The Low Point of My Day Wasn't Cleaning Explosive Dog Diarrhea
A brief commentary on Day 1 of the December ACIP meeting
Yesterday, my day started at 5am with one of my dogs having an accident. Whatever he ate did not agree with him, and I found myself on my hands and knees scrubbing explosive diarrhea out of grout before the sun came up.
I thought that would be the low point of my day.
I was wrong.
I spent the next 12 hours watching the CDC’s Advisory Committee on Immunization Practices discuss whether to weaken the recommendation for hepatitis B vaccination at birth; a policy that has prevented an estimated 500,000 childhood infections and 90,000 deaths since 1991. A policy built on decades of evidence. A policy that represents one of the ten greatest public health achievements of the modern era.
And I watched it all play out on a national broadcast.
This isn’t a closed-door academic debate. Parents are watching. Pregnant women are watching. People in other countries are watching. They’re watching individuals with impressive credentials—PhDs, MDs (albeit sometimes in unrelated fields)—raise concerns about SIDS and encephalitis based on correlation data that has been assessed thoroughly over decades and found not to be causally linked. They’re not presenting new evidence. They’re resurfacing old fears, but now with institutional authority behind them.
And in between the bickering and the ego-wagging, I kept thinking: do they know people are watching this? The answer is yes – they do. I’ve come to realize that that’s the point.
I lost count of how many times we were told we “don’t have adequate safety data.” Honestly, it might have been a thousand times.
This is bewildering to hear.
We have randomized controlled trials. We have cohort studies following hundreds of thousands of infants. We have population-level surveillance spanning decades. We have studies directly comparing birth dose to delayed vaccination showing no difference in adverse events. We have 35 years of real-world evidence demonstrating this vaccine is safe and effective.
What exactly would “adequate” look like? At some point, the goalposts aren’t being moved… they’ve disappeared entirely.
At one point, a speaker referred to the birth dose as a “safety net”— complete with air quotes. As if that’s a bad thing. As if that’s not precisely what public health is supposed to be.
Public health exists because not everyone has equal access to care. Not everyone gets prenatal screening. Not everyone has a doctor who follows up on test results. Not everyone delivers in a hospital with clear protocols. The birth dose exists because we know (from decades of data) that 12 to 18 percent of pregnant women don’t get tested for hepatitis B, and only 35 percent of those who test positive receive all the recommended follow-up care. In a fragmented healthcare system, screening alone cannot catch everyone.
That’s not a failure. That’s exactly what safety nets are for.
And yet, multiple times throughout the day, committee members framed the birth dose as if infants are being asked to “fill the gap” for adults—as if we’re placing an unfair burden on babies to make up for our broken systems.
That framing is backwards.
We’re not asking babies to protect adults. We’re protecting babies—because 90 percent of infants who contract hepatitis B develop chronic infection, compared to less than 5 percent of adults. We’re protecting them from a virus that causes liver cancer, cirrhosis, and death. We’re protecting them in the first hours of life, when they’re most vulnerable, because we cannot predict which families will fall through the cracks. The birth dose isn’t compensation for a flawed system. It’s protection for children in a world where systems will always be flawed.
By the end of the day, my eyes were red and swollen. I’d been stress-rubbing them for 12 hours and looked like an albino rat. My son Dylan—who’s almost ten—asked me what was wrong.
So I tried to explain.
“You know how when your class has to make a decision, you vote on it? And before you vote, your teacher makes sure everyone knows what they’re actually voting on?”
He nodded.
“Well, today there was a really important meeting where grown-ups were supposed to vote on something that affects babies’ health. But they couldn’t vote, because the people in charge kept changing the question, and then no one understood it. And a lot of the people talking didn’t seem to agree on what the facts were, or they were saying things that aren’t really supported by evidence. And some of them were kind of mean to each other. So they had to stop and try again tomorrow.”
He looked at me for a second. “That sounds like a hot mess.”
Yeah, buddy. It does.
One would expect that this would have been the focus of the days (weeks, months) leading up to this meeting. Ironing out clear processes—the kind of process a federal health agency should follow when making decisions that affect children’s lives. The kind of process that used to make ACIP one of the most respected scientific bodies in the country.
Today is day 2. The vote will happen. If I were my father—a betting man—I’d say it’s the end of the hepatitis B birth dose as a universal recommendation.
A few voices in that room stood up and pushed back. Dr. Meissner challenged misleading presentations. Dr. Hibbeln reminded the committee that we have a high burden of proof before dismantling something that’s worked for 34 years. Liaison members from medical organizations called out the cherry-picking of data in real time. Physicians caring for children shared their perspectives with cracked but still incredibly powerful voices.
I continue to be awed by the people who show up and fight for our kids, and for public health, even when the room is stacked against them.
What strikes me, though, is that everyone in that room would probably say they’re fighting for children. Both “sides” use that language. And maybe that’s the saddest part… somewhere along the way, we stopped agreeing on what protecting children actually means.
Today they also plan to discuss the childhood vaccine schedule. I have a pit in my stomach.
Buckle up.
Stay Curious,
Unbiased Science
What, and when, will something be done about this threat to our health care?
Ah, Jess, you have a stronger stomach than I. The gutting of the agencies charged with protecting public health, especially childrens' is AFAIC one of the most egregious crimes against America that could be carried out. Not bombs, not economic ruin, just unnecessary suffering, illness and death.
Very worried how this will play out.