The CDC’s Advisory Committee on Immunization Practices voted to remove the longstanding universal recommendation for a hepatitis B vaccine dose at birth, switching to a model that advises parental consultation when the mother tests negative. ACIP’s vote—8 in favor, 3 opposed—represents a substantive change to guidance in place since 1991 and one that public-health experts warn could increase infant vulnerability in some settings. The panel’s decision followed fraught, contested meetings and has already sparked concern from clinicians and societies who argued there is insufficient evidence to delay the birth dose. The CDC typically adopts ACIP advice, creating an immediate planning and communications challenge for hospitals, health systems, and vaccine manufacturers.