vaccination began?
(03:22):
Part three, what's changing now?
Part four, how this decisionhappened, part five, how babies
get hepatitis B.
Part six, the two concerns aboutdelaying until two months of
age.
Part seven, autism concerns, whythey come up and what we know.
(03:45):
Part eight, Who's Right,supporters versus critics, and
part nine, my take.
So let's begin with part one.
Why hepatitis B matters forbabies.
Hepatitis B is a virus thatattacks the liver.
In adults, most people clear it,but infants, completely
(04:06):
different story.
If a baby gets hepatitis B atbirth or in the first few months
of life, the chance ofdeveloping lifelong chronic
infection is extremely high, upto 90%.
Chronic hepatitis B can lead tocirrhosis and liver failure and
liver cancer decades later.
(04:28):
Before the vaccine wasintroduced for babies in 1991,
about 18,000 U.S.
children became infected everyyear.
That's a huge number for adisease that's so preventable
today.
That's where universal newbornvaccination came in.
(04:48):
Well, part two, well, whathappened after newborn HEP B
vaccination began?
And that is now the topic forus.
In the early 1990s, the U.S.
recommended that all newbornsget the hepatitis B vaccine
before leaving the hospital.
(05:09):
The result?
Childhood hepatitis B plummeted.
Within 10 years, infectionsdropped by roughly two-thirds.
Today they're down over 95 to99% from where we started.
And importantly, after hundredsof millions of doses worldwide,
(05:29):
there really have been no newsafety concerns associated with
giving newborns the hepatitis Bvaccine.
So why change anything?
Let's look at the new proposedguidance.
Part three, what's changing now?
Recently, a federal vaccineadvisory committee, ACIP, voted
(05:51):
to change the guidance.
The proposal is (05:52):
if the mother is hepatitis B positive, baby
still gets the birth dose.
If the mother's status isunknown, baby still gets the
birth dose.
If the mother tests negative,the baby may wait until two
months for the first dose andhave a shared decision-making
(06:14):
discussion with her doctor.
This is a major shift away fromall newborn babies get it while
in the hospital.
Now, it's not final until theCDC director approves it.
Keep in mind that otherorganizations may still
recommend the birth dose.
The American Academy ofPediatrics has already said they
(06:35):
plan to keep recommending thebirth dose for all newborns.
Why the difference?
Well, that takes us to theprocess.
Part four, how this decisionhappened.
This review committee cycle wasdifferent.
The committee was reconstituted,meaning many long-standing
(06:56):
expert members were removed.
Several new members, includingindividuals who really didn't
have medical or scientificbackgrounds, were at it.
Some participants in the actualmeeting were known for vaccine
skepticism, and theirpresentations did not always
reflect the scientificconsensus.
Crucial, there was no new safetyconcerns, no new adverse event
(07:21):
signals, and no new evidenceshowing harm from giving
newborns the vaccine.
Instead, the arguments forchanging the policy centered on,
well, the current low rate ofhepatitis B in U.S.
infants, parental autonomy, thebelief that maternal testing is
(07:41):
reliable enough to skipuniversal birth dosing.
Meanwhile, CDC scientists,pediatric infectious disease
experts, and public healthorganizations strongly disagreed
with altering the universalapproach, warning that reducing
coverage, even a little, couldlead to preventable infections.
(08:05):
The process itself raised someconcerns among professionals.
Policy changes should be drivenby robust evidence, not by
shifts in committee membershipor ideology.
Well, let's step back and lookat how babies actually get
hepatitis B.
Part 5.
How babies get hepatitis B.
(08:27):
And let's begin there.
Some might be thinking, well,hepatitis B is a sexually
transmitted disease, so Ishouldn't have to worry about my
baby.
Others might think, well,hepatitis B in babies comes only
from mother-to-childtransmission during birth.
Well, that is the biggest risk,but it's not the only one.
(08:51):
Young children can be exposedthrough bites that break the
skin, open sores, contact withtiny amounts of infected blood,
shared household items,toothbrushes, razors, nail
clippers.
The point is, exposures canhappen.
And you may not know who in yourbroader family or childcare
(09:12):
circle has chronic hepatitis B.
The birthdose was designed toprotect infants from all of
these uncertainties.
All right, part six.
Dr.
Bobby's two concerns aboutdelaying two months.
Let's break down the two mainworries.
(09:33):
Concern number one, infection inthe first two months.
It is a short window.
The risk is low, but if a babydoes get infected early, the
consequences are lifelong.
The dose of the hospitalprotects against the unexpected,
a misrecorded maternal test, amissed test, an unrecognized
(09:57):
household exposure.
These things happen more oftenthan we'd like.
Concern number two (10:04):
will babies actually get vaccinated at two
months?
This is the big one.
Right now, the birth doseensures nearly universal
coverage because the baby'sliterally right there.
The healthcare team is present,there's minimal friction.
(10:24):
If the first dose happens at twomonths, you introduce friction,
missed appointments, parents whoare hesitant, logistical
challenges, mixed messages fromsocial media.
Maybe we'll wait, becoming maybewe won't.
Even today, about 9% of parentsdelay or skip the hepatitis B
(10:46):
vaccine.
A policy that makes delay thedefault almost certainly
increases the number ofunvaccinated children.
All right, part seven.
Autism concerns.
Why they come up and what weknow.
The full autism discussion needsan episode or many to fully
(11:08):
explore.
But we need to at least touch onsome of the issues.
First, empathy.
Parents want to keep theirchildren safe.
Autism diagnoses have increased.
It's understandable that peopleare looking for causes.
Well, let's go to the evidence.
In my opinion, vaccines don'tcause autism.
(11:30):
This view is backed by lots ofstudies, tens and hundreds of
thousands of children, reviewsby major scientific bodies,
research on the MMR vaccine, thestuff in it like thimerosol,
aluminum, and total vaccineexposure all show no association
between vaccines and autism.
(11:51):
So why are autism diagnosesrising?
Again, for another day.
But most likely reasons?
Broader diagnostic criteria,better awareness, better
screening, environmental factorsnot related to vaccines, things
in our food, pollutants, orfactors we just don't know yet.
(12:12):
Autism is complex, but vaccineshave been studied a lot and
consistently shown not to be thecause.
And there's no evidence thatspecifically links hepatitis B
vaccines to autism.
All right, part A.
Eight.
So who's right?
Supporters.
(12:32):
Part eight.
Who's right?
Supporters of the new guidancesay hepatitis B is now rare in
infants.
If mom is negative, the risk isvery low.
Parents should have more controlover newborn decisions.
All reasonable points.
Critics say, though, even rareinfant infections can be
(12:55):
serious.
Testing moms isn't perfect.
Household exposure happens.
Vaccine hesitancy is rising.
So adding friction may reducekids getting vaccines.
The policy process wasinfluenced by non-experts.
Both sides raise legitimatepoints.
(13:15):
So where do I land?
Part nine, my take.
If I were designing nationalpolicy, I would keep the
universal birth dose.
Why?
It's safe.
There's no new evidence to saythat it isn't true.
The vaccine worksextraordinarily well.
It protects against real-worldgaps.
(13:36):
The proof is in the pudding.
Infant hepatitis B infectionsare rare because the system is
simple.
But I also want to be clear: this change is not catastrophic. (13:43):
undefined
Parents can still choose thebirth dose.
Hospitals can still offer it.
Pediatricians can stillrecommend it.
And most babies whose mothersare hepatitis B negative remain
at very low risk.
My advice for parents (14:03):
know your own hepatitis B status, make
sure it's documented correctly.
Strongly consider the birthdose, even if you test negative.
If you delay, commit to thetwo-month appointment.
Rely on your doctor, not socialmedia.
Public health works best whendecisions are evidence-based.
(14:26):
All right, our closing.
So that's my take.
Balanced, calm, and grounded inthe evidence.
The hepatitis B birthdose is oneof our most successful public
health interventions.
I believe maintaining universalnewborn vaccination is the
safest choice.
But even if the recommendationshifts, parents still have
(14:49):
strong options and the situationis manageable.
If this episode helped clarifythings for you, please share it
with expecting parents,grandparents, or anyone confused
by the headlines.
I'm Dr.
Bobby Du Bois, and this is LiveLong and Well.
Stay curious, stay thoughtful,and I will see you next time.
(15:14):
Thanks so much for listening toLive Long and Well with Dr.
Bobby.
If you like this episode, pleaseprovide a review on Apple or
Spotify or wherever you listen.
If you want to continue thisjourney or want to receive my
newsletter on practical andscientific ways to improve your
(15:34):
health and longevity, pleasevisit me at Dr.
Bobby Livelongandwell.com.
That's doctor as the dr bobbylivelongandwell.com.
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