ACIP Chair Says Polio Vaccine Should be Optional

In a podcast this week, Advisory Committee on Immunization Practices (ACIP) Chair Kirk Milhoan, MD, PhD, said polio and measles vaccines should be optional and alluded to the idea that other vaccines should be as well and provided only after consultation with clinicians. ¹

He made the comments on the podcast “Why Should I Trust You?” and expressed the importance of choice.¹

“If there is no choice, then informed consent is an illusion,” he said. “Without consent it is medical battery.”¹ Milhoan is a pediatric cardiologist, and does not have an educational background in infectious diseases or vaccinology.

Back in December when ACIP was meeting to discuss the hepatitis B vaccine regarding the universal birth dose recommendation, and the panel could not decide on voting language for recommendations around the vaccine, Milhoan called in remotely and tried to justify the voting languages and the potential delay by 2 months in administering the first dose. Specifically, he talked about neonates’ vulnerability at birth and suggested that at 2 months, infants move out of the perinatal period.²

It is important to note this was not based on any scientific data or clinical studies.

And in fact, a modeling analysis showed by delaying the birth dose to 2 months among infants whose mothers are not known to be living with hepatitis B, there could be at least 1400 preventable hepatitis B infections among children, 300 excess cases of liver cancer, 480 preventable deaths, and over $222 million in excess health care costs for each year the revised recommendation is in place.

Additionally, the modeling showed that for each year a delayed birth dose policy is in place, delaying the birth dose to 2 months results in at least 62 preventable deaths and 39 cases of liver cancer.

Before the December meeting on the hepatitis B birth dose vote was changed by the revamped ACIP committee—who were selected by Secretary of Health and Human Services Robert F Kennedy—the prior guidance of the hepatitis B birth dose immunization was widely viewed as a successful public health policy. It had been in existence for decades, and led to a significant reduction in disease. Between 1991 and 2019, HBV infection among children and adolescents dropped 99%, preventing tens of thousands of cases of cirrhosis, liver cancer, and death.²

Approximately 20,000 individuals contracted HBV annually in the US before the universal hepatitis B vaccine birth dose was recommended, with much of the burden on the pediatric population. Despite its success, and without offering any evidence or data to change the hepatitis B birth dose, the ACIP voted to alter the recommendation to individual-based decision making.

The voting language for this new recommendation reflected the ongoing confusion and limited knowledge that this new committee is demonstrating.

For the vote on the universal vaccine language, the new recommendation stated the following:

"For infants born to HBsAg [hepatitis B surface antigen]-negative women: ACIP recommends individual-based decision making, in consultation with a health care provider, for parents deciding when or if to give the HBV vaccine, including the birth dose. Parents and health care providers should consider vaccine benefits, vaccine risks, and infection risks. For those not receiving the HBV birth dose, it is suggested that the initial dose is administered no earlier than 2 months of age."

In a recent interview with Contagion, Sharon Nachman, MD, chief of pediatric infectious diseases, Stony Brook Children's Hospital disagreed with the idea of moving the hepatitis B vaccination back. “I think the change in timing of the hepatitis B vaccine to infants is going to result in many more children getting infected with hepatitis B at birth,” she aid.

In thinking about families, Nachman says the message from CDC’s ACIP is deferment of HBV vaccines.

“That message of deferment tells families you don't need it now; I don't know that you need it later; and I don't know when you need it,” she said. “So we are going to see children who do not get the birth dose, whose mothers are truly not infected with hepatitis B, so their risk at birth of acquiring it is zero, or close to zero. But, if they don't get the vaccine at 2 months, or at 2 years or some other time, they're going to grow up to be adolescents and adults with no memory that they've never gotten this vaccine. They're going on to have behaviors that may include some risk, and they're going to acquire this infection—which is silent at an age when they're quite vulnerable—and get chronic active Hepatitis B, a disease that we could have easily prevented.”

In looking at polio incidence rates prior to the advent of the polio vaccine, polio paralyzed over 20,000 Americans, with more than 60,000 total cases in 1952, making it a major cause of disability. And annual cases of paralytic polio often exceeded 15,000, causing severe fear in the public. In 1916, New York City had a polio outbreak with over 27,000 cases and 6,000 deaths.³

References

1. Mandavilli A. Rejecting Decades of Science, Vaccine Panel Chair Says Polio and Other Shots Should Be Optional. NY Times. January 23, 2026. Accessed January 23, 2026. https://www.nytimes.com/2026/01/23/health/milhoan-vaccines-optional-polio.html

2. APHA joins GW and dozens of public health and policy experts urging the CDC to maintain universal newborn hepatitis B vaccination. Press release. American Public Health Association. December 2, 2025. Accessed December 10, 2025. https://www.apha.org/news-and-media/news-releases/apha-news-releases/public-health-and-policy-experts-urge-the-cdc-to-maintain-universal-newborn-hepatitis-b-vaccination

3. Beaubien J.Wiping Out Polio: How The U.S. Snuffed Out A Killer. NPR. October 15, 2012. Accessed January 23, 2026.
https://www.npr.org/sections/health-shots/2012/10/16/162670836/wiping-out-polio-how-the-u-s-snuffed-out-a-killer3.