The Brief

Kristen Bell knows what an audience wants.

Mostly, they want her to be herself, plus a little bit of the character she's playing at that time.

Veronica Mars, Sarah Marshall, Eleanor, Joanne — all of her characters have a degree of thoughtfulness, quirkiness and smarts. Traits that Bell herself exhibits.

It's an equation she says she's been crunching throughout her career. "Emotional math," she calls it.

Bell sat down with the host of LAist's AirTalk, Larry Mantle, in studio this week to discuss the emotional math she brings to her characters. Plus, the trajectory of her career, taking creative control and staying true to herself throughout.

The following is an abbreviated version of her on-air interview.

Kristen Bell as Joanne in episode 209 of “Nobody Wants This.”

(

Erin Simkin

/

Netflix

)

Mantle:  Share with us a bit about the pleasure you've taken, presumably, in the creative arc of your career.

Bell:  Well, if I'm being brutally honest, I think I've tripped over a lot of these opportunities. I mean, Ted Danson gave me the best piece of advice once when we were working together. He said, "No one knows what they're doing except for a few people. So find the smartest people in the room and hitch your horse to them."

When I started out on Veronica Mars, I certainly stumbled into the brilliance of that show. But it taught me a lot, and I attempted to sponge up everything. That's where I learned how to do comedy. I had not trained in comedy at all.

 I fought that for a while, trying to be everything to everyone. I was like, whoa, what's the next indie movie that's going to go to Sundance? All the things you read about in the trades. My husband said to me once, "Stay in your lane, like ... just do what you're good at. You are a weird, quirky person. Let that come out."

Ted Danson and Kristen Bell in "The Good Place." (Courtesy of NBC)

(

Courtesy NBC

)

Mantle:  Let's talk about how you find that edge between bringing these aspects of yourself and the character that you're doing. I understand you're playing to strengths here, but what are the ways that you walk that line?

Bell: To me,  acting is emotional math. I'm not necessarily a method actor. I don't bring it home. To me, I feel like I can close my eyes and see how to make a math equation that will bring the audience on a ride.

And part of that is playing something authentic and being real, right? Not robotic. I look at most of acting in numbers. How much sympathy do you need in this scene? How much empathy? How revolting can you be? And it's all percentages in my head. So I start by saying, "It's gotta be 50% me and 50% the qualities of the character I'm playing."

Mantle:  I do wanna ask you, as well, Kristen, about faith being a part of The Good Place. Of course, issues of faith were center in that. And in Nobody Wants This, your character is agnostic and dating a rabbi. So faith is central. Is that just sort of coincidental?

 Bell: It was coincidence that Nobody Wants This happened to have a faith and belief aspect, as well. But you can insert any line of demarcation between two people into these characters.

So he happens to be a rabbi and she's agnostic. But you could insert socioeconomic backgrounds. You could insert any faith. It could be blue and red. And can they make a relationship when they have differing beliefs? It could be anything.

 The common ground is always more acreage than the differences. And people forget that. It's so easy to forget.

I think that's what I love about you and your work so much, Larry. You are able to keep the truth.

Season 2 of Nobody Wants This premieres Oct. 23 on Netflix. Listen to Larry Mantle and Kristen Bell's full conversation here:

You can listen to Kristen Bell's debrief of her conversation with Larry below:

For more than three decades, it has been routine to give all newborns in the U.S. the hepatitis B vaccine. That could soon change.

An advisory committee to the Centers for Disease Control and Prevention is expected to vote Thursday on whether to rescind that universal recommendation.

If that happens, pediatricians say, the health consequences could be dire.

"It would be extremely dangerous," Dr. Andrew Pavia told NPR this year. He's a professor of pediatrics and medicine with the University of Utah and a pediatric and adult infectious disease specialist.

The hepatitis B virus attacks the liver. The disease has no cure, and chronic infection can lead to serious outcomes such as liver cancer, cirrhosis and death. And the risks of these outcomes are much higher for people who get infected as infants.

"About 25% of children who develop chronic hepatitis B will die of their infection," says Pavia, who is also a spokesperson for the Infectious Diseases Society of America.

Delaying the birth dose by just two months could result in at least 1,400 additional preventable cases of hepatitis B for each year the revised recommendation is in place, according to a new analysis. Delaying the vaccine until age 12, as President Trump suggested this year, could result in at least 2,700 preventable infections each year, the analysis found. The study was released prior to peer review, ahead of this week's meeting of the Advisory Committee on Immunization Practices.

Before the U.S. began universally vaccinating newborns in 1991, some 18,000 children a year would become infected before age 10. About half were infected through mother-to-child transmission, Pavia says. Giving newborns the shot right after birth prevents the virus from taking hold.

The other half of kids got infected from somewhere else. Trump said hepatitis B is sexually transmitted — which is one means of transmission — so there's no reason to give the vaccine to a baby. But Pavia says the risks for kids are everywhere.

"There have been cases of infections in day care. There have been cases of infection on sports teams. There have been documented infections from shared toothbrushes and from shared razors," he says.

The virus is found in blood, saliva, semen and other bodily fluids, even tears, and it can live on surfaces for up to seven days. A child with a wound who comes into contact with that surface — even days later — could become infected, says Anita Patel, a pediatrician and pediatric critical care physician in Washington, D.C.

According to the Centers for Disease Control and Prevention, about half of people infected with hepatitis B don't know they have the virus, but Patel says they can still pass on the virus unwittingly.

"If you have a cut, that blood could potentially get on the infant," Patel says. "And if that infant has any sort of break in their skin — as infants, frankly, frequently do — they can then get hepatitis B," says Patel.

Dr. Su Wang says she suspects she got infected with hepatitis B as an infant through her grandparents. She says they likely got exposed through their jobs as medical workers in Taiwan. Taiwan used to have very high rates of hepatitis B infection among adults before it began a successful national vaccination program in the 1980s.

"When I was born, they came over to help, like a lot of grandparents do, and they lived with us," Wang says. "They became primary caregivers for the first month of life. And so very likely that's how I got hep B."

Wang is now an internist and researcher specializing in hepatitis at Cooperman Barnabas Medical Center in New Jersey.

She says it's very important to give the shot at birth. Since vaccination of newborns became routine in the U.S., case rates have plummeted 99% among people age 19 and younger.

"When we started doing this as universal for all kids, you saw this blanket protection that protected an entire generation of kids," Wang says.
Copyright 2025 NPR

One year after UnitedHealthcare's CEO was shot and killed, the crisis in U.S. health care has gotten even worse — in ways both obvious and hidden.

People increasingly can't afford health insurance. The costs of both Obamacare and employer-sponsored insurance plans are set to skyrocket next year, in a country where health care is already the most expensive in the developed world.

Yet even as costs surge, the companies and the investors who profit from this business are also struggling financially. Shares in UnitedHealth Group, the giant conglomerate that owns UnitedHealthcare and that plays a key role in the larger stock market, have plunged 44% from a year earlier. (It was even worse before a rally in UnitedHealth shares on Wednesday.)

"UnitedHealth's reputation in the investment community, before December 4 last year, was [as] a safe place to put your money. And that basically got all blown up," says Julie Utterback, a senior equity analyst who covers health care companies for Morningstar.

Then, on Dec. 4, 2024, UnitedHealthcare CEO Brian Thompson was shot on a Manhattan street on his way to an investor event. The shocking act of violence sparked a widespread consumer outcry over U.S. health care costs and denied claims, and plunged UnitedHealth Group into a public relations disaster.

But that was only the start of the business woes for the company and its entire industry — which are facing regulatory scrutiny, tightening margins, and investor skepticism. Many of UnitedHealth's top competitors have also seen their shares suffer in the past year, at a time when the stock market in general has been hitting tech-driven record highs. The S&P 500's healthcare index has lagged the larger market. And some Wall Street analysts are bracing for another rocky year in the business of health care.

"Near term, there's a lot more volatility to come," says Michael Ha, a senior equity research analyst who covers health care companies for investment bank Baird.

Dec. 4 started to reveal the depth of U.S. health care problems

This wide-ranging crisis for both consumers and businesses underlines the brokenness of the U.S. health care system: When neither the people it's supposed to serve nor the people making money from it are happy, does it work at all?

"We're really at an inflection point," says Katherine Hempstead, a senior policy officer at the Robert Wood Johnson Foundation and the author of a book about the insurance industry.

"Every segment of the health insurance business right now is stressed," she adds.

These stresses became brutally visible a year ago — and persist today. Luigi Mangione, the 27-year-old suspect in Thompson's killing, was in court this week for hearings ahead of his trial.

But the crisis in U.S. health care is much bigger than his case. Here are three main ways it's playing out this year, from Main Street to Wall Street.

Prices are going up — and people are getting ready to go without medical care

No matter how you get your health insurance, it will likely cost more next year.

For the roughly 24 million people who get their insurance through the government's health care exchanges, Affordable Care Act subsidies are set to expire at the end of the year — sending premiums soaring. Another 154 million people are insured through their employers — and premiums for those plans are also set to skyrocket.

Costs are increasing for several reasons: Drug companies have developed more effective cancer treatments and weight-loss drugs, which they can charge more for. More people are going back to the doctor after the pandemic kept them away, which is creating more demand and allowing providers and hospitals to increase prices. And some hospitals, doctors' offices, insurance companies and other businesses within the health care system have merged or consolidated, often allowing the remaining businesses to raise prices for their services.

The end result is that nearly half of U.S. adults expect they won't be able to afford necessary health care next year, according to a Gallup poll published last month.

Jennifer Blazis and her family are among them.

"It just always blows me away, how much I have to consider cost when something happens with the kids," the 44-year-old nonprofit worker and mother of four told NPR this fall in an interview for its Cost of Living series.

Blazis and her family live in Colorado Springs and get their insurance through her husband's small property-management business. She says she's postponing leg surgery that would address a condition that's causing her pain, but which her doctors say is not yet urgent.

"We wait to go to the doctor because we know if we do, we're going to get hit with just a massive bill," Blazis says. "And this is with … a really good health insurance plan that our [family] company pays a ton of money for."

Yet even the biggest businesses selling these services are struggling

Some of those increased costs are also hitting insurers — even the ones that also control other parts of the health care ecosystem.

UnitedHealth Group is far more than just the owner of the largest U.S. health insurance company. It's one of the largest companies in the world, and it's involved in almost every part of how Americans access health care — from employing or overseeing 10% of the doctors they see to processing about 20% of the prescriptions they fill.

It's also one of the most influential stocks on Wall Street. UnitedHealth Group is one of 30 companies that makes up the blue-chip Dow Jones Industrial Average — so what happens with its shares helps determine what happens with the overall stock market.

The company has had a miserable year on both fronts. The reasons come down to profits, more than PR: UnitedHealth and its competitors have been facing rising costs in the Medicare Advantage businesses that allow private insurers to collect government payments for managing the care of seniors.

These programs were once widely seen as moneymakers for big health insurers, but now they've gotten UnitedHealth embroiled in financial and regulatory trouble, including a Department of Justice investigation into its Medicare business. The company abruptly replaced its CEO in May, a few months before it acknowledged that it was facing the government probe.

Now UnitedHealth is trying to get rid of about 1 million Medicare Advantage patients — and otherwise move on from the past year's many problems.

"We want to show that we can get back to the swagger the company once had," Wayne DeVeydt, UnitedHealth's chief financial officer, told investors last month.

One prominent investor is betting it can: In August, Warren Buffett's Berkshire Hathaway disclosed that it had bought more than 5 million shares in UnitedHealth Group. The news helped lift the stock from its depths — but it still has a long way to go for both its share price and its profits to recover from this year's slump.

Chief Executive Stephen Hemsley acknowledged as much in October, promising investors "higher and sustainable, double-digit growth beginning in 2027 and advancing from there."

Spokespeople for UnitedHealth declined to comment for this story.

Wall Street used to think health care was safe. It's waiting for a turnaround

Health care spending accounts for about a fifth of the U.S. economy, making the for-profit companies that earn this money some of the most powerful in the world.

That's helped their appeal to investors, who traditionally tend to consider health care stocks "defensive," or safe, investments. That appeal sometimes overrides the industry's current financial challenges: In the past month, as Wall Street had its now-quarterly panic over the artificial intelligence bubble, health care stocks actually outperformed the broader market for a few weeks.

Still, health care is massively lagging the market in the long term.

Morningstar's Utterback is optimistic that the industry can eventually turn around its deeper financial, regulatory and reputational problems. She even calls most health care stocks "undervalued" currently — but she warns that investors will have to have a lot of patience if they want to see bets on the sector pay off.

"My explicit forecast period is 10 years. It's not three," she says. "There's a murky outlook here for the next couple years, at least."

Copyright 2025 NPR

Sleep is a rare commodity at Lindsay Crain’s house. Most nights, she and her husband are up dozens of times, tending to their daughter’s seizures. The 16-year-old flails her arms, thrashes and kicks — sometimes for hours.

But these days, that’s not the only thing keeping Crain awake. The Culver City mother worries about how President Donald Trump’s myriad budget cuts could strip their daughter of services she needs to go to school, live at home and enjoy a degree of independence that would have been impossible a generation ago.

“Every family I know is terrified right now,” Crain said. “We still have to live our everyday lives, which are challenging enough, but now it feels like our kids’ futures are at stake.”

Trump’s budget includes nearly $1 trillion in cuts to Medicaid, which funds a wide swath of services to disabled children, including speech, occupational and physical therapy, wheelchairs, in-home aides and medical care. All children with physical, developmental or cognitive disabilities – in California, nearly 1 million – receive at least some services through Medicaid.

Meanwhile, at the U.S. Department of Education, Trump has gutted the Office of Civil Rights, which is among the agencies that enforce the 50-year-old law granting students with disabilities the right to attend school and receive an education appropriate to their needs. Before that law was enacted, students with disabilities often didn’t attend school at all.

“We have a delicate web of services that, combined, support a whole child, a whole family,” said Kristin Wright, executive director of inclusive practices and systems at the Sacramento County Office of Education and the former California state director of special education. “So when the basic foundational structure is upended, like Medicaid, for example, it’s not just one cut from a knife. It’s multiple.”

Republicans have also suggested moving the office of special education out of the Department of Education altogether and moving it to the Department of Health and Human Services. Disability rights advocates say that would bring a medical – rather than a social – lens to special education, which they described as a major reversal of progress.

Trump has chipped away at other rights protecting people with disabilities, as well. In September, the U.S. Department of Transportation said it would not enforce a rule that requires airlines to reimburse passengers for damaged or lost wheelchairs. Trump has also repeatedly used the word “retarded,” widely considered a slur, alarming advocates who say it shows a lack of respect and understanding of the historical discrimination against people with disabilities. It’s all left some wondering if the administration plans more cuts to hard-fought rights protecting people with disabilities.

Fewer therapists, less equipment

The Medicaid cuts may have the most immediate effect. People with developmental disabilities typically receive therapy, home visits from aides, equipment and other services through regional centers, a network of 21 mostly government-funded nonprofits in California that coordinate services for people with disabilities. The goal of regional centers is to help people with disabilities live as independently as possible.

More than a third of regional centers’ funding comes from Medicaid, which is facing deep cuts under Trump’s budget. The money runs out at the end of January, and it’s unclear what services will be cut.

Schools also rely on Medicaid to pay for therapists, equipment, vision and hearing tests and other services that benefit all students, not just those with disabilities. In light of state budget uncertainty, it’s not likely the state could backfill the loss of Medicaid funding, and schools would have to pare down their services.

Uncertain futures

For Lelah Coppedge, whose teenage son has cerebral palsy, the worst part is the uncertainty. She knows cuts are coming, but she doesn’t know when or what they’ll include.

Lelah Coppedge, her husband Tom Seebach and their son, Jack Seebach.

(

Courtesy of Lelah Coppedge

)

“I go down this rabbit hole of worst-case scenarios,” said Coppedge, who lives in the Canoga Park neighborhood in Los Angeles. “Before this happened, I felt there was a clear path for my son. Now that path is going away, and it’s terrifying.”

Coppedge’s son, Jack, is a 16-year-old high school student who excels at algebra and physics. He loves video games and has a wide circle of friends at school. He uses a wheelchair and struggles with speech, communicating mostly through eye movements. He’ll look at his mom’s right hand to indicate “yes,” her left hand for “no.”

Coppedge and her husband rely on a nurse who comes four days a week to help Jack get dressed, get ready for bed and do other basic activities. Medicaid pays for the nurse, as well as other services like physical therapy. Even though Coppedge and her husband both work and have high-quality private health insurance, they could not afford Jack’s care without help from the government.

They also rely on the local regional center, which they assumed would help Jack after he graduates from high school, so he can remain at home, continue to hone his skills and generally live as independently as possible. If that funding vanishes, Coppedage worries Jack will someday end up in a facility where people don’t know him, don’t know how to communicate with him and don't care about him.

“It feels like we’re going backward,” Coppedge said. “Half the time, I put my head in the sand because I’m just trying to manage the day-to-day. The rest of the time I worry that (the federal government) is looking at people like Jack as medical problems, not as unique people who want to have full, happy lives. It feels like that’s getting lost.”

The current uncertainty is stressful, but it’s even harder for families who are immigrants, Wright said. Those families are less likely to stand up for services they’re entitled to and are facing the extra fear of deportation. English learners, as well as low-income children, are disproportionately represented among students in special education, according to state data.

“That’s the other piece to all this — how it’s affecting immigrant families,” Wright said. “It’s a whole other level of anxiety and fear.”

Decades of progress on the line

Karma Quick-Panwala, an advocate at the nonprofit Disability Rights Education and Defense Fund, said she worries about the rollback of decades’ worth of progress that was hard-won by the disability rights community.

The Individuals with Disabilities Education Act, the 1975 law that created special education, actually predates the federal Department of Education. In fact, Congress created the department in part to oversee special education. Removing special ed would be a devastating blow to the disability community — not just because services might be curtailed, but philosophically, as well, Quick-Panwala said.

In the Department of Education, special education is under the purview of education experts who promote optimal ways to educate students with disabilities, so they can learn, graduate from high school and ideally go on to productive lives. In the Department of Health and Human Services, special education would no longer be overseen by educators but by those in the medical field, where they’re more likely to “look at disability as something to be cured or segregated and set aside,” Quick-Panwala said.

“The disability rights community has worked so hard and gave so much to make sure people with disabilities had a right to a meaningful education, so they could have gainful employment opportunities and participate in the world,” Quick-Panwala said. “The idea is that they wouldn’t just be present at school, but they would actually learn and thrive.”

For the time being, Wright, Quick-Panwala and other advocates are reminding families that federal funding might be shrinking, but the laws remain unchanged. Students are still entitled under federal law to the services outlined in their individual education plans, regardless of whether there’s money to pay for it. The funding will have to come from somewhere, at least for now, even if that means cutting it from another program. And California is unlikely to roll back its own special education protections, regardless of what happens in Washington, D.C.

An imperfect but successful routine

Those reassurances are scant comfort to Crain, whose daughter Lena will rely on government support her entire life. Born seven weeks prematurely, Lena has cerebral palsy, epilepsy, a cognitive impairment and is on the deaf-blind spectrum. But she has a 100-watt smile and a relentless spirit, Crain said. Even after the whole family has been up all night, Lena insists on going to school and getting the most out of every day.

From left, Jack Deacy, his daughter Lena Deacy, and Lindsay Crain at their home in Culver City on Dec. 1, 2025. The family fears potential Medicaid cuts because Lena, who has cerebral palsy, epilepsy and other medical conditions, relies on Medicaid-funded services for her daily care and well-being.

(

Zaydee Sanchez

/

CalMatters

)

Funny and assertive, she has a few close friends and, like many teenagers, plenty of opinions about her parents. She loves her English teacher and spends most of her day in regular classrooms with help from an aide. Her favorite book is about Malala Yousafzai, the Pakistani activist who won a Nobel Peace Prize for fighting for girls’ right to an education.

Between school and home visits from aides and after-school therapists, Crain feels the family has pieced together an imperfect but mostly successful routine for Lena.

“Our entire lives are about teaching her self-advocacy, so she can have the most independent life possible,” Crain said. “Just because you need support doesn’t mean you can’t have a say in your life. There’s been so much work around the culture and the laws and the education system to make sure disabled people can make their own choices in life. We’re absolutely terrified of losing that.”

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.

Powerful federal advisers this week are expected to make a controversial change to how babies are immunized against hepatitis B, and to question how pediatricians inoculate children against more than a dozen other infectious diseases, including measles, mumps, whooping cough and polio.

The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) is convening Thursday and Friday for a closely watched meeting to rethink fundamental elements of the childhood vaccination schedule, which has protected children from dangerous diseases for decades.

The potential changes are welcomed by allies of Health and Human Services Secretary Robert F. Kennedy Jr., who has long questioned the safety and effectiveness of vaccines.

"We're now starting to see truth telling about vaccines, and needless to say, pharma, medicine, academia, mainstream media are not happy," Mary Holland of Children's Health Defense said in a video posted to the group's social media page. The nonprofit advocates against vaccines and was co-founded by Kennedy.

The meeting underscores grave concerns among many public health experts, who fear it will further erode childhood vaccinations, leading to a resurgence of preventable infectious diseases.

"We now seem to have entered a dangerous new phase in Secretary Kennedy's campaign to shut down scientific expertise, silence the best available evidence, and replace it with his own personal agenda," said Dr. Sean O'Leary, a professor of pediatric infectious diseases at the University of Colorado Anschutz who chairs the American Academy of Pediatrics's committee on infectious diseases.

The CDC's advisory committee, established in 1964, had long been considered a definitive source of information about childhood vaccines. It wields enormous power because its recommendations influence how doctors vaccinate patients and dictate whether insurance companies pay for shots.

But the committee has lost the trust of most mainstream medical groups since Kennedy replaced its members in June with his own slate. The committee has also abandoned longstanding collaborations with medical groups like the pediatrics academy and draws less on the experience of CDC experts.

The committee's September meeting devolved into chaos. A scheduled vote on the hepatitis B vaccine was tabled amid confusion. The chairman was replaced this week. The new chair, Dr. Kirk Milhoan, is a pediatric cardiologist and fellow with the Independent Medical Alliance – a group which continues to recommend treating COVID with drugs like ivermectin, even though studies have shown it does not work.

Confidence in the CDC was further eroded last month when the agency changed its stance on whether vaccines may cause autism, a theory championed by Kennedy and other anti-vaccine activists but long debunked by a large body of high-quality research.

In response, many independent medical groups, such as the American Academy of Pediatrics, the American Academy of Family Physicians and a newly formed effort at the University of Minnesota called the Vaccine Integrity Project, have begun issuing independent recommendations, which some states have begun following instead.

Vaccine schedule under the microscope

The vaccine committee is expected to hear the first report by a new working group tasked with scrutinizing the childhood vaccine schedule. The schedule is the finely calibrated timetable pediatricians use to administer the sequence of more than 30 doses to protect against more than a dozen diseases.

The scrutiny is especially troubling to many public health authorities, coming amid new outbreaks of vaccine preventable diseases, which are on the rise because of falling immunization rates.

"We have seen more measles cases in our country this year than we have in recent history. In my own community, we're seeing quite significant upticks in pertussis," said Dr. Raynard Washington, director of the Mecklenburg County Public Health Department, based in Charlotte, N.C., "Any barriers [to vaccination] that might be created by bureaucracy or process pose a threat to the public's health."

Vaccine proponents say every vaccine is carefully evaluated for safety and effectiveness before being added to the schedule. And researchers and regulators monitor all vaccines for safety issues after doctors start using them.

Children receive the roster of shots at a young age to make sure they don't catch dangerous diseases when they're most vulnerable, experts say.

"Every vaccine on that schedule and the recommended timing of it exists for a reason," says pediatrician O'Leary. "It's based on the age at which a child's immune system can provide optimal protection after vaccination, balanced with the age when the child is at highest risk for a disease. There's no reason to delay or space out vaccines – doing so just puts children at risk."

Some who are worried about vaccines argue the number of different antigens and other ingredients could overwhelm a child's immune system. But supporters say children are exposed to far more immune stimulation from naturally occurring microbes than from vaccines. And vaccines have been refined over the decades to minimize the number of ingredients they contain.

"Imagine saying we can only use medicines now that were developed before 1990," O'Leary says. "Imagine where we would be in medicine today. These newer vaccines are a good thing. They save lives. That's why we give them."

A change for the hepatitis B vaccine 

The first concrete step expected from the committee is a vote to change the current recommendation that all babies get vaccinated against hepatitis B within the first 24 hours of life.

It's unclear what the committee might recommend, but it could include delaying the shot or requiring a detailed discussion with parents before administering the shot.

Proponents of the change argue universal vaccination at birth is unnecessary because hepatitis B is often spread through sexual contact and drug use. Babies could be protected by increased screening of pregnant women and only inoculating babies of mothers who test positive, some argue. Supporters of the change also point to other countries that don't give newborns the dose.

But hepatitis B spreads other ways. The virus is highly infectious, and can be transmitted through contact with an infected person's body fluids, such as their blood. People can also get infected by coming into contact with common household objects, such as toothbrushes, and towels, that have been contaminated by another family member.

A new analysis by researchers who have presented at past ACIP meetings finds that delaying hepatitis B vaccination by just a few months could lead to more than $222 million in excess healthcare costs and hundreds of preventable deaths each year.

Most babies infected with the virus end up with chronic infections, which increases their risk for liver disease, failure and cancer.

"Universal vaccination has been the cornerstone of hepatitis B elimination efforts for decades," says Eric Hall, assistant professor of epidemiology at Oregon Health and Science University, and a co-author on the analysis. "It's very important we continue this work and do not undo the important public health achievements of the past 45 years."

Inoculating all babies at birth has resulted in a dramatic decrease in hepatitis B infections.

"The hepatitis B vaccine has one of the most well-established safety records of any vaccine, and it's one of our best," O'Leary says. "We've been using it for a long time. It's one of our best tools to protect babies from chronic illness and liver cancer. This is a situation where one missed case is too many."

He added that pediatricians partner with parents on children's health. "You probably will also hear a lot from individuals in this meeting who claim parents don't get a say in their children's immunizations," he said. "I want to be very clear when I say that's completely false. … We want to make sure we're protecting children from harmful diseases while also making sure the parents are fully informed and involved in the process."

In addition, proponents of universal hepatitis B vaccination at birth argue there is no evidence the current approach is unsafe. And delaying the first dose would cause major problems because the subsequent two doses are administered as part of combination vaccines.

Experts are also alarmed that the CDC is investigating splitting up the MMR vaccine, which protects kids against measles, mumps and rubella in one shot. Giving kids three separate shots would mean more trips to the doctor and more needles, vaccine proponents say. They worry that, inevitably, more kids would end up missing vaccines.

Aluminum ingredients under fire

The committee is also studying the safety of an ingredient commonly used in vaccines, an additive that contains aluminum. Coming after other recent changes to vaccine policy, many public health experts worry that the administration may now try to remove the ingredient.

For almost a century, some important vaccines, including shots that protect against diphtheria, tetanus, hepatitis and the flu, have included aluminum salts, compounds that contain small amounts of aluminum. They are used as adjuvants to give the immune system an extra boost to make the shots protective.

"What aluminum does is it draws the immune system's attention to that particular little protein so that it makes a much more robust immune response that you then are protected by," O'Leary says.

One question the working group is considering is "do either of the two different aluminum adjuvants increase the risk of asthma?" according to a document outlining the group's mandate.

Most public health experts say there's no good evidence that aluminum adjuvants are unsafe and ample evidence that they pose no real concern. In fact, a large Danish study recently debunked any danger. People are exposed to far more aluminum on a daily basis from food, consumer products and their surrounding environment than from vaccines.

In addition to concerns over asthma, critics claim aluminum can also increase the risk for other health problems, including autism and attention deficit hyperactivity disorder.

"Based on large, long-term studies and immunology research, there is no evidence that vaccines cause either allergies or autoimmune disorders e.g., Type 1 diabetes, rheumatoid arthritis, multiple sclerosis, systemic lupus," Dr. Frank Virant, president of the Board of Directors at the American Academy of Allergy, Asthma & Immunology, wrote in an email to NPR.

But removing aluminum from vaccines would render them ineffective, and there are no substitute vaccines ready to go. It could take years to develop reformulated replacements.
Copyright 2025 NPR