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(NEW YORK) — Four Western U.S. states have come together to issue unified vaccine recommendations for the upcoming respiratory illness season, and California has enacted a new law to base the state’s immunization guidance on independent medical organizations, rather than the U.S. Centers for Disease Control and Prevention.
The West Coast states including California, Washington, Oregon, and Hawaii — all led by Democratic governors — banded together earlier this month to create the West Coast Health Alliance (WCHA), citing what they called an erosion of trust in the CDC.
“The alliance represents a unified regional response to the Trump Administration’s destruction of the U.S. CDC’s credibility and scientific integrity,” stated a press release Wednesday from California Gov. Gavin Newsom.
Also on Wednesday, Newsom signed a new law, which will shift the immunization recommendations the state will recommend from the CDC to independent medical organizations that include the American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG).
The recommendations issued by the West Coast states on Wednesday include guidance for receiving the COVID-19, flu and RSV vaccines.
“Science matters. We will ensure our policies are based on rigorous science. We stand united with our partner states and medical experts to put public health and safety before politics. I will continue to do everything in my power to protect Washingtonians,” said Washington Gov. Bob Ferguson.
The announcement came the day ahead of a two-day meeting of the CDC’s the Advisory Committee on Immunization Practices (ACIP), during which the panel of advisers recently picked by HHS Secretary Robert F. Kennedy is expected to vote Thursday on some vaccines on the CDC childhood immunization schedule and Friday on recommendations for COVID-19 vaccines.
The FDA has approved the new COVID-19 vaccines only for those at high risk for severe illness including those 65 and older. Anyone who falls out of those categories is allowed to get a prescription for the vaccine after discussing it with their doctor.
The association that represents many insurance companies (AHIP) pledged to cover the cost for any vaccine that is part of the current guidelines before the new ACIP makes their recommendations this week. The current guidelines suggest anyone older than 6 months should consider getting the COVID-19 and annual flu shot until at least the end of 2026.
Several states have also made rules that allow anyone who wants a vaccine to get one at their pharmacy.
In a statement earlier this month, a spokesperson for the U.S. Department of Health and Human Services blasted the West Coast states’ plans for a health alliance, criticizing COVID-era policies in “Democrat-run states.”
The statement added, “ACIP remains the scientific body guiding immunization recommendations in this country, and HHS will ensure policy is based on rigorous evidence and Gold Standard Science, not the failed politics of the pandemic.
(NEW YORK) — Ahead of a key meeting amongst the Centers for Disease Control and Prevention (CDC) vaccine advisors — now with 12 members hand-picked by health secretary Robert F Kennedy Jr. — doctors, health officials and advocates are raising alarms that the panel could reverse a decadeslong guideline of vaccinating infants against hepatitis B at birth.
On camera on Wednesday, Republican Sen. Bill Cassidy, a doctor specialized in treating liver diseases and chair of the Senate committee that oversees the Department of Health and Human Services (HHS), said the American people should not have confidence in the advisory panel’s decision if they recommend against the birth dose of the hepatitis B vaccine.
The Advisory Committee on Immunization Practices (ACIP) is scheduled to meet Thursday to discuss the hepatitis B vaccine recommended at birth, a shot that decades of research has shown is safe and has virtually eliminated hepatitis B among babies in the United States.
At the last ACIP meeting in June, the advisory panel casted doubt about the necessity of the hepatitis B shot recommended at birth to all babies, comments that sparked concern among physicians.
In testimony on Wednesday, ousted CDC Director Susan Monarez said she was fired because she refused to rubber-stamp future changes Kennedy wished to make to the childhood vaccine recommendations, without a careful review of the evidence herself.
On Thursday, ACIP plans to discuss the hepatitis B birth dose and is expected to vote on a new recommendation, according to a draft of the meeting agenda.
Doctors and advocates told ABC News that the hepatitis B birth dose is still an essential recommendation and delaying it may lead to gaps in insurance coverage, growing health disparities, confusion and an increase in preventable hepatitis B infections.
Doctors call the hepatitis B vaccine ‘one of the cornerstones’ of prevention In a Senate hearing on Wednesday, Republican Sen. Bill Cassidy praised the success of the recommendation to give babies a hepatitis B vaccine at birth.
“Before 1991, as many as 20,000 babies, babies, were infected with hepatitis B in the United States of America, and that changed when the hepatitis B vaccine was approved for newborns,” Cassidy said.
“Now fewer than 20 babies per year get hepatitis B from their mother. That is an accomplishment to make America healthy again, and we should stand up and salute the people that made that decision, because there’s people who would otherwise be dead if those mothers were not given that option to have their child vaccinated.”
“The hepatitis B birth dose is one of the cornerstones of our hepatitis B prevention policy,” Dr. Sean O’Leary, an infectious disease specialist and chair of the American Academy of Pediatrics committee on infectious diseases, said in a press briefing following the last ACIP meeting in June.
The CDC currently says a timely administration of a hepatitis B vaccine is essential to help prevent transmission of the virus from mother to child at birth. While efforts to test for this virus during pregnancy have improved detection, cases can still be missed, or documentation may be inaccurate or incomplete.
Doctors and public health experts said that the hepatitis B shot is currently recommended for all babies at birth because the risk if a baby is missed is too high.
“A child that is infected at birth has a 90% chance of going on to develop chronic active hepatitis B. Of those children, of those 90%, 25% of them will then go on to die of the disease,” O’Leary said.
The first hepatitis B vaccine was licensed in 1981, and the ACIP recommended a vaccine dose universally for all babies in 1991. The hepatitis B birth dose “acts as a safety net, reducing the risk for perinatal transmission when the [hepatitis B] status of the parent is either unknown or incorrectly documented at delivery,” the CDC said.
“Because the stakes were so high, because you’re so much more likely to get cirrhosis or liver cancer if you get this virus as a young child, that’s why [there’s a] birth dose,” Dr. Paul Offit, director of the Vaccine Education Center and professor of pediatrics in the Division of Infectious Diseases at Children’s Hospital of Philadelphia, told ABC News. “We did a dramatic job of virtually eliminating the disease in young kids.”
Doctors say a risk-based hepatitis B vaccine strategy didn’t work in the past Before 1991, hepatitis B shots were only given to infants considered high risk; however, this strategy missed many cases.
“Four to five decades of implementation science shows us that risk-based vaccine recommendations in this case, don’t work,” Chari Cohen, DrPH, MPH, president of the Hepatitis B Foundation, told ABC News.
“We were not very good at identifying all kids at high risk as there were other factors for which we were not accounting and because of imperfections in the system,” Dr. Gary Freed, a professor of pediatrics, health management and policy at the University of Michigan, told ABC News.
“To make sure no high-risk infants were missed, a universal hepatitis B vaccine strategy was adopted,” Freed told ABC News.
In 1999, there was a temporary pause in the universal recommendation, in favor of a risk-based recommendation for a brief period that year. At least one child in Michigan died of hepatitis B infection that year, who was missed, according to a CDC MMWR report, due to improper documentation.
Cohen said the birth dose doesn’t just protect babies from getting the virus from their mother but protects babies from getting it through close contacts who may not know they are infected.
“You only have 24 hours to save a baby from getting Hepatitis B if they’re born to a positive mom. However, you’re also trying, trying to prevent early childhood exposure, especially among families who don’t know that there’s a family member or a caregiver that has hepatitis B,” Cohen said.
Dr. Su Wang, a primary care doctor and person living with chronic hepatitis B who is a spokesperson for the Hepatitis B Foundation, knows how easily people can get missed from both sides of the healthcare system.
“We certainly cannot count on our system in the U.S., the way it is, our broken healthcare system to actually even identify those who are at risk, much less those who don’t have an identified risk. You just couldn’t imagine all the different ways that people can fall through the cracks,” Wang said.
“It’s a huge burden on somebody to have to have [hepatitis B] for the rest of their life, especially if it starts in childhood,” Wang said. “You could prevent all that with a simple vaccine.”
Wang learned she was living with hepatitis B when she tried to donate blood in college and later found out that she likely contracted the virus from a family member when she was a baby.
“This does happen, household transmission,” Wang said. “When I think about my case, I think the birth dose is something that would have helped me.”
Ending the recommendation may also worsen health disparities On Tuesday, American health insurers pledged to cover the cost of all vaccines based on previous recommendations by the ACIP that were in place as of Sept. 1. While this may protect access for many kids with private health insurance, it may leave a critical gap for kids who rely on no-cost vaccines through the Vaccines for Children Program (VFC), if the recommendation is reversed.
The CDC said over half of all American kids were eligible for shots through the VFC program in 2023. If ACIP no longer recommends a hepatitis B shot at birth, a majority of these kids may lose access.
“Fifty percent of newborns who are going to be eligible for Vaccines for Children may not have the vaccine any longer available to them,” Michaela Jackson, MS, program director of prevention policy for the Hepatitis B Foundation, told ABC News. “Policy changes can seem very, very small on the surface, but they have long-reaching impacts on the ground.”
Hepatitis B rates have improved but remain a ‘silent epidemic’ The recommendation for all babies to get the hepatitis B shot at birth has virtually eliminated this disease in young kids, but the virus still remains a “silent epidemic” in the U.S., Offit said.
Before universal vaccination at birth, it was estimated that 200,000-300,000 new hepatitis B infections occurred annually in the U.S. from 1980-1991 and over 1 million people were living with chronic hepatitis B infection, who were potentially infectious to others.
CDC data shows that there were at least 2,214 reports of acute hepatitis B cases in the U.S. in 2023, which corresponds to an estimated 14,400 acute infections with the virus, after adjusting for unrecognized or underreported infections. There were over 17,000 newly reported chronic hepatitis B cases and nearly 1,800 hepatitis B-related deaths that year.
It’s estimated that up to 2.4 million people are living with chronic hepatitis B in the U.S., many asymptomatic and unaware of their diagnosis.
“There’s a lot more hepatitis B in this country than we people realize. Risk is much higher than people know it is,” Cohen said.
The virus is contagious and spreads through contact with blood or body fluids from a person infected with the virus, according to the CDC. A person can be asymptomatic for many years and spread the infection.
There are medications people can take to slow down the virus, but there’s no cure.
“Until we have a cure for Hepatitis B, it is critically important to prevent it,” Cohen said.
The Hepatitis B Foundation has voiced grave concern that the recommendation for universal hepatitis B vaccination at birth will be reversed by the current ACIP.
“For decades, the birth dose recommendation has prevented thousands of Americans from a devastating and life-threatening illness. It is a critical part of our nation’s strategy to eliminate hepatitis B and protect the health of future generations,” the foundation said in a statement in June.
The organization called for a “zero-tolerance policy for perinatal hepatitis B transmission in the U.S.”
“We cannot allow a preventable, cancer-causing virus to destroy more lives. The health of our children and the integrity of our public health system deserve better,” the statement said.
In a letter to the ACIP ahead of Thursday’s meeting, the pharmaceutical company Merck, which makes one of the FDA-approved hepatitis B vaccines that can be given at birth, said 330 million doses of its shot have been distributed worldwide since its approval in 1986 and “have been evaluated in over 30 clinical studies enrolling approximately 13,000 participants.
Among these studies, 12 post-approval studies included 3,646 neonates, newborns, infants and children.”
“The safety profile of RECOMBIVAX HB has been well established and closely monitored for more than 35 years. Merck remains vigilant in monitoring scientific literature, healthcare reports and other data sources to ensure the continued safety of RECOMBIVAX HB,” Merck said.
Wang said $0.20 per shot could prevent a lifetime of suffering. “It’s not just a liver disease, you know, it affects your life completely.”
(NEW YORK) — The United States death rate decreased by 3.8% in 2024 as COVID fell out of the top 10 leading causes of death for the first time in four years, new provisional federal data shows.
The overall rate declined from 750.5 per 100,000 people in 2023 to 722 per 100,000, according to the report from the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS).
This marks the lowest death rate recorded since 2020, during the first full year of the COVID-19 pandemic, and follows declines that began in 2022.
The report also found that overall deaths fell from 3.09 million in 2023 to 3.07 million in 2024.
Additionally, the report showed the three leading causes of death stayed the same from 2023 to 2024, with heart disease as the leading cause, followed by cancer and unintentional injury, respectively.
Suicide replaced COVID-19 as the 10th leading underlying cause of death, knocking the disease off the top 10 list for the first time since 2020.
“‘It’s pretty noteworthy that COVID-19 fell off the top 10 and suicide, which had been had fallen off in recent years, is … ranked again,” Farida Ahmad, corresponding author of the report and health scientist at NCHS, told ABC News. “I think that’s a pretty interesting finding given where we spent the last five years.”
Ahmad said fewer deaths from COVID in 2024 compared to 2023 may be a reason behind the 3.8% decline.
“Ever since it came onto the scene in 2020, COVID was one of the top 10 leading causes of death,” Ahmad said. “It started off as a third-leading cause and, in 2024, we see that it’s not ranked at all, actually. So, it’s still among the 15 leading causes, but not in the top 10.”
Dr. Sharonne Hayes, a professor of cardiovascular medicine at Mayo Clinic in Rochester, Minnesota, agreed that fewer cases of COVID-19 are likely driving the reduction in mortality.
“I think there’s a little less COVID, right? I mean, that’s part of it,” she told ABC News. “I think that the pandemic was such a time of both COVID-related deaths, but also just rising risk factors, particularly around cardiovascular disease, people’s lifestyles were less healthy. And maybe we are coming back to more of where we are before.”
Ahmad said another driver for the drop in deaths could be the decline in drug overdose deaths.
A CDC report published in May found that U.S. drug overdose deaths fell by nearly 27% in 2024 to the lowest levels seen in five years.
Dr. Katie Schmitz, a visiting professor of medicine in the department of medicine and cancer epidemiologist at the University of Pittsburgh, told ABC News that leading causes of death continue to be cardiac disease and cancer-related deaths due to an aging population, as well as underlying factors such as obesity.
Schmitz noted that we have an increase in proportion of the population with these co-morbidities and it’s important to highlight that access to health care can be limited, particularly for rural populations.
Other leading causes of death in the report included stroke, chronic lower respiratory disease, Alzheimer’s disease, diabetes, kidney disease and chronic liver disease and cirrhosis.
The report also found that death rates decreased from 2023 to 2024 among all racial/ethnic groups. Rates in 2024 were lowest for multiracial people at 332.3 per 100,000 and highest for the Black population at 884 per 100,000.
Death rates decreased from 2023 to 2024 for all age groups except infants younger than one year old, according to the report. Death rates in 2024 were lowest for children between ages 5 and 14 at 14.4 per 100,000 and highest for people age 85 and older at 13,835.5 per 100,000.
Schmitz said investments should be made that focus on prevention — such as addressing rising obesity rates — and early screenings, which can vary with socioeconomic status and geography.
Hayes said making lifestyle changes is hard, but it is one of the best ways to lower the risk of some of the leading causes of death, including heart disease and cancer.
“Whether it’s eating more vegetables, [decreasing] saturated fat, maintaining a healthy weight is going to help stroke, cancer, and heart disease risk as well as liver disease, kidney disease, and diabetes,” she said. “Aside from unintentional injury and suicide, virtually every other thing of that list would be impacted by lifestyle.”
Dr. Lisa Gwynn says Florida’s vaccine decision will create ‘perfect storm’ for diseases. ABC News.
(FLORIDA) — A top Florida pediatrician warned Thursday that the state’s plan to eliminate all vaccine mandates could lead to outbreaks of preventable diseases and put vulnerable populations at risk.
Dr. Lisa Gwynn, a former president of the American Academy of Pediatrics’ Florida chapter, told ABC News that removing vaccine requirements for public school children could endanger not just students, but also “newborn infants, elderly populations, and people with compromised immune systems, including those undergoing chemotherapy.”
The warning came a day after Florida Surgeon General Joseph Ladapo announced the state would become the first in the nation to remove all vaccine mandates, including those for common childhood diseases like polio, measles, chickenpox, and tetanus. Currently, all 50 states and Washington, D.C., require certain vaccinations for school attendance.
“It’s not just about parental choice,” Gwynn explained to ABC News. “When children are in close contact in classrooms, that’s a perfect storm for these types of diseases to spread.”
Gwynn argued that existing exemption policies already provide options for parents who oppose vaccination.
“There are other ways parents can achieve choice for their children,” she said. “As pediatricians, we work together with parents so they can make informed decisions.”
She also raised concerns about health equity, noting that removing mandates could create a “case of the haves and have-nots.” Children from under-resourced communities who lack access to regular medical care might enter school unvaccinated not by choice, but due to healthcare barriers, she explained.
School entry vaccination mandates are determined by each state. All states allow medical vaccine exemptions, and most states already have exemption policies in place for people with strong religious objections, in an effort to balance the need for public health with the ideal of individual freedom of choice. Some states allow exemption based on personal belief alone.
Florida’s decision to end vaccine mandates comes amid broader changes in national health policy. Health and Human Services Secretary Robert F. Kennedy Jr. appeared before the Senate Finance Committee Thursday to discuss the administration’s healthcare agenda, following recent shake-ups at both the FDA and CDC.
“These changes were absolutely necessary adjustments to restore the agency to its role as the world’s gold standard public health agency with the central mission of protecting Americans from infectious disease,” Kennedy said.
Ladapo defended the decision to end mandates on Wednesday, calling them “an immoral intrusion on people’s rights” during his announcement at Grace Christian School in Valrico, Florida.
Gwynn countered this view, pointing to decades of research supporting vaccination programs.
“Public health measures have saved millions of lives,” she told ABC News. “School vaccination requirements have been the best public health achievement of this century.”
A spokesperson for the Florida Surgeon General’s Office did not immediately respond to ABC News’ request for comment.
(NEW YORK) — People who use their smartphones while sitting on the toilet face are at higher risk for painful, itchy hemorrhoids, according to new research published in the journal PLOS One.
Researchers investigated the bathroom habits of 125 adults undergoing screening colonoscopies at Beth Israel Deaconess Medical Center in Boston. About two-thirds of participants reported scrolling through their smartphones while sitting on the toilet.
Those who were glued to their phone while using the bathroom were 46% more likely to have hemorrhoids compared to those who left their device in another room.
“The likely explanation is that prolonged sitting increases pressure in the veins around the rectum, which can contribute to hemorrhoids,” Dr. Ernesto Gonzaga, a gastroenterologist from the Hospital of the University of Pennsylvania and who did not contribute to the study, told ABC News.
Scrollers spent a longer time on the toilet, the researchers found — about five times as many smartphone users logged over five minutes of toilet time per visit. When researchers asked what they were doing on their phones while doing their business, people confessed to catching up on the news, cruising through their social media feeds, or sending emails and texts.
Gonzaga pointed out that phone users also reported getting less exercise than non-users, suggesting that their broader lifestyle patterns could also contribute to their risk of hemorrhoids.
Hemorrhoids are swollen blood vessels around the anus and rectum, according to the National Institutes of Health. They can cause itching, pain and discomfort, and in many cases, they can also lead to rectal bleeding. Studies show that they are common in both men and women and affect about 1 in 20 Americans and about half of adults over 50 years old have hemorrhoids.
They are mainly treated with more fiber and fluids, soothing creams or sitz baths, and in tougher cases, they may require surgery.
“In clinical practice, we still recognize the more classical risk factors for hemorrhoids, including constipation, straining, low fiber intake, prolonged toilet sitting, pregnancy, obesity, and sedentary lifestyle. Constipation and abnormal bowel habits are particularly strong risk factors, while high fiber intake is protective,” Gonzaga said.
Gonzaga noted that the study does have some limitations. It looked at a small number of subjects and relied on self-reporting, so it doesn’t necessarily prove that phone use on the toilet is a direct cause of hemorrhoids, he said. He called for more research to get to the bottom of it.
“Given that hemorrhoids already account for millions of outpatient visits and substantial healthcare costs, these findings raise a broader public health concern about a growing burden of disease, potentially extending into younger populations as smartphone use,” he added.
Noor Shaik, MD, PhD, is a neurology resident physician and a member of the ABC News Medical Unit.
