The rate of hepatitis B virus vaccinations given to newborns fell by 10 percentage points between 2023 and 2025, to just over 73%, according to new research published in JAMA.

After the COVID pandemic, attention shifted toward other childhood immunizations, while anti-vaccine media coverage and social media discourse shaped attitudes among parents, researchers wrote. They cited one interview during the study period, in which US Department of Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr, said babies do not need the hepatitis B vaccine and repeated debunked claims the shot raises the risk for autism — messaging that may have influenced parent choices.

James D. Campbell, MD, MS, professor of pediatrics at the University of Maryland School of Medicine in Baltimore and vice chair of the American Academy of Pediatrics Committee on Infectious Diseases, said he is disheartened by the decreased rates “because of people sowing doubt.”

“I always ask people, ‘Have you ever taken care of a child with cirrhosis, with liver failure? Have you ever been there in an ICU when an unvaccinated teenager died after two liver transplants because they hadn’t had hepatitis B vaccine, a $30 shot?’ I can say yes to all of those questions, most people cannot,” Campbell said. “The fewer children who are vaccinated, the more of them who will get infected.”

Nine out of 10 infants infected with the virus at birth will develop hepatitis infections that last over 6 months. The CDC also reported that people with chronic hepatitis B infections have up to 25% risk of dying from hepatitis, cirrhosis, liver cancer, or other diseases caused by the virus.

The hepatitis vaccine “can reduce the risk of acquiring what can become a lifelong serious infection that can lead to complications,” said Joshua Rothman, MD, MS, an assistant professor in the Department of Pediatrics at the UC San Diego School of Medicine, who led the research.

Rothman and colleagues calculated vaccination rates using electronic health records in the Epic Cosmos database representing more than 300 million patient records from 1800 hospitals and 41,500 clinics in the US.

Using data from more than 12.4 million newborns, they found vaccination rates rose from 67.5% in January 2017 to a peak of 83.5% in February 2023, before declining to 73.2% by August 2025 — a decline of more than 12%.

Experts have said they expect vaccination rates will further decrease following a recommendation from a federal immunization committee in December to provide the hepatitis B vaccination only to newborns of women who test positive for the virus or whose status is unknown. Babies born to women without the virus can receive the vaccine starting at 2 months of age, after parents and clinicians undertake shared decision-making.

New Era in Vaccination

Some patients have been skeptical about vaccines since widespread vaccination for smallpox began in the early 1800s. But physicians have noted that the COVID pandemic accelerated activism against vaccines.

The new data on declining rates of hepatitis B vaccination “reinforces my angst because it’s telling me, ‘Guess what, you’re not winning, you’re losing,’” in the fight that children deserve protection, said Sharon Nachman, MD, chief of the Division of Pediatric Infectious Disease at Stony Brook Children’s Hospital in Stony Brook, New York. “Since COVID, it’s been accepted to be a vaccine refuser.”

Nachman said that during her residency in 1985, she watched an unvaccinated 14-year-old girl die of hepatitis B.

“I can’t tell parents enough, hepatitis B kills children,” she said. “Vaccinate. This is going to be the one life-saving thing you could do right at this minute.”

Campbell noted that when the hepatitis vaccine was licensed in 1981, clinicians targeted high-risk populations, which included injection drug users, patients on hemodialysis, and infants born to mothers who tested positive for the virus. But he said those efforts did not lead to a decrease in the incidence of infections.

In 1991, the CDC’s Advisory Committee on Immunization Practices (ACIP) recommended hepatitis B vaccination at birth for all infants. Since then, annual perinatal infections have dropped from 16,000 cases per year in the early 1990s to less than 20 reported in recent years.

Last year, the ACIP changed its position after Kennedy, Jr, removed all members of the ACIP panel and replaced them with new members, including vaccine skeptics.

For infants born to women who test negative for the virus, the CDC now suggests that infants not receive the vaccine before 2 months of age and that the ultimate choice should involve shared decision-making between parents and clinicians. Infants born to women who have the virus should still receive the vaccine at birth.

ACIP cited low rates of perinatal transmission and that screening for the infection during pregnancy identifies nearly all cases.

“Parents and healthcare providers should consider whether there are infection risks such as a household member who has hepatitis B or frequent contact with persons who have emigrated from areas where hepatitis B is common,” along with vaccine risks and benefits during shared decision-making, the HHS wrote in a news release in December 2025.

Rothman reported having no financial conflicts of interest. Nachman reported receiving research grants from the National Institutes of Health. Campbell reported that his university has received funding from vaccine manufacturers, including Pfizer, Merck, and Sanofi, for some of his vaccine studies.

Brenda Sandburg is a freelance journalist for Medscape Medical News. She has written about the biopharmaceutical industry and legal issues for the Pink Sheet and American Lawyer Media.