Delaying Hep B and MMR now will cost lives later

A quiet virus today can become a devastating diagnosis decades from now. We dig into the uncomfortable math behind hepatitis B: why a universal birth dose prevents chronic infection and, by extension, a significant share of future liver cancer. The science is clear—infants who contract Hep B are far more likely to become chronically infected, and transmission often happens in ordinary settings through trivial blood contact. Waiting to vaccinate until school age sounds reasonable, but it misses the window when protection is most powerful and risk is highest.

From there, we turn to measles and the fragile line between “eliminated” and “spreading.” Elimination never meant measles disappeared; it meant high vaccination coverage kept chains short. With coverage slipping below the herd immunity threshold, outbreaks have grown, hospitalizations are up, and preventable deaths are back. We unpack the data behind the surge, why most cases are among the unvaccinated, and how even small drops in uptake reshape community risk. We also examine proposed schedule changes—MMR versus MMRV, timing debates, and febrile seizure risks—and explain why convenience and adherence often matter more than theoretical tweaks.

Throughout, we focus on first principles: protect infants early, keep schedules stable unless strong evidence demands change, and remember that some children depend entirely on our collective immunity. If you care about practical, evidence-based public health—and want clear answers on Hep B, MMR, and herd immunity—this conversation brings the data and the context you need. If it resonates, share it with a friend, subscribe, and leave a review so more people can find it. Your voice helps keep good science in the spotlight.

Chapters

• 0:00 Setting the Stakes: Hep B
• 4:20 The Silent Reservoir and Early Childhood Risk
• 8:30 Why Universal Infant Vaccination Matters
• 12:50 Policy Missteps and Long‑Term Fallout
• 15:40 Pivot: The Measles Reality Check
• 19:30 Elimination vs. Eradication Clarified
• 23:00 Falling Coverage, Rising Outbreaks
• 27:40 Schedule Changes and Their Consequences

Transcript

SPEAKER_00: 0:00

Welcome back to Pizza Cafe, it's my name is Michelle. So here's the thing with hepatitis B. So uh RFK June has recently taken it off the schedule for infants, which is completely stupid. And I'm gonna explain why. Here's the thing, right? So before the vaccines, um, or and even now because the vaccines haven't been around forever for very long enough, about 1% of the adult population is hepatitis B positive, has chronic hepatitis B infection. And if you have chronic hepatitis B infection, you are up to 25 times more likely to have uh liver cancer, which is a deadly disease, um in your lifetime. So in Australia, about 40 to 50% of all liver cancer cases are linked to chronic hepatitis B infection. So that that it's a very startling statistic. So Australians living with chronic hepatitis B have an annual liver cancer incidence of roughly 1% per year, and once cirrhosis develops, versus uh zero less than 0.01% per year in people without. So lifelong anti- so you know, you can have lifelong antiviral treatment, but that's not without its drawbacks. But basically, hepatitis B was found to be like the cause of a large proportion of liver cancer, which is a horrible disease. Okay. Now, the thing about these people with chronic hepatitis B is they have no memory of ever getting unwell with an acute hepatitic illness. Um, and what we know about the hepatitis B virus is if you catch it in adulthood, you will clear the virus, right? You will not get chronic hepatitis B, right? It's when you get it in infancy, in very early childhood, that that 90% of people who get it in early childhood will get go on to develop chronic hepatitis B. So the majority of cases in the adult population are due to the contraction of hepatitis B in early, early childhood. We're talking like, you know, before five years of age, sort of thing. So even though it's a rare condition and um there's certain risk factors for it, it's a bloodborne condition as well. The prevalence within the adult population of people who don't know that they've got it is large. Um it's large, you know. So there is a big reservoir of virus that is unknowingly passed on. So hepatitis B is not just sexually transmitted or transmitted through needles, you know. You can you can transmit it very easily if someone has a blood nose, like a kid has a blood nose in the classroom, you know, and blood gets everywhere, and then someone's got to cut that way. Very, you know, there's some there's because there's often no obvious event that's led to the transmission of the disease, uh, it spreads very easily, um, even though it's bloodborne, I guess. So, you know, people like, you know, toothbrushes that can be transmitted on nail clippers, household items. And, you know, you can have two negative parents, but there could be any person that comes into the household, be it a guest or like a babysitter or something like that, you know, um a sibling's friend or something, it's it that's you just don't know because the the population reservoir was 1%, it's a high prevalence of people having it, being able to pass it on, and not being aware of it, basically, okay? And given the fact that it causes liver cancer a lot of the time, like it's very high risk of liver cancer is a fucking terrible disease, as is cirrhosis, it's entirely preventable. So that's why um global WHO recommended worldwide global immunization of hepatitis B in you know early infancy, like as soon as you're born, sort of thing, have that jab. And the rationale for this, I want to just reiterate that to get it very clear in people's minds, is because there is a one percent, one percent of the adult population is walking around with is as a h chronic hepatitis B disease and they're oblivious to it, they don't even know about it because these tests are not often ordered. Um, so one percent of the population is not a small uh slice of the pies. It's in medicine we we consider that as a significant amount of people walking around there as a reservoir of hepatitis B. Number one. All right. Number two is that by the time like so um is that uh you know, most people have chronic hepatitis B, they don't even remember an event where they got it, you know. Um, and that's looking at people whose parents were negative, for instance, you know. So the bl the spread of hepatitis B, even though it's bloodborne, um, can happen very, very easily through trivial blood contact, household contacts, caregivers in in you know, like um childcare centres or visitors coming into the home. So you can have two negative parents but still have a child develop chronic hepatitis B from trivial contact that you don't even know. Like this is the thing, this is how it's picked up. Like in medicine, sometimes you have someone who just comes with liver failure, and like you presume it's just booze, and then you do their serology and you find out fuck they've got like you know, chronic hepatitis B, that's why they've got uh cirrhosis. This is how it presents, okay? It's a very silent disease. So you've got this silent disease, 1% spreads really, really easily to kids who mind you, you can't wrap them in crop cotton wool. There could be many instances where they get you know exposed to blood from other kids or other caregivers or you know, anything. I've just illustrated that to you fairly clearly. Um, you know, and and the fact that if you get this exposed to this virus, you know, between uh you know being one day old and five years of age, uh that's that you've got a 90% chance of it going to a chronic infection, right? Without it even knowing. So the rationale beh behind mass immunisation is that it's silent, it's easily spread, and if you get it really early in life, you're fucked, basically. I I have to put it bluntly. So, you know, uh that's why they recommend having immunisation in the first day of life, and moving it away from that time point is fucking pointless because by the time you're giving it at five years of age, your risk of uh, you know, if you've got hepatitis B exposure, you probably just clear the virus, okay? So that's why they want to give it uh at a young age. It's not because you know we think that babies of of that age are going to be sexually active or anything perverse like that, like the MAGA people want to make it about. No, there's good logic behind it, there's good reasoning, and you know what? Um if I oh I have a child, I had him ha get the HEP B injection. Why? Because I don't want him, you know, having to die an unnecessary death of liver cancer in 30 years' time, you know? It's simple maths, really is. Uh and you know, if we can say the dangerous thing, the dangerous thing about this uh sort of stopping the hep B vaccinations is it's not gonna be clinically apparent. Like you're not gonna have a huge wave of hepatitis B infection or anything else. It's gonna be more insidious than that. So by taking that off the vaccination schedule, what you're gonna notice is when it's too late in fucking 20 or 30 years' time, you know, very likely there could be a spike in liver cancer from hepatitis B positive people. Because I know you can treat it, but you've got to know you've got it. And as I say, it's often a very silent disease. People don't know they've got it until they're fucked, you know. Um so yeah, like I object to I I object um uh you know the logic that has just been used to take this in vaccination off the uh off the you know regular regime is yeah, it just it so demonstrates why how these people are so ignorant and just don't know what the fuck they are doing. They're like, yeah, it's a rare disease, you know, if your parents are like negative, then you're not gonna get it. You know, why would you expose a baby that age to, you know, uh like a poisonous vaccine? Like, like all the reasons why you give it at that age are because it's the only time that there's benefit, you know, and you can get hepatitis B without positive parents, and you can have a parent who has got hepatitis B with a negative result too, by the way. So, you know, it's it's just a it it's just the fact that that's their rationale, it flies in the face. Like it just shows us, you know, anyone who knows anything about medicine how fucking ignorant these people are and how dangerous it is having them at the helm, you know, in charge of public health. Now I want to switch to thinking about measles because there is a big measles outbreak in um the United States and there's a lot of misconceptions out there. So I hear every day, you know, like I got measles, it wasn't that big a deal, I didn't get sick, and I'm alright now, you know. But that's not the fucking point, okay? People are so selfish. Like the thing is that yes, it can be a minor disease, but it is still a fatal disease for some people. So RFK uh junior, as you know, or may not know, he's not keen on the measles MMR vaccine. Uh that was the initial um uh vaccine that was uh said to cause autism in the fraudulent study that sparked the anti-vax movement. Um so that's why that one's not popular. So um yeah, there's a lot of rhetoric going on that it's unnecessary to. Um so let's have a look at a look at the facts. Alright, so before the vaccination era pre-1963, the US experienced three to four million measles cases per year with 400 to 500 deaths annually in many years. Right? That's 500 kids dying per year. Now this is after we account for incre improved you know nutrition and sanitation, which also did drop the death rate uh from measles. But this is is accounting for that before vaccines, before we had high herd immunity, 500 deaths annually of measles, which is unacceptable. After vaccine introduction and into the elimination era, reported cases dropped dramatically. Okay, so from 2020 uh 2001 to 2022, we this was the modern elimination era, okay? So I'll explain to you what that means. So the elimination era, elimination means absence of continuous disease transmission within a defined geographical area for at least 12 months, even though the disease still exists elsewhere in the world. So it doesn't mean eradication like smallpox, you know, which would be global and permanent like smallpox. Um it means that um all cases are either imported or directly linked to importation rather than being due to ongoing community spread, which happens in an unvaccinated um community. So um the United States achieved measles elimination in 2000 after decades of high vaccination coverage and rapid outbreak containment. From 2000 onwards, every measle case was either imported or part of the short-term chains that were stopped within a few transmission cycles. That period, 2000 to the present, um uh is called the elimination period. Uh, the US has maintained that a designation by showing no sustained transmission for over 12 months and a high population immunity. And that means more than 95% with two MMI coverages nationally. Now, um recently though, there has been multi-state outbreaks with more than 1,500 cases and extended spread. It's still ongoing, it hasn't been contained. And it's prompted to the CDC and who WHA to review whether elimination status might be at risk since prolonged chains lasting over a year could technically end this. Um, as of the latest CDC update, the US still holds measles elimination elimination status, but that is being closely monitored and at threat. And I I hazard to guess that's probably going to be gone. So what we see over the years um is that is elimination years uh for reported cases of measles um for each year has been anywhere between like less than a hundred pretty much until 2013 when it was a little bit up, and then it started to go up in 2014, and there'd been no deaths at all until 2015, which was the first measles-related death. And then you see this sort of trend of rising cases per year. There was a spike in 2019 of 1200, but more recently this year, and concerningly is there there has been three deaths, and there is an ongoing measles uh epidemic um that is spreading. They haven't contained it yet. So this year there have been now 1,500 measles cases, so more than um in the last 20 calendar years, and three deaths, which is again far more than in the last even 30, 40 years, um, which is alarming. That's three kids that didn't need to die. Out of the cases that got measles, 97% of them were unvaccinated, and 3% had only one vaccine. Um and yeah, so um and the actual general unpopular uh unvaccinated population in the US amongst children is 7.5%. Uh so that's c high enough to allow this sort of activity to start rumbling. And the trends are pretty concerning. So, like the CDC's morbidity mortality weekly report noted that children born in 2021 had lower coverage of nearly all recommended vaccines by age 24 months compared to cohorts born in 2018 to 2019, and the decline ranged from between 1.3 to 7.8 percentage points. So this suggests that more children in recent birth cohorts are falling behind on standard early immunisations. And this is before RFK Junior started to stick his fucking finger in the pie. Um for kindergarten children in the in the two 2024 to 25 school year cohort vaccination coverage for MMR among kindergartners fell to 92.5% below the 95% threshold commonly cited for herd immunity, and reports say the vaccination rate rates declined for all major vaccines among entering kindergartners. So um the trend in overall app vaccination for full series in early childhood, so data um from USA facts show that for children born b in 2020 to 2021, only about 72.8% had combined had completed the combined seven series of recommended vaccines um by age 35 months, which is staggeringly low. You know, if we're looking at herd immunity being up and above 95%, this is why, this is why you're seeing deaths now starting to come about from this measles spread. And you know what? It's only going to get worse if the level of vaccination uh goes down. Um it's an absolute disaster. And indeed, as I said, this now, this outbreak in in USA, they've not contained it yet. It is ongoing because of the lack of herd immunity. So what people don't tend to grasp, they're so selfish and looking at their own circumstances, you know, my kid got measles, so it didn't get really that sick. No, that's not the point. Your kid is a disease vector who will be asymptomatic, will be carrying virus around because they're not vaccinated, right? And it's not them that we're worried about, it's the like immunosuppressed children who are particularly vulnerable to this disease who will die. If they've got more cases in the population, then you've got more exposure of vulnerable uh kids and more deaths. That's how it happens, you know? And people just can't see past their own backyard and can't think about the community, and this is how this all eventuates. And again, it's completely, completely and utterly um infuriating, you know. So these are the figures at baseline before RFK Jr. got in. Now, what exactly is he doing? Well, we already know he's dismantled the um advisory committee on immunisation practices, right? He's a all the really experienced people who are fucking the guns in this field, he's sacked them, right? And he's uh put in this whole host of anti-vaxxers to replace them, right? So that's the first thing. Um and he's pushing to review potentially change uh and and potentially change the childhood vaccination schedule, including MMR, MMRV. Even in the context of a known fucking outbreak of measles, this is Manning. Uh his new ACIP of idiots is actively re-examining when MMR should be given, like the timing. So whether the combined MMRV should remain as an option and whether the separate MMR plus pharacera shots might be preferred in some age group, so separating it for fuck knows why, I don't know. Um, in particular, in September 2025, the panel voted against recommending that children under age four receive combination MMRV vaccine. So discouraging or limiting that combined option in younger children. While the vaccine remains covered, in many cases, this could change. Uh this could change this change could affect how parents and providers choose between MMR plus varicella versus MMRV and that age bracket. The panel is also considering whether the timing of MMR um should be altered to resolve religious objections, which doesn't make any fucking sense, which suggests possible pressure to allow more leeway or delay in some cases. He's stated that he wants to change the schedule even in the absence of new supporting data. So, according to the testimony from former CDC director Susan Monarez, RFK Junior told her he would be making changes to the childhood vaccine schedule beginning in September, even before the new panel's data reviews were complete. Monarez also said RFK Jr. claimed that the CDC had never collected all the data on the science or evidence associated with the vaccine schedule, suggesting more openness to questioning long-established schedules. So public uh experts and pediatric organizations are pushing back. Um the American Academy of Pediatricians has stated that under RFK RFK Junior's changes, it will continue publishing its own vaccine schedule because it considers ACIP under his control to have lost credibility. And critics warn that altering a stably proven and highly effective vaccine schedule without strong new data risks undermining vaccine confidence, causing confusion and increasing the risk of outbreaks. What he's not doing, he's not outright moved the MMRB vaccine from the recommended schedule. No credible source shows that that is being banned. The changes are primarily about timing, so combined dose versus separate doses, and many of the proposals and votes are preliminary and subject to reversal, dependent on how insurance federal funding and state mandates. But the implications and risks are because the AC CIP recommendations strongly influence insurance coverage, state school vaccine requirements and provider practice, changes to the recommendation schedule could have broad downstream effects. So people getting more lax influencing what shots are covered or mandated. If MMRV option is limited, that might push parents towards separate injections, which might reduce convenience or uptake of some. Altering a schedule that has been stable for many for decades without strong new evidence risks undermining public confidence in immunisation, especially given RFK juniors' prior associations with vaccine skepticism. And some of the changes being proposed are justified by pointing to known small increased risks. So, for example, febrile seizures in children under certain age groups receiving MMRV. But public health consensus so far has uh has been that the benefits far outweigh the risks of standard schedules. So like febral compulsions usually pretty benign and settle down with paracetamol, which apparently causes autism now, so you but um it's not uh not the end of the world, it's certainly not as bad as dying from measles, you know. So, um, anyways, um looking at the actual stated rationale for the changes to the MMR vaccination that RFK Junior has cited, the panel cited evidence that the combined MMRB vaccine uh contains a slightly higher risk of fever-triggered seizures in young children, particularly 12 to 23 months, compared to giving separate MMR plus varicella vaccines. Now, um, in terms of what that rate is, um for the first dose in the 12 to 23 month old, the combined MMRV shot was about to double the shot short window risk for febibrile seizure compared with just giving MMR and varicellars two separate shots. But the absolute risk is still small. So the absolute risk seven to ten days after vaccination is eight point five per 10,000 after MMRV versus 4.2 per 10,000 after MMRV plus uh MMR uh plus V. So one extra febrile seizure for every 2,000 to 3 2300 to 2600 MMR V doses. This excess risk is seen after the first dose at 12 to 23 months, but not after four to six years. And but you know, febrile seizures are scary but typically are very brief and benign with no long-term effects. So again, it's not like it sounds bad, but it's still it's not a terrible side effect um that they're going on about. And I guess the risk is that you know, if if you start to divide um uh uh vaccines up into separate doses, the risk is that the person that like the mum is only going to get one vaccine and just forget to get the other, or you know, it's just it's better more sensible to give them all in one shot because then it's done. The baby doesn't have any have to have any more needles, it's not one extra health visit, which is a risk of that vaccine not being given. Um so yeah, like if what studies have shown that if you separate the doses of vaccines, there's a lower uptake rate of vaccination, basically. So um because uh this risk of febrile seizure is like um uh is increased in very young children, based on that, the new recommendation is that children under four only receive separate MMR plus V varicella for first dose, reserving the combined dose for older children. So, in terms of the other uh reasons for fucking around with the very good and um robust and efficacious uh vaccine schedule, the second rationale is removing unnecessary risks and harms as a public health priority. The new ACIP chair appointed under Idiot RFK Junior framed the changes as part of t a pro-vaccine agenda. So remember, he promised not to fuck with the vaccines because he's an anti-vaxxer, but clearly he is fucking with the vaccines, but just in a more insidious way. So reducing risk where possible while maintaining protection. The narrative is that the panel is trying to restore public confidence by removing unnecessary risks and harms. Fuck you, RFK. In media statements and internal discussions, some panel members have questioned whether prior panels or vaccination policy fully assess cumulative or combat combinatorial effects of the schedule and propose reassessing the time and combinations of intervals of doses. Cumulative effective vaccine schedule. One of the agenda items on the count on the panel has announced it is to re-examine the cumulative effective number, timing, and spacing of vaccine doses in the pediatric schedule. The goal is to see if spacing order could be modified to reduce side effects or improve safety margins, which are already pretty good. In particular, the panel is reviewing vaccines like Hemitus V, and I already discussed that, and they're retarded for fucking with that. Um and also they're like responding to parental concerns, um, restoring trust. So some of the rationale is cast in trust transparency terms that parents should have more information and fewer hidden risks, and that is that this review is intended to show that vaccine policy is responsive to safety signals. The reshaping of it, so it's just basically fucking pandering to anti-vaxxers. Uh, reshaping of the ACV itself is justified by some proponents as necessary because prior panels were seen by them that's too closely aligned with industry, there's no there've been no conflict of interest, by the way, ever found. Um, regulatory insurance and implementation effects. Because ACIP recommendations strongly influence insurance covers state mandates and federal vaccine programs, changes to recommendations should could shift how vaccines are covered or which combinations insurers favour. For some of the shifts also appear strategic. For example, though ACIP changed the recommendation for younger children not to use MMRV, in that same meeting the panel voted not to change the VFC programme coverage for MMRV. It remains available under federal vaccine purchase programmes. This suggests a staggered or partial approach to implementation, perhaps to soften the impact. Critiques, limitations, and contested points. So while these are stated rationales, many experts and pediatrician pediatric organisations of vaccine safety specialists have raised concerns and counter-arguments. The increase in febrile seizure risk is very small in absolute terms, and febrile seizures are generally benign and transient with excellent prognosis and no long-term neurological damage. Critics say that the change is not strongly supported by new science and that the safety trade of losing the convenience of compliance benefits of the combined vaccine would outweigh the small benefit in reduced seizures. I would agree with that. It's true. Some pediatric groups, such as the American Academy of Pediatrics, have explicitly rejected the change for MMRV in young children, continuing to support that option and denouncing the panel's approach as fear-driven. Concerns about vaccine uptake and adherence combination vaccines, so fewer injections tend to then lead to higher compliance with and fewer meth doses. Introducing more separate shots may lead to dropouts or delays. Absolutely. And some critics argue that the panel is bringing up settled debates now at a moment when confidence in vaccines is crucial amid the 2025 measles outbreak, absolutely, which could sow confusion and hesitancy. So RFK Junior needs to be fucking out there and telling everyone to vaccinate their kids against measles and not pussyfooting around like this. It's bullshit. The process itself is controversial. The panel was overhauled and replaced. Many longstanding advisors and layers and organizations have been excluded from decision-making processes, raising questions about legitimacy, expertise, and conflicts of interest. So, you know what? Thing is, is that you've just got a bunch of idiots who don't know what they're doing, making all these stupid decisions, and in the midst of a measles pan uh uh epidemic, which has already led to three deaths, you know, like what's infuriating about this whole situation is that it's really dangerous, like really dangerous, and for the sake of leveraging up pup popularity from the you know, from um you know, disgruntled right wing people who have got, you know, that the that's the thing, it's just all about getting votes and these people they don't give a shit about public safety and it's it's maddening, you know. Um it's really frightening that that these anti-vaxxers are getting now uh more legitimacy and um more validation for their pseudoscience rubbish that uh is just you know gonna kill people in the end of the day, you know. Look, um, you know, I guess I'm gonna leave it there getting impassioned. Listen, uh watching these anti-vaxxers and their rubbish that they put up on social media like is infuriating. It really is. It it just you know, when you know what I know about public health and vaccines, it's like getting kicked in the guts, you know? It's like standing on a beach and seeing a tsunami fire at the sea, you know, you can see the wolf water rising glittering in the distance. As you stand shouting to the people on the sand, get to higher ground, it's coming. But they just laugh and turn up their music and keep building sandcastles, confident that the waves have always stopped where they are. You scream louder, waving your arms, desperate for them to understand. They roll their eyes and queer paranoid, they tell you to relax. They don't trust you. As the tide tends to rush out and the birds fall silent, you realise the most painful truth of it all. You can't save people who refuse to see the horizon. That's all for today. Be kind to another and stay tuned for my next episode. Namaste.