The CDC’s Advisory Committee on Immunization Practices (ACIP) adjourned without resolving whether the universal newborn hepatitis B birth dose recommendation should be changed, delaying a high-profile vote for a second time. Panel members and presenters signaled confusion about the language and options under consideration, prompting procedural delays. Presenters outlined three possible votes — retain the universal birth dose, remove it, or make it optional for infants of HBV-negative mothers — and members reported receiving last-minute revisions to the ballot. Clinicians and public-health stakeholders submitted thousands of public comments and voiced concerns about even short delays in neonatal vaccination. The procedural failures have immediate implications: if ACIP changes the recommendation, neonatal and obstetric workflows, hospital policies, and supply chains for newborn immunization could be affected. The episode also highlights how process breakdowns can drive policy uncertainty for vaccine manufacturers and health systems.