In this episode, Pennsylvania Secretary of Health and ASTHO member Dr. Debra Bogen joins us to break down a major change in national vaccine guidance, and why it has sparked concern among pediatric and public health leaders.
In this episode, Pennsylvania Secretary of Health and ASTHO member Dr. Debra Bogen joins us to break down a major change in national vaccine guidance, and why it has sparked concern among pediatric and public health leaders. Dr. Bogen explains the recent ACIP vote that weakened the long-standing recommendation for all newborns to receive the hepatitis B vaccine within 24 hours of birth, a practice that has nearly eliminated the disease in young children since the early 1990s. She shares why this shift could create confusion for parents, what’s at stake for infant health, and how Pennsylvania is doubling down on clarity, access, and science-based information, including through a recent executive order from Pennsylvania Governor Josh Shapiro. Dr. Bogen also speaks to the broader moment facing public health, from rising misinformation to the importance of unified, evidence-driven messaging.
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JOHN SHEEHAN:
This is Public Health Review Morning Edition for Thursday, December 11, 2025. I'm John Sheehan, with news from the Association of State and Territorial Health Officials.
Today, we continue to discuss the recent change in guidance to the administration of the hepatitis B vaccine as voted on by the CDC Advisory Committee on Immunization Practices.
DEBRA BOGEN:
We know from experience that when vaccines are recommended and accessible, diseases decline, and when access falters, preventable infections return.
SHEEHAN:
This is our guest, Pennsylvania Secretary of Health, Dr. Debra Bogen.
BOGEN:
The Federal Vaccine Advisory Committee really voted to weaken the long-standing recommendations that every newborn receive the hepatitis B vaccine within 24 hours of birth. Instead of strengthening access, their decision really sows a lot of confusion at a time when parents really need certainty. You know, they have a newborn and they need a good, strong recommendation. We are committed to ensuring that children continue to have access to that vaccine here in Pennsylvania, to ensure that we can protect children from hepatitis B, which can be a lifelong liver disease. And so, we know from past experience that targeted vaccine efforts did not eliminate hepatitis B from children and infants. But since 1991, we've had a universal recommendation to give the vaccine at birth, and we have essentially eliminated hepatitis B from our young children and infants in the United States. Through this effort, we are truly blessed to have had that amazing outcome, and we want to ensure that that continues.
SHEEHAN:
Yeah, based on that history, can you give us some idea of what some possible impacts could be from this decision?
BOGEN:
Children are at particular risk for hepatitis B if they acquire it in infancy, as a young child. If a young infant gets a hepatitis B infection, either through transmission from mother to baby or through close family contact or caregiver contact in the first year of life, that they have a 90% chance of developing chronic hepatitis, and that chronic hepatitis leads to young age liver failure and liver cancer. If you're an adult and you get hepatitis B, you only have about a 5% chance of developing chronic hepatitis. So, our concern, of course, by eliminating this birth dose, is that we will return to pre-1990 data, where we have children who acquire this infection, who didn't need to that we could have prevented through a vaccination effort, and so we are all concerned that in a few years down the road, as fewer and fewer children get a hepatitis B vaccine, that we will return to that prior state. We know it's completely preventable through our approach that has worked since the 19- early 1990s. 50% of adults who have hepatitis B are not aware of it, and as a result, they are putting the people they associate with at risk unknowingly. So, again, if there's a caregiver in the home who's got close contact with a young infant, they can inadvertently, through just general contact, pass that infection to a young infant and child.
SHEEHAN:
For parents who are looking for more of that sort of clear, concise guidance, what would you say in this case?
BOGEN:
So, I would recommend that parents use the American Academy of Pediatrics as their go-to source for vaccine guidance. And I say that because actually, the American Academy of Pediatrics has been putting out advice for families on vaccinations for close to 100 years now, and they base their recommendations on science and evidence, and they are the organization for pediatricians across the country. I am a pediatrician, and I can tell you that our number one focus is the safety and well-being of children.
SHEEHAN:
Is that the approach that Pennsylvania is taking?
BOGEN:
In Pennsylvania, our governor, Governor Shapiro, signed on October 1 of this year, an executive order to ensure that families continue to have access to vaccines and vaccine information across the Commonwealth. And that executive order has done a number of things. One, is it made us- required the department to put all of our vaccine information in a single place, so that families have a single source of information that we have done and is available. The executive order also requires us to provide education to health care providers and to families and to create a work group to bring forth best practices in that information. So that is, moving forward, we have also aligned all of our state agencies to make sure that any role that we play in vaccination efforts, whether it's Medicaid, private insurers, schools, et cetera, all are working together to ensure access, and that we're reducing any barriers, and finally, to ensure that there's access to vaccines, if in the future, there is a removal of vaccines access in our communities.
SHEEHAN:
It strikes me that Pennsylvania is sort of very representative of the larger nation. It's- it has very, very rural areas. It has very urban areas. Can you sort of describe how the- those challenges that Pennsylvania faces in sort of communicating this information, sort of, is representative of the nation?
BOGEN:
Yeah, Pennsylvania is kind of a little microcosm of the United States in that we have diversity in many areas. But I think the message is clear that people, no matter where you live, that you need accurate information to make a good decision, right? As parents, as caregivers, we need good scientific information to be able to make recommendations and to make decisions. The challenge we all face in public health and in medicine is that people have a choice on where they get their information, and there is, unfortunately, a lot of disinformation and misinformation that families receive, and so, we need to present data with clarity and honesty so that people can make the best informed decisions they can. And that's what we are working to do, at least at the Department of Health and with all of our other state agencies and with all the community partners that we work with across the state,
SHEEHAN:
And do you have any final thoughts or maybe some reflections on this situation? It sounds like a very specific set of guidance for a specific vaccine, but it also feels like a larger moment in public health.
BOGEN:
Right, the ACIP meeting that happened at the beginning of December was really focused a lot on hepatitis B, and again, I want to reinforce to people, that hepatitis B vaccine is available and should continue to remain available, and that it's a safe and effective vaccine at preventing this illness in children. I do think there is a larger issue of creating confusion for families around vaccines in general, and we know that upcoming meetings will have other challenges for us to address in public health. And so, making sure that we continue to work together as a community to provide public health information that is consistent. And again, all the medical associations across the country and the public health associations have really spoken with one voice about the importance of vaccines, and we need to continue to do that as a group, really countering the disinformation that- that we know is out there for families and that confusion will unfortunately lead to lower rates of vaccination, which will lead to return of infectious diseases that we have largely eliminated if we're not thoughtful and careful in that process. And so, we are all working hard to make sure that that isn't what happens in our country, and me personally, working here in Pennsylvania.
SHEEHAN:
Dr. Debra Bogan is an ASTHO member and the Pennsylvania secretary of health.
Be sure to tune in to the PHIG Impact Report on Tuesday, December 16. We'll review a PHIG Impact Report interview with ASTHO member Patricia Tilley, associate commissioner of the New Hampshire Department of Health and Human Services on the critical needs the Public Health Infrastructure Grant has helped with in her state.
Our latest ASTHO brief, Creating a Culture of Community and Belonging in the Workplace, reveals how leaders can break down silos, build trust, and create environments where every employee feels valued, supported, and empowered to grow. Discover practical strategies to boost innovation, engagement, and team connection. Learn how to cultivate a culture of community and belonging by visiting astho.org to read the brief or find the link in our show notes.
This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.
