“It’s a no-brainer”: Matthew Pullen, MD, on Why Hepatitis B Vaccination—Especially in Infants—Can’t Wait

Asked whether he’s seeing pushback on hepatitis B vaccination, infectious diseases physician Matthew Pullen, MD, said his clinic—largely patients living with HIV—has been supportive. “Most of my patients are all on board with vaccines. They want to be as healthy as they can,” he explained. However, he has watched the wider debate become distorted by misinformation. “I’ve seen a lot of discourse online…that really shows a true misunderstanding of the data and what hepatitis B is.”

Pullen is blunt about transmission risks and why the birth dose matters. “Hepatitis B…in children, one of the more common routes is transmission during birth,” he said. “That’s why we vaccinate so early in babies. If you don’t vaccinate early on…and an infant gets hepatitis B, it can lead to liver failure. It can lead to liver cancer.” He’s seen the consequences up close: “Liver failure is no joke. It is a horrible, horrible disease process.”

The public-health payoff of early vaccination, he emphasized, is measurable. “When we started introducing hepatitis B vaccination very early in a child’s life, the rates of early liver cancer and liver failure plummeted. I mean, you can’t deny the effect it’s had.” For families, the pathway is straightforward: “Protecting from hepatitis B is a very easy way to prevent serious outcomes, especially for children.”

Cost shouldn’t be a barrier, Pullen stressed, pointing to the federal Vaccines for Children (VFC) safety net. “If you’re under 18 and you need a vaccine—doesn’t matter whether you’re insured, uninsured, have money, no money—you can get vaccinated. Because the important thing is getting people vaccinated.”

The conversation turned to treatment access when insurance falters. The interviewer described a friend whose hepatitis B therapy was paused midcourse after coverage lapsed. While noting that hepatitis treatment typically falls to gastroenterology, Pullen said, “I don’t think interrupting it would make it unavailable in the future…often patients have to restart therapy.” The larger problem, he added, is insurer interference. “Some of my patients’ insurance companies have decided that they’re now physicians.”

He’s had to fight denials: “It took me threatening to go to our state board and the insurance ombudsman before they would approve it.” Too often, appeals lead to “peer-to-peer” reviews with the wrong specialty: “Usually a retired radiologist or an endocrinologist…someone [who] has no knowledge of my field, but they have the authority to tell me I’m not allowed to make that decision.”

His verdict on the system: “It’s not a good system.”

Despite the noise, Pullen keeps the message simple: Hepatitis B vaccination—especially the newborn series—saves lives. “A couple [of] vaccines,” he said, “can prevent a horrible outcome. It’s a no-brainer to me.”