The Brief

A key federal vaccine advisory panel whose members were recently replaced by Health Secretary Robert F. Kennedy Jr. is expected to vote to recommend delaying, until age 4, the hepatitis B vaccine that's currently given to newborns, according to two former senior officials at the Centers for Disease Control and Prevention.

"There is going to likely be a discussion about hepatitis B vaccine, very specifically trying to dislodge the birth dose of hepatitis B vaccine and to push it later in life," said Demetre Daskalakis, the former director for the National Center for Immunization and Respiratory Diseases. "Apparently this is a priority of the Secretary's."

The vote is expected to take place Thursday during the next meeting of the CDC's Advisory Committee on Immunization Practices, or ACIP. The meeting is scheduled for September 18-19 at a CDC office in Atlanta, Georgia.

For more than 30 years, the CDC has advised that infants get the first of three shots of the hepatitis B vaccine at birth. In that time, the potentially fatal disease has been virtually eradicated among American children. Between 1990 and 2022, case rates plummeted 99 percent among people age 19 and younger.

Pediatricians warn that waiting until age 4 to begin vaccination opens the door to more children contracting the virus.

"Age four makes zero sense," said pediatrician Eric Ball, who practices in Orange County, California. "We recommend a universal approach to prevent those cases where a test might be incorrect or a mother might have unknowingly contracted hepatitis. It's really the best way to keep our entire population healthy."

In addition to the hepatitis B vaccine, the panel will also discuss and vote on recommendations for the combined measles, mumps, rubella, and varicella vaccine, and COVID vaccines.

Pediatricians worry changes to the schedules of these vaccines will limit access for many families, because ACIP's recommendations generally determine whether insurance plans and federal programs pay for the vaccines.

Typically, ACIP would undertake an analysis of the data before recommending a change to vaccine guidelines. As of the end of August, this process had not begun for the hepatitis B vaccines, Daskalakis and another former official said.

"This is an atypical situation. There's been no work group to discuss it," Daskalakis said.

The second former official spoke to NPR and KFF Health News on condition of anonymity.

In an email, a Health and Human Services spokesman, Andrew Nixon, wrote, "ACIP exists to ensure that vaccine policy is guided by the best available evidence and open scientific deliberation. Any updates to recommendations will be made transparently with gold standard science."

The draft agenda for the upcoming ACIP meeting was released to the public Sunday, only a few days before the meetings are scheduled to begin.

At the last ACIP meeting in June, chairman Martin Kulldorff, one of the new members handpicked by Kennedy, questioned the need to vaccinate every newborn, citing only two of the many ways the virus can spread.

Dr. Martin Kulldorff speaks during a June 25 meeting of the Advisory Committee in Immunization Practices at the CDC in Atlanta.

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Kulldorff is a former Harvard Medical School professor who became known for opposing some public health measures during the COVID-19 pandemic.

"Unless the mother is hepatitis B positive, an argument could be made to delay the vaccine for this infection, which is primarily spread by sexual activity and intravenous drug use," Kulldorff said.

The infection requires direct exposure to infected bodily fluids like blood and semen. The disease has no cure and can lead to serious conditions like cirrhosis and liver cancer later in life. The CDC advisory panel may maintain the recommendation to inoculate newborns whose mothers are considered at high risk of the disease, the former officials said.

Protection from birth

In 1991, federal health officials determined it was advisable for newborns to receive their first dose of the hepatitis B vaccine within 24 hours of birth, which blocks the virus from taking hold if transmitted during delivery.

While parents may opt out of the shots, many daycare centers and school districts require proof of hepatitis B vaccination for enrollment.

The prospect of altering the recommendation has left some people living with the virus deeply unsettled.

"I am goddamn frustrated," said Wendy Lo, 52, who lives in the San Francisco Bay area. Lo says she has probably had hepatitis B since birth. Years of navigating the psychological, monetary, medical and social aspects of chronic hepatitis B has impacted almost every aspect of her life.

"I would not want anyone to have to experience that if it can be prevented," she said.

Lo only learned she had the disease due to a routine screening in order to study abroad in college as a young adult.

Lo credits the vaccines with protecting all the members of her close family from infection.

"I shared with my partner, 'if you get vaccinated, we can be together,'" she said. He got the vaccine, which protects him from infection, "so I'm grateful for that," she said.

The CDC estimates half of people with hepatitis B do not know they are infected. It can range from an acute, mild infection to a chronic infection, often with few or no symptoms.

Most people with chronic hepatitis B were born outside of the U.S. Asians and Pacific Islanders, followed by Black people, have the highest rates of newly reported chronic infections.

When her children were born, Lo was adamant that they receive the newborn dose, a decision she says prevented them from contracting the virus.

The earlier an infection occurs, the worse the lifetime consequences, according to the CDC. When contracted in infancy or early childhood, hepatitis B is far more likely to become a chronic infection, silently damaging the liver over decades.

Those who become chronic carriers can also unknowingly spread the virus to others and face an increased risk of long-term complications including cirrhosis and liver cancer, which may not become evident until much later in life.

Treatments like the antivirals Lo now takes weren't available until the 1990s. Decades of the virus replicating unchecked damaged her liver. Every six months she gets scared of what her blood tests may reveal.

"Now I'm in my 50s, one of my big concerns is liver cancer. The vaccine is safe and effective, it's life-saving, and it protects you against cancer. How many vaccines do that?" Lo said.

Thirty years of universal vaccination

After a vaccine was approved in the 1980s, public health officials initially focused vaccination efforts on so-called "high-risk" adults.

"I, and every other doctor, had been trained in medical school to think of hepatitis B as an infection you acquired as an adult. It was the pimps, the prostitutes, the prisoners, and the healthcare practitioners who got hepatitis B infection. But we've learned so much more," said William Schaffner, professor of infectious diseases at the Vanderbilt University School of Medicine and a former voting member of ACIP.

As hepatitis B rates remained stubbornly high in the 1980s, scientists realized an entire vulnerable group was missing from the vaccination regime – newborns. The virus is often spread from an infected mother to baby in late pregnancy or during birth.

"We may soon hear 'let's just do a blood test on all pregnant women.' We tried that. That doesn't work perfectly either," Shaffner said.

Some doctors didn't test, he said, and some pregnant women falsely tested negative, while others acquired hepatitis B later in pregnancy, after they had already been tested. In 1991, Schaffner was a liaison member to the ACIP group that voted to recommend universal vaccination for hepatitis B before an infant leaves the hospital.

"We want no babies infected. Therefore, we'll just vaccinate every mom and every baby at birth. Problem solved. It has been brilliantly successful in virtually eliminating hepatitis B in children," he said.

In 1990, there were 3.03 cases of hepatitis B per 100,000 in those 19 years old and under in the U.S., according to the CDC.

Since the federal recommendation to vaccinate all infants, cases have dramatically decreased. CDC data shows that in 2022, the rate of cases among those ages 19 was less than 0.1 per 100,000.

While hepatitis B is often associated with high-risk behaviors such as injected drug use or multiple sexual partners, health experts caution that it is possible for the virus to be transmitted in ordinary situations, especially among young children.

The virus can survive for up to seven days outside the body. During that time, even microscopic traces of infected blood on a school desk or playground equipment can pose a risk.

If the virus comes into contact with an open wound or the mucous membranes of the eyes, an infection can occur. This means that unvaccinated children who are not considered "high risk" can still be exposed in everyday environments.

Future access uncertain

If the CDC significantly alters its recommendation, health insurers would no longer be required to cover the cost of the shot if given before the new recommended age. That could leave parents to pay out of pocket for a vaccine that has long been provided at no charge.

Children who get immunizations through the federal Vaccines for Children program would lose free access to the shot as soon as any new ACIP recommendations get approved by the acting CDC director.

The two former CDC officials said that plans were underway to push back the official recommendation for the vaccine as of August, when they both left the agency, but may have changed.

Schaffner is still a liaison member of ACIP, and hopes to express his support for universal newborn vaccination at the next meeting.

"The liaisons have now been excluded from the vaccine work groups. They are still permitted to attend the full meetings," he said.

He intends to speak up if he can, because he's worried about the next generation of babies and the doctors who care for them.

"We'll see cases of hepatitis B once again occur. We'll see transmission into the next generation," he said. "And the next generation of people who wear white coats will have to deal with hepatitis B, when we could have cut it off at the pass."

This story was produced in partnership with KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF.

NPR Health Correspondent Will Stone contributed to this story. Copyright 2025 KFF Health News

Perhaps nobody embodies artificial intelligence mania quite like Jensen Huang, the chief executive of chip behemoth Nvidia, which has seen its value spike 300% in the last two years.

A frothy time for Huang, to be sure, which makes it all the more understandable why his first statement to investors on a recent earnings call was an attempt to deflate bubble fears.

"There's been a lot of talk about an AI bubble," he told shareholders. "From our vantage point, we see something very different."

Take in the AI bubble discourse and something becomes clear: Those who have the most to gain from artificial intelligence spending never slowing are proclaiming that critics who fret about an over-hyped investment frenzy have it all wrong.

"I don't think this is the beginning of a bust cycle," White House AI czar and venture capitalist David Sacks said on his podcast All-In. "I think that we're in a boom. We're in an investment super-cycle."

White House AI adviser David Sacks speaks onstage during The Bitcoin Conference at The Venetian Las Vegas in January.

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"The idea that we're going to have a demand problem five years from now, to me, seems quite absurd," said prominent Silicon Valley investor Ben Horowitz, adding: "if you look at demand and supply and what's going on and multiples against growth, it doesn't look like a bubble at all to me."

Appearing on CNBC, JPMorgan Chase executive Mary Callahan Erdoes said calling the amount of money rushing into AI right now a bubble is "a crazy concept," declaring that "we are on the precipice of a major, major revolution in a way that companies operate."

Yet a look under the hood of what's really going on right now in the AI industry is enough to deliver serious doubt, said Paul Kedrosky, a venture capitalist who is now a research fellow at MIT's Institute for the Digital Economy.

He said there is a startling amount of capital pouring into a "revolution" that remains mostly speculative.

"The technology is very useful, but the pace at which it is improving has more or less ground to a halt," Kedrosky said. "So the notion that the revolution continues with the same drum beat playing for the next five years is sadly mistaken."

The huge infusion of cash

The gusher of money is rushing in at a rate that is stunning to financial experts.

Take OpenAI, the ChatGPT maker that set off the AI race in late 2022. Its CEO Sam Altman has said the company is making $20 billion in revenue a year, and it plans to spend $1.4 trillion on data centers over the next eight years. That growth, of course, would rely on ever-ballooning sales from more and more people and businesses purchasing its AI services.

There is reason to be skeptical. A growing body of research indicates most firms are not seeing chatbots affect their bottom lines, and just 3% of people pay for AI, according to one analysis.

"These models are being hyped up, and we're investing more than we should," said Daron Acemoglu, an economist at MIT, who was awarded the 2024 Nobel Memorial Prize in Economic Sciences.

"I have no doubt that there will be AI technologies that will come out in the next ten years that will add real value and add to productivity, but much of what we hear from the industry now is exaggeration," he said.

Nonetheless, Amazon, Google, Meta and Microsoft are set to collectively sink around $400 billion on AI this year, mostly for funding data centers. Some of the companies are set to devote about 50% of their current cash flow to data center construction.

Or to put it another way: every iPhone user on earth would have to pay more than $250 to pay for that amount of spending. "That's not going to happen," Kedrosky said.

To avoid burning up too much of its cash on hand, big Silicon Valley companies, like Meta and Oracle, are tapping private equity and debt to finance the industry's data center building spree.

Paving the AI future with debt and other risky financing

One assessment, from Goldman Sachs analysts, found that hyperscaler companies — tech firms that have massive cloud and computing capacities — have taken on $121 billion in debt over the past year, a more than 300% uptick from the industry's typical debt load.

Analyst Gil Luria of the D.A. Davidson investment firm, who has been tracking Big Tech's data center boom, said some of the financial maneuvers Silicon Valley is making are structured to keep the appearance of debt off of balance sheets, using what's known as "special purpose vehicles."

An aerial view of a 33 megawatt data center with closed-loop cooling system in Vernon, California.

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The tech firm makes an investment in the data center, outside investors put up most of the cash, then the special purpose vehicle borrows money to buy the chips that are inside the data centers. The tech company gets the benefit of the increased computing capacity but it doesn't weigh down the company's balance sheet with debt.

For example, a special purpose vehicle was recently funded by Wall Street firm Blue Owl Capital and Meta for a data center in Louisiana.

The design of the deal is complicated but it goes something like this: Blue Owl took out a loan for $27 billion for the data center. That debt is backed up by Meta's payments for leasing the facility. Meta essentially has a mortgage on the data center. Meta owns 20% of the entity but gets all of the computing power the data center generates. Because of the financial structure of the deal, the $27 billion loan never shows up on Meta's balance sheet. If the AI bubble bursts and the data center goes dark, Meta will be on the hook to make a multi-billion-dollar payment to Blue Owl for the value of the data center.

Such financial arrangements, according to Luria, have something of a checkered past.

"The term special purpose vehicle came to consciousness about 25 years ago with a little company called Enron," said Luria, referring to the energy company that collapsed in 2001. "What's different now is companies are not hiding it. But having said that, it's not something we should be leaning on to build our future."

Enormous spending hinging on returns that could be a fantasy

Silicon Valley is taking on all this new debt with the assumption that massive new revenues from AI will cover the tab. But again, there is reason for doubt.

Morgan Stanley analysts estimate that Big Tech companies will dish out about $3 trillion on AI infrastructure through 2028, with their own cash flows covering only half of that.

"If the market for artificial intelligence were even to steady in its growth, pretty quickly we will have over-built capacity, and the debt will be worthless, and the financial institutions will lose money," Luria said.

Twenty-five years ago, the original dot-com bubble burst after, among other factors, debt financing built out fiber-optic cables for a future that had not yet arrived, said Luria, a lesson, it appears, tech companies are not worried about repeating.

"If we get to the point after spending hundreds of billions of dollars on data centers that we don't need a few years from now, then we're talking about another financial crisis," he said.

Circular deals raise even more concern

Another aspect of the over-heated AI landscape that is raising eyebrows is the circular nature of investments.

Take a recent $100 billion deal between Nvidia and OpenAI.

Nvidia will pump that amount into OpenAI to bankroll data centers. OpenAI will then fill those facilities with Nvidia's chips. Some analysts say this structure, where Nvidia is essentially subsidizing one of its biggest customers, artificially inflates actual demand for AI.

"The idea is I'm Nvidia and I want OpenAI to buy more of my chips, so I give them money to do it," Kedrosky said. "It's fairly common at a small scale, but it's unusual to see it in the tens and hundreds of billions of dollars," noting that the last time it was prevalent was during the dot-com bubble.

Open AI CEO Sam Altman speaks during Snowflake Summit 2025 at Moscone Center in June.

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Lesser-known companies are getting in on the action, too.

CoreWeave, once a crypto mining startup, pivoted to data center building to ride the AI boom. Major AI companies are turning to CoreWeave to train and run their AI models.

OpenAI has entered deals with CoreWeave worth tens of billions of dollars in which CoreWeave's chip capacity in data centers is rented out to OpenAI in exchange for stock in CoreWeave, and OpenAI, in turn, could use that stock to pay its CoreWeave renting fees.

Nvidia, meanwhile, which also owns part of CoreWeave, has a deal guaranteeing that Nvidia will gobble up any unused data center capacity through 2032.

"The danger," said the MIT economist Acemoglu,"is that these kinds of deals eventually reveal a house of cards."

Some high profile investors see bubble-popping on the horizon

Some influential investors are showing signs of bubble jitters.

Tech billionaire Peter Thiel sold off his entire stake in Nvidia worth around $100 million earlier this month. That came after SoftBank sold a nearly $6 billion stake in Nvidia.

And in recent weeks, AI bubble pessimists have rallied around Michael Burry, the hedge-fund investor who made hundreds of millions of dollars betting against the housing market in 2008. He was the subject of the 2015 film The Big Short. Since then, though, he's had a mixed reputation for market predictions, having warned about imminent collapses that never came to pass.

For what it's worth, Burry is now betting against Nvidia, accusing the AI industry of hiding behind a bunch of fancy accounting tricks. He's homed in the circular deals between companies.

"True end demand is ridiculously small. Almost all customers are funded by their dealers," Burry wrote on X. He later wrote: "OpenAI is the linchpin here. Can anyone name their auditor?"

As tech companies sink billions into data centers, some executives themselves are freely admitting there looks to be some over exuberance.

OpenAI CEO Sam Altman told reporters in August: "Are we in a phase where investors as a whole are overexcited about AI? My opinion is yes. Is AI the most important thing to happen in a very long time? My opinion is also yes."

And Google chief executive Sundar Pichai told the BBC recently that "there are elements of irrationality" in the AI market right now.

Asked how Google would fare if the bubble burst, Pichai responded: "I think no company is going to be immune, including us."

Copyright 2025 NPR

A record number of people are expected to travel within the U.S. for Thanksgiving, be it plane, train or automobile.

Nearly 82 million are projected to travel at least 50 miles from Nov. 25 to Dec. 1, an increase of 1.6 million people compared to last year's holiday, according to an AAA report released on Monday.

Most of them will be hitting the road in a car, with about 73.2 million people expected to drive, AAA said. That's 1.8% more car travelers compared to the 2024 holiday period.

AAA projected 6 million people to travel by plane within the country for the holiday, a 2% increase from last year. Due to concerns over recent flight delays and cancellations, however, AAA also said that number could end up dropping slightly if travelers make last-minute arrangements to use other forms of transportation. Staffing shortages during the prolonged government shutdown earlier this month resulted in mass flight disruptions.

The FAA lifted its directive that called for an emergency reduction in flights, allowing airlines to return to operating normally. Aviation experts warned it could take some time before flights return to normal, but industry leaders appeared confident that airline operations would return to normal pre-shutdown levels in time for the Thanksgiving travel frenzy. Weather forecast to bookend the holiday in some parts of the country could cause flight disruptions and delays.

The Federal Aviation Administration (FAA) said Friday it expected the upcoming holiday rush to be the busiest Thanksgiving travel time for air travel in 15 years, with Tuesday being the busiest flying day.

Travel across other transport modes — bus, train and cruise — was forecast to increase 8.5% this year, with a likely uptick in last-minute bus and train bookings

"People are willing to brave the crowds and make last-minute adjustments to their plans to make lifelong memories, whether it's visiting extended family or meeting up with friends," Stacey Barber, vice president of AAA Travel said in a statement on Monday.

Here is what else to know:

Driving in the afternoon? Think again

Tuesday and Wednesday afternoon are expected to be the most congested times for drivers in major metro areas, according to INRIX, a transportation analytics firm.

If driving, the best times to hit the road for the holiday will be before noon on Tuesday and 11 a.m. on Wednesday to avoid backups, according to the firm. Thanksgiving Day will have minimal road traffic impacts.

When returning home after the holiday, travelers are advised to start driving before noon on any day except Monday. The Sunday after Thanksgiving will likely have heavy traffic most of the day and the best time to travel Monday will be after 8:00 p.m., INRIX said.

Weather could be messy, but should clear up for your trip back

During peak travel times, from Monday through Wednesday, rain extending from Southern Texas up to Minnesota will move across the country to the east, according to the National Weather Service (NWS).

"Monday into Tuesday will probably be a little problematic anywhere from Texas, eastern Oklahoma, into Arkansas and northwestern Louisiana," Bob Oravec, lead forecaster for the NWS, told NPR.

By Thanksgiving Day, things will be a little drier across the U.S. Temperatures will be colder than average for a majority of the country on Thanksgiving morning, with central parts of the U.S. seeing temperatures in the teens. On Black Friday, there will be warmer than average temperatures from the Great Plains to the West Coast, with places like Denver, Colo., seeing temperatures in the mid-50s, Oravec said.

Some of the worst weather will be across much of the central and eastern U.S. where there will be lake-effect snow showers coming off the Great Lakes, Oravec said.

For holiday travelers returning home on Friday and Saturday, the weather should be decent for a large portion of the country, he said. But a storm system is expected to develop over the weekend.

On Saturday and Sunday, the system could bring heavy snow across western Nebraska, South Dakota and North Dakota as well as parts of Minnesota into Wisconsin, according to Oravec. On Sunday, from Texas up into Missouri and Illinois, chances of rain are forecast to increase.

Copyright 2025 NPR

Some of the red ink in California’s budget deficit is coming from unplanned spending in state prisons, according to a new report from the Legislative Analyst’s Office.

The California Department of Corrections and Rehabilitation is on track to exceed its budget by roughly $850 million over three years despite recent cuts that include four prison closures and some labor concessions that trimmed payroll expenses. The state budget included $17.5 billion for prisons this year.

The office attributed the corrections department’s shortfall to both preexisting and ongoing imbalances in its budget. The analyst’s annual fiscal outlook projected a nearly $18 billion deficit for the coming year, which follows spending cuts in the current budget.

The corrections department last year ran out of money to pay its bills. In May, it received a one-time allocation of $357 million from the general fund to cover needs including workers’ compensation, food for incarcerated people and overtime.

Democratic Sen. Scott Wiener of San Francisco in a June 17 letter to the Department of Finance said he was “shocked and disappointed that (the corrections department) overspent its budget by such a significant amount” while the state faced a $12 billion general fund shortfall that resulted in cuts to key health care and social service programs.

“These were dollars that could have been used to provide basic services to some of our most underserved communities,” wrote Wiener. “While this year’s budget included measures requiring departments to ‘tighten their belts’ and reduce state operating expenses by up to 7.95%, (the corrections department) did the opposite, and overspent by nearly three percent.”

Without having any new dedicated funding to align its actual costs with its budget, Wiener warned, deficits “will likely persist” and put additional pressure on the general fund in years to come.

That’s despite Gov. Gavin Newsom’s attempts to save the state money through prison closures. Newsom in May moved to close the state prison in Norco in Riverside County next year, the fifth prison closure under his tenure.

Newsom’s administration estimates it saves about $150 million a year for each prison closure, which lawmakers and advocates regard as the only way to significantly bring down corrections spending. A spokesperson for Newsom’s Finance Department declined to comment on the analyst’s projection. Newsom will release his next budget proposal in January.

“We are allowing wasteful prison spending to continue while Californians are being told to tighten their belts and brace for deep federal cuts to core programs,” said Brian Kaneda, deputy director for the statewide coalition Californians United for a Responsible Budget in a statement to CalMatters. “We are spending millions on prisons that could be safely closed. That is government waste, not public safety.”

A new electric streetcar service connecting Garden Grove and Santa Ana is currently undergoing testing. If all goes as planned, the new service will be in operation starting next summer.

The nearly $650 million project — funded through a combination of state, federal and local funds — was originally set to begin service in 2021, but has been beset by rising costs and delays.

A train operator sits inside one of the OCTAs OC Streetcars for safety testing.

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Back on track

Darrell E. Johnson, Orange County Transportation Authority's CEO, told LAist that the service is 95% complete. The current testing phase could take anywhere between six and 12 months.

That means testing the train pulls out of the platform properly, control systems are operating properly, and that the train system interfaces with the street signal system along its route.

All aboard

Each car is over 90 feet long and has the capacity to carry up to 211 passengers.

“The fleet itself is eight vehicles. The service that we plan to run will take six of them every day.” Johnson said.

The new service will travel across some of densest areas of Orange County, ferrying an expected 5,000 passengers a day across the route's 10 stops.

The eastern side of the route starts at Santa Ana Regional Transportation Center, where over 50 Amtrak and Metrolink trains pass through daily.

The Civic Center for the county — which houses state, federal and county courthouses as well as Santa Ana City Hall — is in the middle of the route.

The service will end at the Harbor Boulevard — a heavily used bus route that sees more than 10,000 passengers a day.

The front view of an OC Streetcar on tracks.

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Transportation future

OCTA says it plans to charge the exact same amount as their bus system to ride the streetcar service — $2 one way or $5 for a day pass.

The service is slated to run every day from 6 a.m. to 11 p.m., with extended hours on weekends.

Officials are hoping for an Aug. 1 launch next year. And they don't anticipate stopping there.

“This is the beginning of something, whether we go north on Harbor Boulevard or South on Bristol Street or we continue westerly towards Artesia, Cerritos and LAX,” Johnson said. “That’s probably a decision that will be discussed in the next two to five years.”