By Jackie Fortiér, KFF Health News

A key federal vaccine advisory panel whose members were recently replaced by Health and Human Services 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 Centers for Disease Control and Prevention officials.

“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, former director of the National Center for Immunization and Respiratory Diseases. “Apparently this is a priority of the secretary’s.”

The vote is expected to take place during the next meeting of the CDC’s Advisory Committee on Immunization Practices, scheduled for Sept. 18-19.

For more than 30 years, the first of three shots of hepatitis B vaccine has been recommended for infants shortly after birth. In that time, the potentially fatal disease has been virtually eradicated among American children. Pediatricians warn that waiting four years for the vaccine opens the door to more children contracting the virus.

“Age 4 makes zero sense,” pediatrician Eric Ball said. “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-19 vaccines. Pediatricians worry changes to the schedules of these vaccines will limit access for many families, leaving them vulnerable to vaccine-preventable diseases.

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 senior official spoke to NPR and KFF Health News on the condition of anonymity.

In response to questions from KFF Health News, HHS spokesperson 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 less than a week before it is scheduled to begin.

At the last ACIP meeting, in June, Martin Kulldorff, the chair and one of seven new members handpicked by Kennedy, questioned the need to vaccinate every newborn, citing only two of the many ways the virus can spread. Kulldorff is a former Harvard Medical School professor who became known for opposing some public health measures during the 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,” he said.

The virus spreads via direct exposure to an infected bodily fluid like blood or 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 have hepatitis B or 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 day care centers and school districts require proof of hepatitis B vaccination for enrollment.

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

“I am goddamn frustrated,” said Wendy Lo, who has lived with the liver disease, likely since birth. Years of navigating the psychological, monetary, medical, and social aspects of chronic hepatitis B has touched almost every aspect of her life.

“I would not want anyone to have to experience that if it can be prevented,” she said. Lo learned she had the disease due to a routine screening to study abroad in college.

Lo credits the vaccines with protecting her close family members 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 to no symptoms. Most people with chronic hepatitis B were born outside of the U.S., and 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 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.

“Now I’m in my 50s, one of my big concerns is liver cancer. The vaccine is safe and effective, it’s lifesaving, and it protects you against cancer. How many vaccines do that?” Lo said.

Thirty years of universal vaccination

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

After a vaccine was approved in the 1980s, public health officials initially focused vaccination efforts on people thought to be at highest risk of infection.

“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 health care practitioners who got hepatitis B infection. But we’ve learned so much more,” said William Schaffner, a 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 transmitted 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,” Schaffner said.

Some doctors didn’t test, he said, and some pregnant women falsely tested negative while others acquired hepatitis B after they had been tested earlier in their pregnancies.

In 1991, Schaffner was a liaison representative to ACIP when it voted to advise 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 people 19 years old or 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 among those 19 or under was less than 0.1 per 100,000.

While hepatitis B is often associated with high-risk behaviors such as injection drug use or having multiple sexual partners, health experts note that it is possible for the virus to be transmitted in ordinary situations too, including 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 not considered at 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 shots. 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 an alternate 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.

Schaffner is 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.”

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KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

By Jamie Ducharme, KFF Health News

After losing 50 pounds on the injectable weight loss medication Zepbound, Kyra Wensley received a surprising letter from her pharmacy benefit manager in April.

Her request for coverage had been denied, the letter said, because she’d had a body mass index of less than 35 when she started Zepbound. The 25-year-old who lives in New York had been taking Zepbound without incident for months, so she was confused: Why was her BMI, which had been around 32 when she started, becoming an issue only now?

Wensley had no interest in quitting an effective drug. “Going right off like that, it’s easier said than done,” she said.

Her doctor fought to keep her on the GLP-1 agonist, the category that includes weight loss and Type 2 diabetes drugs Ozempic, Wegovy, Mounjaro, and Zepbound. But Wensley ultimately had to switch from Zepbound to Wegovy to meet her plan’s requirements. She said she doesn’t like Wegovy as much as her old medication, but she now feels lucky to be on any GLP-1.

Lots of research suggests such medications must be used indefinitely to maintain weight loss and related health benefits. But with list prices of roughly $1,000 a month, public and private payers are struggling to keep up with ballooning demand for GLP-1 weight loss drugs and in some cases are eliminating or restricting their coverage as a result.

North Carolina Medicaid plans to end GLP-1 coverage for weight loss on Oct. 1, just over a year after starting the coverage. Pennsylvania is planning to limit Medicaid coverage to beneficiaries at the highest risk of complications from obesity. And despite recent reports of a potential federal pilot program to extend coverage of GLP-1 obesity drugs under Medicaid and Medicare, all state Medicaid programs are likely to be under pressure due to steep spending cuts in the budget reconciliation package recently signed into law by President Donald Trump.

Already, many GLP-1 users quit within a year, studies suggest — often due to side effects, high costs, or insurance issues. Now a growing number of researchers, payers, and providers are exploring deliberate “deprescription,” which aims to taper some patients off their medication after they have taken it for a certain amount of time or lost a certain amount of weight.

The U.K.’s National Institute for Health and Care Excellence, which creates guidance for the National Health Service, recommends two-year limits on the use of some weight loss medications, such as Wegovy. And the concept was raised in a recent Institute for Clinical and Economic Review report on affordable access to obesity drugs.

A. Mark Fendrick, who directs the Center for Value-Based Insurance Design at the University of Michigan, has argued that if some people using GLP-1s to lose weight were eventually transitioned off, more people could take advantage of them.

“If you’re going to spend $1 billion or $100 billion, you could either spend it on fewer people for a long period of time, or you can spend it on a lot more people for a shorter period of time,” he said.

Fendrick’s employer, the University of Michigan, indeed does that. Its prescription drug plan caps coverage of GLP-1 drugs at two years if they’re used solely for weight loss.

Jamie Bennett, a spokesperson for Wegovy and Ozempic maker Novo Nordisk, declined to comment on the concept of deprescription, noting that its drugs are intended for chronic conditions. Rachel Sorvig, a spokesperson for Zepbound and Mounjaro manufacturer Eli Lilly, said in a statement that users should “talk to their health care provider about dosage and duration needs.”

Studies have shown that people typically regain a substantial amount of weight within a year of stopping GLP-1 medications, and that many people who quit ultimately go back on the drugs.

“There’s no standard of care or gold standard on how to wean right now,” said Allison Adams, an obesity and internal medicine doctor with UK HealthCare in Kentucky.

But the math shows why time-limited coverage is appealing to payers that struggle to pay for beneficiaries’ GLP-1 prescriptions, said Michelle Gourdine, chief medical officer for the pharmacy benefit manager CVS Caremark.

And states are “between a rock and a hard place,” said Kody Kinsley, who until January led North Carolina’s Health and Human Services Department. “They’re going to have to look at every single thing and trim dollars everywhere they can.”

Pennsylvania was looking for cost-saving strategies even before the new federal tax-and-spending law, according to Brandon Cwalina, press secretary for the state’s Department of Human Services. Pennsylvania projects it will spend $1.3 billion on GLP-1 drugs this year.

Plans could see real savings, Fendrick said, if they covered GLP-1s for initial weight loss then moved people to cheaper options — such as more affordable drugs or behavioral health programs — to maintain it.

Plenty of companies are eager to sell insurers, employers, and individuals on behavioral alternatives. One is Virta Health, which advertises its nutrition-focused weight management program as “a proven approach for deprescribing GLP-1s when clinically appropriate.” A Virta-funded study assessed 154 people with Type 2 diabetes who stopped using GLP-1 medications but continued following Virta’s program, concluding that their weight did not significantly increase after a year.

Researchers affiliated with a European weight management company also recently reported that slowly tapering off the medications may help maintain weight loss.

For employers and insurers, the “initial question” was whether to cover GLP-1s for obesity, said Virta CEO Sami Inkinen. “Now, basically, everyone’s coming to the middle and asking, ‘How do we responsibly cover these drugs?’”

Part of responsible coverage, Inkinen said, is providing other forms of support to patients who stop using GLP-1 medications, by choice or otherwise.

For some people, however, maintaining weight loss without a GLP-1 remains a challenge, even with other options available.

Lily, who lives in Michigan, lost almost 80 pounds in roughly 18 months on Wegovy. But she had to quit the drug when she turned 26 and left her parents’ insurance plan this year. The plan her employer offers stopped covering GLP-1s for weight loss right around the time she joined.

Lily, who asked to be identified by only her first name because she is not out to her family as transgender, has tried other medications since then, and previously tried lifestyle programs to control her weight. But she said nothing works as well for her as Wegovy.

She has regained 20 pounds since going off the drug at the beginning of the year and worries that number will continue to rise, potentially contributing to future health problems.

“Just give people the drugs,” she said. “It seems cheaper and safer in the long run.”

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

By Paula Span, KFF Health News

It started with a high school typing course.

Wanda Woods enrolled because her father advised that typing proficiency would lead to jobs. Sure enough, the federal Environmental Protection Agency hired her as an after-school worker while she was still a junior.

Her supervisor “sat me down and put me on a machine called a word processor,” Woods, now 67, recalled. “It was big and bulky and used magnetic cards to store information. I thought, ‘I kinda like this.’”

Decades later, she was still liking it. In 2012 — the first year that more than half of Americans 65 and older were internet users — she started a computer training business.

Now she is an instructor with Senior Planet in Denver, an AARP-supported effort to help older people learn and stay abreast of technology. Woods has no plans to retire. Staying involved with tech “keeps me in the know, too,” she said.

Some neuroscientists researching the effects of technology on older adults are inclined to agree. The first cohort of seniors to have contended — not always enthusiastically — with a digital society has reached the age when cognitive impairment becomes more common.

Given decades of alarms about technology’s threats to our brains and well-being — sometimes called “digital dementia” — one might expect to start seeing negative effects.

The opposite appears true. “Among the digital pioneer generation, use of everyday digital technology has been associated with reduced risk of cognitive impairment and dementia,” said Michael Scullin, a cognitive neuroscientist at Baylor University.

It’s almost akin to hearing from a nutritionist that bacon is good for you.

“It flips the script that technology is always bad,” said Murali Doraiswamy, director of the Neurocognitive Disorders Program at Duke University, who was not involved with the study. “It’s refreshing and provocative and poses a hypothesis that deserves further research.”

Scullin and Jared Benge, a neuropsychologist at the University of Texas at Austin, were co-authors of a recent analysis investigating the effects of technology use on people over 50 (average age: 69).

They found that those who used computers, smartphones, the internet, or a mix did better on cognitive tests, with lower rates of cognitive impairment or dementia diagnoses, than those who avoided technology or used it less often.

“Normally, you see a lot of variability across studies,” Scullin said. But in this analysis of 57 studies involving more than 411,000 seniors, published in Nature Human Behavior, almost 90% of the studies found that technology had a protective cognitive effect.

Much of the apprehension about technology and cognition arose from research on children, sometimes focused on adolescents, whose brains are still developing.

“There’s pretty compelling data that difficulties can emerge with attention or mental health or behavioral problems” when young people are overexposed to screens and digital devices, Scullin said.

Older adults’ brains are also malleable, but less so. And those who began grappling with technology in midlife had already learned “foundational abilities and skills,” Scullin said.

Then, to participate in a swiftly evolving society, they had to learn a whole lot more.

Years of online brain-training experiments lasting a few weeks or months have produced varying results. Often, they improve a person’s ability to perform the task in question without enhancing other skills.

“I tend to be pretty skeptical” of their benefit, said Walter Boot, a psychologist at the Center on Aging and Behavioral Research at Weill Cornell Medicine. “Cognition is really hard to change.”

The new analysis, however, reflects “technology use in the wild,” he said, with adults “having to adapt to a rapidly changing technological environment” over several decades. He found the study’s conclusions “plausible.”

Analyses like this can’t determine causality. Does technology improve older people’s cognition, or do people with low cognitive ability avoid technology? Is tech adoption just a proxy for enough wealth to buy a laptop?

“We still don’t know if it’s chicken or egg,” Doraiswamy said.

Yet when Scullin and Benge accounted for health, education, socioeconomic status, and other demographic variables, they still found significantly higher cognitive ability among older digital technology users.

What might explain the apparent connection?

“These devices represent complex new challenges,” Scullin said. “If you don’t give up on them, if you push through the frustration, you’re engaging in the same challenges that studies have shown to be cognitively beneficial.”

Even handling the constant updates, the troubleshooting, and the sometimes maddening new operating systems might prove advantageous. “Having to relearn something is another positive mental challenge,” he said.

Still, digital technology may also protect brain health by fostering social connections, known to help stave off cognitive decline. Or its reminders and prompts could partially compensate for memory loss, as Scullin and Benge found in a smartphone study, while apps help preserve functional abilities like shopping and banking.

Numerous studies have shown that while the number of people with dementia is increasing as the population ages, the proportion of older adults who develop dementia has been falling in the United States and several European countries.

Researchers have attributed the decline to a variety of factors, including reduced smoking, higher education levels, and better blood pressure treatments. Possibly, Doraiswamy said, engaging with technology has been part of the pattern.

Of course, digital technologies present risks, too. Online fraud and scams often target older adults, and while they are less apt to report fraud losses than younger people, the amounts they lose are much higher, according to the Federal Trade Commission. Disinformation poses its own hazards.

And as with users of any age, more is not necessarily better.

“If you’re bingeing Netflix 10 hours a day, you may lose social connections,” Doraiswamy pointed out. Technology, he noted, cannot “substitute for other brain-healthy activities” like exercising and eating sensibly.

An unanswered question: Will this supposed benefit extend to subsequent generations, digital natives more comfortable with the technology their grandparents often labored over? “The technology is not static — it still changes,” Boot said. “So maybe it’s not a one-time effect.”

Still, the change tech has wrought “follows a pattern,” he added. “A new technology gets introduced, and there’s a kind of panic.”

From television and video games to the latest and perhaps scariest development, artificial intelligence, “a lot of it is an overblown initial reaction,” he said. “Then, over time, we see it’s not so bad and may actually have benefits.”

Like most people her age, Woods grew up in an analog world of paper checks and paper maps. But as she moved from one employer to another through the ’80s and ’90s, she progressed to IBM desktops and mastered Lotus 1-2-3 and Windows 3.1.

Along the way, her personal life turned digital, too: a home desktop when her sons needed one for school, a cellphone after she and her husband couldn’t summon help for a roadside flat, a smartwatch to track her steps.

These days, Woods pays bills and shops online, uses a digital calendar, and group-texts her relatives. And she seems unafraid of AI, the most earthshaking new tech.

Last year, Woods turned to AI chatbots like Google Gemini and OpenAI’s ChatGPT to plan an RV excursion to South Carolina. Now, she’s using them to arrange a family cruise celebrating her 50th wedding anniversary.

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The New Old Age is produced through a partnership with The New York Times.

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.