1040: When Vaccine Guidance Shifts: Michigan’s Chief Medical Executive on the Stakes of ACIP’s Hepatitis B Vote

JOHN SHEEHAN: 

This is Public Health Review Morning Edition for Wednesday, December 10, 2025. I'm John Sheehan, with news from the Association of State and Territorial Health Officials.

Last week, the CDC Advisory Committee on Immunization Practices, or ACIP, voted to narrow its guidance for administering the hepatitis B vaccine to newborns. Today, we'll discuss that guidance, what it is, and its ramifications with Dr. Natasha Bagdasarian, ASTHO's liaison to the Advisory Committee and Michigan's chief medical executive.

Dr. Natasha Bagdasarian, welcome to the show.

NATASHA BAGDASARIAN: 

Thanks for having me on.

SHEEHAN: 

Dr. Bagdasarian, you're ASTHO's liaison to the Advisory Committee on Immunization Practices. What does that mean?

BAGDASARIAN: 

That means I get to attend the meetings. I don't get to vote, but there is a portion of the meeting where I can make comments on behalf of ASTHO.

SHEEHAN: 

And let's- let's dig right into the news of the day. The Committee voted to narrow its guidance on the hepatitis B vaccine for newborns. Could you- could you tell us what the committee decided, how it voted, and- and kind of what it means.

BAGDASARIAN: 

What I thought was really interesting, number one, is the type of evidence they heard during the meeting. Essentially, the people from ACIP who were presenting and who were really given a lot of time to speak were not physicians or people with a lot of background in vaccinology. We had folks who were, you know, environmental scientists, mathematicians, who were really speaking about vaccines. And one of the things that I was really struck by in the way that ACIP went and the direction they voted was the language around individual decisions and shared clinical decision-making. Meaning that they really, sort of, pull back on their broad public health guidance, on the guidance that we all depend on, and really seem to be narrowing this as an individual decision for babies born to hepatitis B negative mothers and- and that was a little bit troubling to me for a number of reasons.

SHEEHAN: 

Sure. Could you expand on that?

BAGDASARIAN: 

It was- it was troubling to me because, number one, we know that we live in a very imperfect health system. We live with a very imperfect health system. We know that there are folks who slip through the cracks. So, there was an emphasis on, how do we improve hepatitis B screening for pregnant women? That, of course, would be ideal, but we know how incredibly hard it is when we look at congenital syphilis, and we look at how many pregnant women are missed with our- with our syphilis screening, and how many babies are therefore born with congenital syphilis every year. So, we know that it's an imperfect system. We know that people fall through the cracks. We also know that hepatitis B is not only transmitted from mother to baby, but there can be transmission from other household members, and that that neonatal period is a time period when infants are very susceptible to infection with hepatitis B that could become fulminant, that could become chronic. And so, leaving this as an individual decision for babies born to hepatitis B mothers troubled me because of number one, folks who slipped through the cracks, folks who number one don't receive hepatitis B testing during pregnancy, or those whose results are lost or misrecorded, which we know happens. And the second issue to me is this issue of other exposures, other sources of exposure to hepatitis B in neonates that really wasn't addressed, they focus solely on maternal exposure. So, it was troubling to me that we focus so much on individual decision-making for babies born to hepatitis B-negative mothers, for those reasons, and also because when we start talking about shared clinical decision-making, having this really be an individual decision, it really puts a lot of unnecessary weight and pressure on the clinicians and on patients. People are looking for broad guidance. They're looking for what does the CDC recommend? They're looking for a broad set of recommendations that can then be tailored. And when we don't give clinicians and patients a broad set of recommendations, it makes people feel that, number one, all of the pressure is on them to make this decision. And number two, it makes them feel that there is something really controversial about this particular vaccine, that there's not data or that there's a reason for them to be concerned. For clinicians, I hear often that they're concerned about extra documentation that they need in terms of this shared clinical decision-making. Do they need a special form for this? Do they need to worry about extra liability when they're recommending this vaccine? And so, those are my concerns with the direction that they headed. And I did raise those concerns on the call.

SHEEHAN: 

And the vaccine for the last 30 years has been credited with reducing infant rates of hepatitis B by some- some very large percent, 90 plus percent. So, what are the- what are the possible ramifications from, sort of, softening that guidance?

BAGDASARIAN: 

You know, I think we have to think about the individual ramifications. I think we have to think about babies who could be missed, who could fall through the cracks, as I mentioned. And then I think we have to think about the broader implications. Will healthcare providers and the public, will they see hepatitis B vaccine, in general, as being something that's controversial? Will we see rates of hepatitis B vaccine at all ages start to decline, and then we also know that when we sort of raise the specter of scientific uncertainty, the way that was done in this meeting, even if it doesn't really exist, when we raise this issue and make it a thing, if you will, it can also impact other vaccines. We saw that with COVID and the COVID vaccine, there was a lot of controversy and a lot of political rhetoric around the COVID vaccine, and it's impacted our childhood vaccination rates. It's impacted other vaccines, and I wonder if what has now happened around hepatitis B vaccine will also impact other vaccines.

SHEEHAN: 

What are some other possible consequences of this decision?

BAGDASARIAN: 

Well, you know, we have, of course, seen Hepatitis B rates decline in our nation. Are we going to start seeing those rates coming back up? Are we going to start seeing more school-age kids who haven't received not only their hepatitis B vaccine, but other vaccines here in my state of Michigan? We have seen a steady decline in vaccination rates for kindergartners and seventh graders across the board. And then when we do a deeper dive and look at communities, there are some particular communities with very low vaccination rates, leaving them vulnerable for outbreaks of disease.

SHEEHAN: 

Yeah, and this is something that would apply to all communities, and states, and territories equally, but the impacts would not be felt equally.

BAGDASARIAN: 

I agree with you. I think that when we think about vaccines, we've really got to think about disparities. We know that there are disparities that already exist with vaccine uptake. There are racial disparities, there are socioeconomic disparities, geographic disparities, and when we think about who could be most impacted by a policy like this, it is definitely those who are more disadvantaged. It is socioeconomically disadvantaged communities, people who are relying on, for example, the Vaccines for Children program, people who are relying on Medicaid, I think, who have the most to lose here.

SHEEHAN: 

And for clarification, when we're speaking about what parents should do, what guidance they need, when considering the hepatitis B vaccine, what do you recommend parents think about and how should they weigh this decision?

BAGDASARIAN: 

You know, I think that everyone is trying to make the best decision possible. One of the things that I have to remind myself is that no one is making vaccine decisions based on solely their political ideologies. People are really making decisions based on what they think is best for their kids. Everyone is sort of struggling with, what is the best thing for me to do here? What is the best data? What's the best evidence? And I think it's really troubling right now, when we have respected governmental bodies like ACIP, who are raising controversy, perhaps even creating controversy around vaccines that have long been established. But I think that where we still can leverage trust, right - we are seeing trust eroded in governmental agencies, in public health agencies - but where we can still leverage trust is in those individual relationships, in a relationship between a patient and their health care provider, people might not trust big government. They might not trust the CDC right now. They might not trust their state public health agency, but they do trust their pediatrician. They trust their school nurse. They trust their local pastor, their community leaders. And so, I think where we can really leverage those sources of local trust, those relationships, are going to be helpful. And so, a lot of what I try to do is talk to physicians so that physicians are equipped, or other health care providers are equipped to talk to their local community members. A lot of folks now get their vaccines in pharmacies. We've got to make sure that pharmacists have the best available data, and we've got to leverage on the trust that still exists.

SHEEHAN: 

And what is the guidance from the Michigan Department of Health and Human Services?

BAGDASARIAN: 

Well, like many states, we have broken with the CDC and ACIP on this particular guidance. So, we issued a statement several weeks ago saying that in terms of our childhood vaccination guidance, we were going with the American Academy of Pediatrics and the American Academy of Family Practice, which many states have done as well. And so, for hepatitis B, we are again going with AAP, American Academy of Pediatrics. They continue to recommend a birth dose, as do we.

SHEEHAN: 

And can you leave us with any sort of final thoughts on how to how to consider this situation, how to think about it?

BAGDASARIAN: 

I think that's a really interesting question, because we're in a position now where, as public health leaders, we have seen our institutions be eroded. We've seen science, the scientific method is- is questioned, not only data and recommendations, but the whole scientific methodology is being questioned. And it's- it's, again, really difficult, and I think we have to think now about how do we best communicate with folks? How do we keep those channels of communication open? How do we listen and understand that people truly are coming to this conversation with real doubts, rather than political ideologies? I think what started at the national level as political rhetoric has now become people's very real concerns on- on how to proceed with vaccinating their kids. And again, we've got to leverage those local sources of trust, the people in our communities who parents know and trust.

SHEEHAN: 

Well said. Dr. Natasha Bagdasarian, thanks so much.

BAGDASARIAN: 

Thanks for having me on.

SHEEHAN: 

Dr. Natasha Bagdasarian is the Michigan Department of Health and Human Services chief medical executive and ASTHO's liaison to the CDC Advisory Committee on Immunization Practices.

In the first installment of a new ASTHO webinar series, state leaders from Iowa, Indiana, Washington, and Georgia share innovative tools and strategies for partnership management, relationship evaluation, and customer service in public health. Panelists explore a range of approaches, from low-code and no-code CRM development, to tailored feedback systems, and RFP planning that support infrastructure improvements and more responsive engagement with local jurisdictions and community partners. Find a link to the webinar, Public Health Approaches to Relationship and Partnership Management, in the show notes.

And at no point in time has the importance of public health been more evident. Visit publichealthcareers.org to explore public health resources, careers, and internship opportunities. Connect with local, state, and territorial health departments and join us in our efforts to protect and promote the health and well-being of all Americans. That's publichealthcareers.org. This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.