Su Wang, MD, tuned in to a meeting of federal vaccine advisers earlier this month with some trepidation.

She wanted to share her experience living with hepatitis B and encourage the advisers to continue recommending vaccine for all newborns. But she was also prepared to hear vaccine misinformation from the committee, whose members were handpicked by Health and Human Services Secretary (HHS) Robert F. Kennedy Jr., a longtime anti-vaccine activist.

What Wang didn’t anticipate, she said, was anti-immigrant rhetoric and calls for racially profiling moms and babies.

“I felt targeted,” said Wang, an internal medicine physician whose parents immigrated legally to the United States from Taiwan.

Disparaging comments ‘pervasive’

Throughout the two-day meeting, speakers and committee members singled out immigrants and people from Asia as potential sources of infection.

“That elephant in the room that I’ll mention is immigration,” said Evelyn Griffin, MD, a member of the Advisory Committee on Immunization Practices (ACIP), which advises the Centers for Disease Control and Prevention (CDC) on vaccines. 

“We have had years of illegal immigration, undocumented people coming in from higher-endemicity countries,” said Griffin, an obstetrician-gynecologist who said she immigrated from Poland legally.

Robert Malone, MD, ACIP’s vice chair, singled out “economically disadvantaged Asian immigrant populations” as being at high risk for hepatitis B, which can cause liver failure and cancer. Up to 25% of children with chronic hepatitis B infections will die prematurely because of the disease.

Climate researcher Cynthia Nevison, PhD, a CDC contractor, described hepatitis B as primarily a concern for babies of “foreign-born” mothers and said it can occur in some “high-risk immigrant families,” stressing that there was little risk that the “average American child” would contract the virus from siblings or other relatives. 

Nevison suggested that immigrants be tested for the virus before entering the United States—a practice already recommended by the CDC. The health agency’s website says that most refugees are tested for hepatitis B before departing for the United States. The US Customs and Immigration Services already requires immigrants to receives vaccines against hepatitis B and other immunizations recommended by ACIP.

Flor Munoz, MD, a non-voting liaison member of ACIP, told CIDRAP News the committee’s remarks about immigrants were“derogatory and discriminatory” and “absolutely so scary.”

Disparaging comments about immigrants was “pervasive,” said Munoz, a pediatric infectious disease specialist in Texas who became a US citizen after moving to the United States to work as a physician. “It was not just a mention here or there,” she said. “It’s terrifying for government appointees to describe immigrants this way.”

An HHS spokeswoman said ACIP’s recommendations “rely solely on established scientific standards. Allegations of racial bias distort the record and undermine the hard work of committee members who carry out an evidence-driven process to protect the public and our nation’s children.”

Targeting immigrants

Hepatitis B can spread through microscopic amounts of blood. Children can be infected with hepatitis B by their mothers during delivery, or later through close contact with household members. Hepatitis B also can spread through sex with an infected partner or by sharing needles. Health care workers can be infected from patients with hepatitis B, which can survive for a week on surfaces. 

It’s terrifying for government appointees to describe immigrants this way.

In spite of these risks, ACIP voted during the meeting to drop a 34-year-old recommendation that all babies receive their first dose of hepatitis B vaccine at birth, a practice that has been credited with reducing hepatitis B infections in children by 99%. 

Instead of encouraging universal vaccination, the committee issued different recommendations depending on whether mothers have tested positive for the virus. The committee recommended a birth dose of hepatitis B vaccine only for the newborns of mothers who test positive for the virus or whose infection status is unknown.

ACIP voted to recommend “shared decision making” for babies of mothers who test negative for hepatitis B, in which patients and health providers discuss the most appropriate intervention for an individual. 

A footnote to the voting language on the CDC website advises parents and health care providers to consider the additional risk to babies if a household member tests positive for hepatitis B or if “there is frequent contact with persons who have emigrated from areas where hepatitis B is common.” That advice reads like a prescription for racial and ethnic profiling, said Wang, one of only a handful of members of the public selected to address the committee. 

Wang was prepared to speak to ACIP via teleconferencing, describing how she was infected as a baby from her grandparents, both of whom were health care professionals and unaware of their diagnosis. Her grandfather, a dentist, later died of liver cancer related to hepatitis B.

After reading the footnote, Wang said she briefly considered providing her testimony off-camera and under a pseudonym. As the child of Asian immigrants, she didn’t want to reinforce the stereotype the committee was creating.

Wang said her initial fear turned to resolve, however, and she refused to be silenced. In her testimony, she urged the committee to continue recommending the universal birth dose of hepatitis B vaccine, as it has for 34 years.

“I see patients with hepatitis B every day, many of whom do not have any of the risk factors,” Wang told the committee, live on camera and using her real name. “I’m here to advocate for all children.”

Added layer of misinformation

“We definitely felt a very anti-immigrant sentiment being expressed by the committee,” said Jason M. Goldman, MD, MACP, a non-voting liaison member of ACIP, who also addressed the committee via videoconferencing.

Blaming certain groups for spreading a disease creates a stigma that can leave people afraid to be tested or seek treatment, said Goldman, who is president of the American College of Physicians and a clinical affiliate professor at Florida Atlantic University. 

“I honestly do not know where this is coming from,” Goldman told CIDRAP News.

Because nations in Africa and the the Western Pacific have the highest burden of hepatitis B, the footnote could lead doctors to single out Asian and African immigrant families, said Richard J. Pan, MD, MPH, a pediatrician on the faculty at the University of California, Davis School of Medicine. 

Pan noted that immigrants have long been falsely blamed for spreading infectious diseases. Many recent infectious disease outbreaks in the United States have been started not by immigrants, but by unvaccinated American citizens who travel to countries with low vaccination rates and bring infections back with them, Pan said.

Using racial and ethnic stereotypes when discussing disease is harmful for everyone, not just immigrants, Pan said. That’s because parents who are not recent immigrants may assume their children are not at risk for the virus, leaving them unprotected.

“Viruses don’t care about state borders, what language you speak, or color you are,” Wang told CIDRAP News.

Suggesting that only immigrants are at risk of hepatitis B “gives the false impression that if you’re not in a ‘high-risk’ category, you’re somehow immune,” Goldman said. “That’s now how diseases work.”

Viruses don’t care about state borders, what language you speak, or color you are.

Health care providers already spend an enormous amount of time trying to counter anti-vaccine information. Goldman fears that providers will need to begin dispelling myths about immigrants and infectious disease, as well.

“We now have this other layer of misinformation and disinformation that we’re going to have to push back against, because it’s not good for public health,” Goldman said. “It’s very disheartening and disturbing that this is a further politicization of health care…

“This committee, Secretary Kennedy’s vaccine committee, is going backwards into a situation where they’re putting more people at risk,” Goldman said.

Profiling Asians called ‘completely insane’

Demetre Daskalakis, MD, MPH, former director of the CDC’s National Center for Immunization and Respiratory Diseases, described the footnote and conversation as “shocking/not shocking.”

Instead of carefully considering scientific evidence, Daskalakis said the committee “just sort of went with the vibes and their vibe is, “If you identify Asian people somewhere near your child, then maybe you should get them a hep B vaccine,’ which is completely insane.”

At a September ACIP meeting, “they kept saying, “Hepatitis B isn’t a problem in a normal household,” said Daskalakis, who resigned from the agency in August due to Kennedy’s undermining of public health.

Daskalakis compared the profiling of Asian immigrants to the language that many people used about AIDS in the early 1980s, when the disease was characterized as an illness affecting only gay men, people who inject illegal drugs and Haitian immigrants.

Targeting vaccines to people in particular groups didn’t work in the past, said Ravi Jhaveri, MD, head of infectious diseases at Lurie Children’s Hospital of Chicago. When the United States vaccinated only babies believed to be at high risk, many infected infants fell through the cracks, and hepatitis B infections failed to decline.

Tina Q. Tan, MD, a professor of pediatrics at Northwestern University Feinberg School of Medicine, encouraged parents not to follow the ACIP vaccine recommendations, which “have absolutely no scientific basis. This type of recommendation really severely negatively impacts the American public and only does harm.”

Instead, Tan said parents and physicians should look for guidance from the American Academy of Pediatrics and the Vaccine Integrity Project, whose recent report found no reason to stop vaccinating newborns against hepatitis B.

Putting babies at risk

Munoz said she has seen what can happen to unvaccinated babies.

A few years ago, she cared for a 3-month-old baby who needed a liver transplant because of organ damage caused by chronic hepatitis B. The baby’s mother tested negative for hepatitis B while she was pregnant and assumed her baby would not need a birth dose of the vaccine. That blood test, however, was incorrect.

“This was a highly educated family,” Munoz said. “The mother had prenatal care.”

Although the baby recovered well from the transplant surgery, Munoz said the girl will need immunosuppressive drugs for the rest of her life to prevent her body from rejecting the donated organ.