A major controversy erupted in the United States this week after reports that advisers to the Centers for Disease Control and Prevention (CDC) are considering removing the hepatitis B vaccine given within 24 hours of birth from the universal immunisation schedule. Health experts worldwide have called the move scientifically baseless and potentially dangerous.
While the debate is centred in the US, India, which carries a far higher burden of hepatitis B, cannot afford confusion over a vaccine that prevents lifelong liver disease. Paediatricians warn that a shift in perception could erode trust in one of the country’s most critical newborn interventions.
A massive 40-year evidence review by the Center for Infectious Disease Research and Policy (CIDRAP), analysing more than 400 studies and reports, reconfirmed why the birth dose remains essential. If a baby acquires Hep B at birth, 90 per cent will develop chronic infection. One in four chronically infected individuals will eventually die of liver failure or liver cancer.
The review also found no safety concerns associated with the vaccine across decades of usage.
The World Health Organisation (WHO) estimates that India has nearly 10 million people living with chronic hepatitis B. Unlike the US, where childhood Hep B infections dropped by 99 per cent after universal newborn vaccination, India still struggles with uneven antenatal screening, missed birth doses, especially during home deliveries, low awareness of perinatal transmission and high prevalence in several states.
For many newborns, the Hep B shot given within 24 hours of birth is the only protection against an infection that can silently persist for decades.
US anti-vaccine groups argue that maternal testing makes newborn vaccination unnecessary. But CIDRAP’s data shows why this reasoning collapses even in the best-resourced health systems. 18 per cent of pregnant women in the US do not receive hepatitis B testing. 65 per cent of those who test positive do not complete recommended follow-up care. In India, missed tests and loss to follow-up are far higher, especially in rural and low-resource settings.
Paediatricians whom THE WEEK spoke to highlighted the challenges in the system. "We need to ensure timely vaccination for it to be effective. Even before that, we need to convince parents of the need for vaccination in the first place," says Dr Lokeshwar, a paediatrician based in Mumbai.
Also read
- CDC delays Hepatitis B shot for newborns: What you need to know about the vaccine and its uses
- Hepatitis stigma in India: A silent epidemic beyond the virus
- The silent epidemic: Why adult hepatitis B vaccination in India can't wait
- World Hepatitis Day 2025: Strategies for prevention, screening, and treatment
The CIDRAP review reiterates that the Hep B vaccine at birth has no credible safety signals linked to serious adverse effects. Both global and Indian surveillance systems have consistently found it to be one of the safest childhood vaccines.
Paediatricians warn that misinformation travels faster than policy, and global debates can influence parental perceptions in India. India has committed to the WHO’s hepatitis elimination goals for 2030. Achieving this requires strengthening, not weakening, birth dose coverage, especially in high-burden districts.
As one of the simplest and most effective interventions in newborn care, the Hep B birth dose remains a cornerstone of India’s public health strategy. Any confusion around its necessity could set back decades of progress against a preventable but deadly infection.
