Western Alaska, where almost all the residents are Indigenous, used to have the world’s highest rate of childhood liver cancer caused by hepatitis B. After decades of screenings and vaccinations, that problem has been eliminated: Since 1995, only one person under the age of 30 has been diagnosed with hepatitis-caused cancer.
Now the Trump administration is seeking to end one of the key tools credited with accomplishing that goal: hepatitis B vaccinations of newborns.
The federal Advisory Committee on Immunization Practices on Dec. 5 voted to drop a long-standing recommendation for universal hepatitis vaccines for newborns. That is in accordance with the controversial views of U.S. Health Secretary Robert F Kennedy Jr., a vaccine skeptic who fired all members of the previous committee and appointed like-minded members to replace them.
Current federal childhood hepatitis B vaccination guidelines recommend one dose of the vaccine at birth, followed by additional doses at intervals through 18 months. The recommendation for newborn vaccinations has been in place since 1991.
The advisory committee, part of the U.S. Centers for Disease Control and Prevention, determined that children under 2 months should not be vaccinated unless their mothers are infected or could be infected by hepatitis B.
Some vaccine critics in the administration, including Kennedy and President Donald Trump, argue — contradicting medical experts and years of medical research — that hepatitis B vaccines for young children are unnecessary, claiming that it is spread primarily or exclusively through adult behavior like sex and sharing of needles for illegal drug use.
“Hepatitis B is sexually transmitted. There’s no reason to give a baby that’s almost just born hepatitis B. So I would say wait till the baby is 12 years old and formed and take Hepatitis B,” Trump said at a Sept. 22 news conference.
Those claims are false, said Dr. Brian McMahon, medical and research director of the liver and hepatitis program at the Alaska Native Tribal Health Consortium.
There is no credible evidence of a link between the vaccine and any other health problem, McMahon said.
Sexual transmissions accounted for only a tiny percentage of Alaska’s hepatitis B cases, he said.
Aside from mother-to-infant transmissions, which occur during childbirth, hepatitis B was predominantly spread in Western Alaska through normal daily activities. That is because, unlike the HIV virus or other hepatitis viruses, the hepatitis B virus can live for seven days on surfaces in schools and homes.
“The virus can be found all over, on school luncheon tabletops, counters and homes,” McMahon said. “Kids have open cuts and scratches from bug bites or anything else, and then they shed millions of particles of the virus on environmental surfaces. And then another kid comes along with an open cut or scratch.”
Nationally, only 12.6% of chronic hepatitis B cases recorded from 2013 to 2018 were attributable to sexual transmission, according to a 2023 CDC study. Transmissions of all forms of hepatitis, including hepatitis B, are possible through contact sports like football, rugby and hockey, researchers have found.
Before the past decades of vaccination and screening, hepatitis B was so prevalent in Western Alaska that it was classified as endemic there. It was the only part of the United States with such a classification. In some villages, 20% to 30% of the residents were infected, McMahon said.
The remoteness of Indigenous communities meant isolation from medical services, making early diagnosis difficult in the past, allowing infections to linger and be passed down through generations, according to scientists.
In Alaska, children infected with the virus early in life had a high likelihood of winding up with chronic infections that caused serious complications later, such as liver failure. The worst cases resulted in cancer, and even death.
For McMahon, now in his 80s, treating cancer-stricken children in the Yukon-Kuskokwim region, where he worked in the 1970s, was harrowing.
One of his patients was a 17-year-old high school valedictorian. A few months earlier, she started having abdominal pains, but she ignored them.
“She was really busy with school, and she’d gotten a full ride scholarship and was excited about going to the University of Alaska, representing her community,” McMahon said.
The pains turned out to be cancer, caused by a hepatitis B infection that she had not known she had. Too sick to be flown home, she died in the Bethel hospital.
Another patient was an 11-year-old boy, also diagnosed after he complained of similar abdominal pain. McMahon visited him at home, where the boy was “in horrible pain” and yellow from jaundice.
“He was just crying. He said I know I’m going to die. Just help me with my pain,’” McMahon said.
“My wife was with me. She was a public health nurse. She was in tears. The community health aid practitioner was in tears. I was fighting my tears and pulling everything I could out of my bag to try to help this patient sedate. It was just something I’ll never forget. Never.” McMahon said.
He has relayed these and other experiences to the vaccine advisory committee in hopes of persuading members to keep the infant recommendations in place.
“I said, ‘Do you want to be responsible for children getting liver cancer because of this decision?’” McMahon said.
Alaska was one of the first places in the world where the hepatitis B vaccine was used as soon as it became available in 1981.
The pilot vaccination project was at the insistence of Alaska Native organizations, along with the state government and Alaska’s congressional delegation. Under that pilot program, according to newly published study by McMahon and other researchers, tribal health organizations and their partners screened 53,860 Alaska Native people for infection and gave vaccines to 43,618 who tested negative, along with starting the universal newborn vaccinations.
Since 1995, according to the study, there have been no new symptomatic cases of hepatitis B among Alaska Natives under 20 anywhere in the state. Since 2000, no new cases of hepatitis-related liver cancer have been identified among Alaska Natives of any age in the Yukon-Kuskokwim Delta, a region where prevalence was concentrated in the past, the study said.
The vaccine committee’s new recommendation must be approved by the CDC administrator before it becomes federal policy.
McMahon said that no matter how national policy might change, Alaska Native tribal health organizations will continue administering hepatitis B vaccines to newborns.
“I know they’re not going to stop. Even if they have to pay for it. They’re so aware of this,” he said.
The Alaska Beacon is an independent, donor-funded news organization. Alaskabeacon.com.
