John Law (4:34)

All right.

Isaac Saul (4:35)

With that, I'm gonna send it over to John for today's main topic and I'll be back for my.

John Law (4:46)

Thanks, Isaac, and welcome everybody. Hope y' all had a wonderful weekend. Let's get straight into it with today's quick hits. First up, President Donald Trump released his National Security Strategy document outlining his foreign policy vision. The document calls for US Supremacy in the Western Hemisphere and increased strength in the Indo Pacific, while also calling on Europe to address issues related to demographic change. Number two, the Supreme Court announced it will hear arguments on Trump v. Barbara, a case challenging the Trump administration's executive order ending birthright citizenship in the U.S. separately, the Supreme Court will hear arguments on Monday in a challenge to President Trump's attempt to fire Rebecca Slaughter as commissioner of the Federal Trade Commission. The case could roll back protections against removal for members of independent agencies. Number three, Defense Secretary Pete Hegseth said he would not commit to releasing footage of the US Military's second strike on an alleged drug boat in the Caribbean in September, which has prompted heightened congressional scrutiny over the past week. Number four, Israeli Prime Minister Benjamin Netanyahu said he expects the second phase of the Israel Hamas ceasefire in Gaza to commence soon, though he did not specify the timeline and number five the Trump administration will reportedly announce $12 billion in aid to US farmers on Monday afternoon. Most of the package will go toward the Farmer Bridge Assistance Program, which supports US Crop Farm.

Sponsor/Advertisement Voice (6:17)

A CDC advisory panel voted to roll back a decades long recommendation on Hepatitis B vaccines for newborns yeah, this is a big deal. I mean, the panel suggests that women who test negative for hepatitis B should decide with their doctor whether their baby.

Isaac Saul (6:31)

Should get a birth dose of this.

Sponsor/Advertisement Voice (6:33)

Vaccine, the group also suggesting waiting until at least 2 months of age for that first dose if the vaccine is not given at birth.

John Law (6:41)

On Friday, the Advisory Committee on immunization practices voted 8 to 3 to eliminate a long standing recommendation that all newborns receive a first dose of the hepatitis B vaccine. The committee instead recommended that women who tested negative for hepatitis B should consult with their doctors to determine whether their baby should be given the first dose of the vaccine, suggesting that the initial dose be administered after the infant is at least two months old. The committee voted on the change after it heard presentations from several vaccine critics. No Centers for Disease Control and Prevention subject matter experts presented to the panel for context. ACIP developed recommendations for the CDC on safe vaccine use and the US Adult and childhood immunization schedules. The committee's recommendations also impact which vaccines are covered by insurers and federal health programs. In June, Health Secretary Robert F. Kennedy Jr. Fired all 17 committee members, claiming that they were not capable of independently evaluating the safety and efficacy of vaccines. Kennedy has since appointed new members to the acip, many of whom have criticized vaccines. Hepatitis B is a virus that can cause liver infection and lead to severe liver damage, liver cancer and death. Prior to Friday's vote, the CDC had recommended for over three decades that infants receive the first dose of the hepatitis b vaccine within 12 hours to newborns with infected mothers and within 24 hours to all other newborns. Doctors and public health experts have widely credited the vaccine with curbing the virus prevalence. ACIP members who supported the change said that the risk of newborns contracting the virus if their mothers test negative is very low and called for more substantive studies to determine whether the vaccine is safe for newborns, though past studies have found that it is safe. Dr. Tracy Beth Hogue, the acting director of the center for Drug Evaluation and Research at the Food and Drug Administration, argued that children should not receive the hepatitis B vaccine at all. Many medical groups, doctors and public health experts criticized the vote, saying that ACIP has become ideologically driven under Secretary Kennedy. A long time vaccine skeptic, Dr. Deborah Horry, who resigned as the CDC's chief medical officer in August said she was very concerned about the future of the agency under Kennedy, calling it heartbreaking to see this science driven agency turn into an ideological machine. Others warned that the recommendation change will lead to an uptick in hepatitis B. Acting CDC Director Jim o' Neill will decide at a later date whether to accept ACIP's new guidance. President Donald Trump praised the committee's new guidance, calling it a very good decision. He also announced that he had signed a presidential memorandum directing the Department of Health and Human Services to conduct a review of childhood vaccine schedules in other countries and better align the US Vaccine schedule so that it is finally rooted in the gold standard of science and common sense. Today we'll survey arguments from the left and the right about ACIP's vote and then Isaac's take.

Isaac Saul (9:46)

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John Law (11:59)

All right, first up, let's start with what the left is saying. The left criticizes the committee's decision, saying it has no medical justification. Some suggest ACIP is now steered by ideology, not science. Others say Kennedy is accomplishing his anti vaccine goals. In the Washington Post, Leanne S. Wen said the CDC's change to hepatitis B vaccination is even worse than it seems. On the bright side, the policy doesn't change care for the babies at highest risk. Infants born to mothers known to have hepatitis B will still receive the vaccine, along with a preventative immunoglobulin to reduce the risk of perinatal transmission. And families who want their newborns to receive the hepatitis B shot can still choose it and have it be covered by insurance, wen wrote. But this new approach attempts to solve an issue that doesn't exist. There is no evidence that the birth dose is unsafe, and no evidence that waiting until two months offers any advantage to safety or efficacy. Plus, transmission doesn't just happen. Mother to baby Hepatitis B can spread through casual contact, including shared household items, small amounts of blood or saliva on toys and surfaces. Everyday interactions such as sharing spoons or cups, handling a baby with microscopic cuts on one's hands or or even inadvertently mixing up toothbrushes can be enough to transmit the virus, Wen said. Universal newborn vaccination has helped drive childhood hepatitis B infections down from 18,000 cases in 1991 to just about 20. Why change a policy that has been so effective? In STAT News, Dorit Rice argued ACIP is beset by incompetence, bias and procedural chaos. The committee had several presentations on hepatitis B vaccines, but none were presented by experts in hepatitis B, and none of the workgroup members once they were mentioned were experts in hepatitis B, Rice wrote. It quickly became clear that the presentations were not vetted by anyone with expertise in the subject matter. One presenter, Cynthia Nevison, is a climate researcher who co authored a retracted paper on vaccines and autism. Another, Mark Blaxill, is a longtime anti vaccine activist who in 2017 tried to convince the Somali community in Minnesota that vaccines cause autism in the middle of a measles outbreak that hospitalized many of their young, unvaccinated children. Maybe the most glaring example of incompetence was the fact that members asked to delay the vote from Thursday to Friday because they were not sure what they were voting on. Voting language was put up a few days before the meeting, but was apparently changed multiple times before the meeting, confusing members, rice said. Since 1964, ACIP gave us careful evidence based recommendations on vaccines. That is no longer true. The current ACIP is biased, incompetent and makes decisions that will harm children and adults. We deserve better. In the Bulwark, Jonathan Cohen wrote, this is what it looks like when RFK Jr wins. Exactly how or when the new hepatitis B vaccine guidelines would change actual behavior is difficult to say. It's not as if anybody forces parents to get their kids vaccinated today, the proof being that some parents declined the hepatitis B shot for their kids already, cohen said. But there's a reason both supporters and critics of vaccines fight about these guidelines. They really do affect decision making. They signal to parents what top scientists believe is the smartest course of action. And they can influence physicians who look to bodies like the CDC to undertake the kind of ongoing exhaustive literature and research reviews they don't personally have time to do on their own. Kennedy has gone well beyond recruiting some contrarians with novel perspectives. He has populated the advisory committee almost exclusively with people with records of attacking vaccines in one way or another, cohen wrote. The best case scenario is that the health system's collective muscle memory on hepatitis B is strong enough to keep current practices going. But in a highly politicized environment where the president and the nation's top healthcare officials are constantly taking down vaccines, some people are bound to take their word seriously.

John Law (16:05)

Alright, that is it for what the left is saying. Which brings us to what the right is saying. Many on the right say the change simply aligns the US with other countries. Some argue skepticism about the number of vaccines infants receive is rational. Others say the value of the CDC acting as a vaccine authority is limited. In the Daily Caller, Emily Kopp said ACIP's decision aligns childhood vaccination schedule with other high income nations. The pivot away from a universal shot within hours of birth aligns the US policy with the approach of 24 other high income nations that recommend a first dose at two months old or three months old, kopp wrote. Though the American hepatitis B vaccine schedule now resembles those of other Western nations. And despite the continued availability of the vaccine to all mothers, the legacy media characterized the decision as a reckless upheaval. CDC panel makes most sweeping revision to Child vaccine schedule under RFK Jr. A Washington Post headline blairs. All of the committee members agreed that the committee lacks key data on the risks and benefits. The Food and Drug Administration did not require randomized placebo controlled clinical trials of the two hepatitis B vaccines that it approved for the first day of life in the 1980s, according to FDA acting Center for Drug Evaluation and Research Director Tracy Beth Hoag. Kopp said the data that we used to approve the hepatitis B vaccines were based on studies that had a very short term follow up and no control group, Hoag said. She identified anaphylaxis and fever as rare side effects in Red State. Streiff argued the change reflects growing concern about the number of vaccines children receive. Hepatitis is a potentially serious infection that can cause severe liver damage. It is also easily avoidable, but we'd be bad people to bring that up. There is no clear reason why infants are subjected to this vaccination. Hepatitis B can be passed from mother to child at delivery, according to nih. The prevalence rate of hepatitis B among pregnant women is extraordinarily low, Streiff said. Even though about 3.68 million of the approximately 3.7 million babies born will not be at risk for hepatitis B, all of them will get the vaccine. The new ACIP is wary of the number of vaccines mandated for children. By the time your child is 18 months old, they will probably have received a minimum of 26 vaccines, more if they've had the jebs for influenza, Covid and some others. There is a growing concern about the effects of these successive assaults on the child's very immature immune system and the downstream effects, streiff said. The most unfortunate outcome of the meeting was the effort of the dissenters to summarily dismiss valid public health and ethical questions about mandatory vaccination and to paint everybody opposed to the status quo as anti vax nutters. In Cato, Jeffrey Singer wrote about why medical guidance shouldn't come from Washington. Many professional medical and public health organizations opposed the decision, including the American Academy of Pediatrics, the American Public Health association and the American Pharmacists association, as well as numerous clinical researchers and medical specialists. Singer said this episode highlights a deeper institutional problem. As I have written previously, members of the medical and scientific community who have long supported an active government role in health issues likely never expected that a controversial figure like Robert F. Kennedy Jr. Would become the leader of the country's public health system. This underscores why Congress should return the CDC to its original purpose, being a focused partner that assists states in tracking and controlling infectious diseases. The federal government should leave medical and scientific debates to scientists and clinicians. By involving itself in these debates, the CDC fosters the impression that there is a single right answer to complex, nuanced questions, singer wrote. If there is a silver lining, it's that controversies like this may finally encourage clinicians, researchers and patients to rely less on federal pronouncements and more on diverse, independent medical expertise.

John Law (19:59)

Alright, that is it for what the left and right are saying. Which brings us to what medical professionals are saying. Medical professionals uniformly criticize the change in guidance, saying it has no scientific basis. Others suggest the change will put an undue burden on parents. The American association of Immunologists said that they were extremely disappointed in the recommendation change. The science behind the hepatitis B vaccine is robust and well established. The hepatitis B vaccine has an exceptional safety record and is extremely effective at preventing lifelong chronic infections in infants who might otherwise be exposed to the virus during childbirth or early life, the group wrote. More than 90% of infants who contracted hepatitis B at or around birth will go on to develop chronic hepatitis B. Of those, roughly one in four face a premature death from liver disease or liver cancer. The impact this has on families and the healthcare system can be effectively mitigated with use of vaccines. Delaying the vaccine would mark a dangerous departure from decades of achievement in preventing hepatitis B infection and its complications. Recent independent analysis warns that even a modest delay could result in a substantial increase in preventable chronic infections like liver cancers and deaths. Now is not the time to undermine confidence in one of the most successful vaccine based public health interventions in modern history. In your local Epidemiologist Caitlin Jettalina shared her key takeaways from the vote. In the end, the committee voted to move America back to pre1991 by removing the universal vaccination recommendation for the hepatitis B infant dose despite no new evidence of harm and ignoring clear benefits. They also recommended that parents ask clinicians for an antibody blood test to determine the need for subsequent doses. Even though there's no evidence that this works, jettalina said. This ultimately shifts the burden to clinicians and parents and abdicates the responsibility of the recommending body. Where this goes from here depends on what happens next. If confusion dominates headlines and clinical practice and falsehoods fill the void, the consequences could be serious. But if we respond, the way we saw many do today, pushing back with clarity, authority, evidence, coordination and grassroots strength, the harm can be contained and minimized, jettalina wrote. Unfortunately, our work is not done. There will be increasing confusion about evidence based vaccination options for parents, clinicians, hospital systems and schools. This will decrease vaccination coverage, leading to more disease and unnecessary suffering. Alright, let's head over to Isaac for his take.

Isaac Saul (22:39)

All right, that is it for the left and the right are saying. Which brings us to my take. I have a 10 month old baby at home, so I'm just going to start by saying I'm in the thick of the frustration and fear and confusion of the vaccine schedule. As a new parent, even seemingly uncomplicated decisions, they become complicated. Vaccinate your kids seems obvious enough until you try to do basic research on the safety of a vaccine and get bombarded with stories of kids dying 24 hours after a shot or Internet rumors about how some former voting member of ACIP made millions with Big Pharma. Even for a professional information consumer like me, separating fact from fiction is is a scary and fraught process. This is intensified by the actual experience holding an infant child down on a table while they get pricked and prodded, them crying in pain and then often experiencing a day or two of fussiness and fever. Are they okay? What have I done? Was this really worth it? You ask yourself, since you are listening to a politics podcast right now, I am not going to give you or your children medical advice. Instead, I will speak on my own experience and how some vaccination decisions for children feel less obvious than others. Getting a COVID vaccine for an infant, for instance, did not seem straightforward. Unlike with other vaccines, our doctor was much less forceful in her opinion about what we should do. Covid vaccines are newer and less tested for infants, and Covid is often less dangerous for young children. My wife had Covid while she was pregnant and our baby breastfed, so he was theoretically getting antibodies from her. Since she was vaccinated and had the virus before our son arrived, my wife and I decided on a process for making decisions like this. We were going to pick one or two trusted sources outside of our medical team and use the information from our doctors combined with those sources to make better informed decisions. That way, we could try to ignore the fire hose of information we encounter every time we open a social media app or turn on the news. For us, the source we leaned on most heavily was Emily Oster, the professional economist behind the bestseller Expecting Better and the parenting website Parent Data. She's also somebody who's come on this podcast before, and she makes all of her decisions through a data first framework. Her educated opinion felt like a nice compliment to the medical advice from our doctors, and she provided a trustworthy single source for the unavoidable questions that pop up during and after pregnancy. To be candid, my wife and I did not seriously consider skipping the hepatitis B vaccine when our son was born. We had decided to lean on the wisdom of my wife's doctor and Oster, who both said the decision carried close to zero risk and offered only upside. We might have had one drawn out discussion after our doula told us we could pass on the vaccine when my wife tested negative for the virus, but we didn't see any compelling reason to question the advice of our medical team. So this is the lens through which I've been watching this story unfold. Even though I'm not personally someone who would trust the government guideline above all else, I do think agencies like the CDC must present reliable, clear information for parents navigating these difficult decisions. Unfortunately, after picking all new members for ACIP to ensure vaccine skeptical outcomes like this, Robert F. Kennedy Jr. Is offering parents like me, only more doubtful and confusion. To better understand the effects of the new panel's first major decision, I turned to two public health commentators whose insight I trust, Dr. Leanna S. Wen, an open minded public health expert who backed Kennedy's push to remove fluoride from water, and Caitlin Jettalina, the epidemiologist behind your local epidemiologist. Both were alarmed. Jetalina emphasized that the outcome is not as bad as some headlines make it seem, given that the vaccine will still be widely available and eligible for for insurance coverage. Yet her trepidation came through. She offered a worried but optimistic take on how public pressure and a few determined ACIP members were able to push back on the flimsiness of some of the claims presented to the committee and prevent a far worse outcome. Wen instead focused mostly on the practical effects of the new guideline outcome that parents will now be asked to test antibody levels in their children after the first of the vaccine's three dose series. After our two day stay in the hospital after our son was born, we had a one month checkup, a three month checkup and a six month checkup paired with a couple of visits for a rash here or a fever there and various follow ups with individual specialists. Parents of even a healthy baby already end up going to the doctor eight or 10 times in the first 10 months, adding another infant blood draw another doctor's appointment and more cost to the already overwhelming early infancy is to me, pretty preposterous. Meanwhile, I found the counterpoints to this view unconvincing. Some writers claim the vaccine addresses a non existent risk. The blogger Streef under what the Right Is Saying said every expectant mother is tested for the virus when she is admitted for delivery, and if she is positive the infant can be vaccinated then this simply is not true. The CDC recommends testing in the first trimester, not at delivery, and many mothers, including my wife, are only tested for hepatitis early on in pregnancy. That test is consulted during delivery, but a new test is often not administered. If the mother was negative, that means new mothers could have become carriers for the virus and without knowing it. Many commentators have also emphasized that this new guidance brings us in line with many other peer nations. But those nations are not really our peers when it comes to healthcare or population. Denmark, for instance, has universal healthcare, more consistent prenatal care, and a population that is much smaller and far less diverse than ours. The population differences alone demand a different approach. Denmark's incidence of hepatitis B is going up, and the rate of virus among the migrant population is higher than among the native born population. Here in the US with a very different healthcare system overseeing a much larger and more diverse population is not really comparing apples to apples again. I'll reemphasize that my perspective is not expert and that a variety of expert viewpoints is good for new parents. Secretary Kennedy often promotes a similar message, but the actions of the department he leads actually shut down genuine scientific exchange of ideas, which to me is the most frightening aspect of ACIP's decision. For their latest meeting, Kennedy broke from tradition by refusing to allow presentations from CDC subject matter experts. So while scientists who study the hepatitis B vaccine for a living were shut out from deliberations, a lawyer and longtime Kennedy ally named Aaron Seri, who has petitioned the government to stop distributing the polio vaccine, was able to state his case. This is decidedly not scientific debate. It's working towards a preordained outcome. And while this particular outcome is not the worst case scenario, it is another very worrying step of Kennedy's health department. And it will have real practical implications for parents and infants who who are unlucky enough to encounter hepatitis B in the coming years.

Isaac Saul (30:01)

We'll be right back after this quick break.

Isaac Saul (30:06)

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Isaac Saul (31:17)

All right, that is it for my take. Which brings us to your questions answered. This one's from Adam in Denver, Colorado. Adam said, is Pete Hegseth the Secretary Defense or Secretary of War? Is that renaming official? If so, why does Tangle not use it? Okay, so great question, by the way. In a sense, he's both. And no, the rename is not official. In the White House's September 5th fact sheet announcing the Trump administration's restoration of the name Department of War, the title is officially stated to be secondary. A secondary title is one that agencies can use to refer to themselves in official government communications and often matches their already utilized informal names. They're usually just inversions, like Justice Department instead of Department of Justice, or or abbreviations like DOE for Department of Energy. Only Congress has the authority to officially rename a federal department or agency. At Tangle, we have a policy of using the official name of the department as a default, but we often use informal titles so our reporting sounds more natural and less repetitive. For example, we might occasionally refer to the Department of Defense as the Pentagon, the department's headquarters. And we could refer to the Central Intelligence Agency as Langley, the Virginia city where CIA is headquartered. When it comes to a person's title, we're always going to use the official names. That means we're not going to write Secretary of War. Just as we never write Secretary of the Pentagon, we could broaden the scope and ask a tougher question. Would Tango ever write the Department of War? Maybe, but it's trickier for us to adopt. First, informal names are often determined by popular usage, not top down dictum, so we're often resistant to follow a government order to change the title we've been using without issue all our lives. Second, the Department of Defense has a history behind its name. The Department of War that existed from 1789 to 1947 is actually not the same as the modern DOD. At first, that agency only oversaw the army, while the Navy had its own cabinet level department. President Trump consolidated the departments along with the new Air Force under the National Military establishment Act in 1947. Then he restructured them again into the Department of defense in 1949. The change also emphasized the military's use as a deterrent and de emphasized war as a cabinet level pursuit for our government. So bringing back the older title seems like a step in the other direction. Maybe we'll write it occasionally, but it's not a title we're eager to employ. All right, that is it. For your questions answered. I'm going to send it back to John for the rest of the pod and I'll see you guys tomorrow. Have a good one. Peace.

John Law (34:00)

Thanks, Isaac. Here's your under the Radar story for today, folks. Last week, U.S. steel announced that it had plans to resume steelmaking at a facility in southwestern Illinois that had not produced steel for two years. The company had planned to continue reducing operations at the plant before the Trump administration intervened to block that move in September. US Steel now says that demand for steel has risen enough to warrant a restart in production, particularly as the company completes rental renovations at other steel mills. We are confident in our ability to safely and profitably operate the mill to meet 2026 demand, US Steel CEO David Brewert said. The Wall Street Journal has this story and there's a link in today's episode Description.

John Law (34:44)

Alright, next up is our numbers section. The year the hepatitis B vaccine was discovered was 1965. The year the Food and Drug Administration approved the first hepatitis B vaccine for human use was 1981. The percent decrease in pediatric hepatitis B incidence since 1991 is 99%. The approximate number of babies born to women with hepatitis B annually in the US is 17,000. The approximate percentage of liver cancer globally that is caused by chronic hepatitis B and C is 80%. According to an October 2025 Pew Research survey, 63% of US adults say they are highly confident that childhood vaccines are effective at preventing serious illness. According to a July August KFF Washington Post survey, 5% of U.S. parents reported that they skipped the hepatitis B vaccine for at least one of their children, and 4% said they delayed the hepatitis B vaccine for at least one of their children. 8% of US parents who called themselves. Supporters of the Make America Healthy Again movement reported that they skipped the hepatitis B vaccine for at least one of their children. And 5% of U.S. parents who called themselves supporters of the Make America Healthy Again Again movement reported they delayed the hepatitis B vaccine for at least one of their children.

John Law (35:58)

And last but not least, our have a nice day story. Roughly 40% of families in the Standing Rock Reservation live below the poverty line. Tribal owned energy group SAGE had an idea for an initiative to return investment promoting electric vehicle access to the rural community, where gas prices significantly raised the cost of living. Through a regional initiative called Electric Nation, SAGE spent three years installing EV chargers along the border of north and South Dakota and the project wrapped at the end of November. Even though tribes have been skipped over and underfunded, they've become a keystone to filling in infrastructure gaps in rural America. Len Nessover, a Navajo citizen and energy expert, said the New York Times has this story and there's a link in today's episode Description alright everybody, that is it for today's episode. As always, if you'd like to support our work, Please go to retangle.com, where you can sign up for a newsletter membership, podcast membership or a bundled membership that gets you a discount on both. We'll be right back here tomorrow. For Isaac and the rest of the crew, this is John Law signing off. Have a great day, y'. All. Peace.

Isaac Saul (37:01)

Our Executive editor and founder is me, Isaac Saul, and our Executive producer is John Lowell. Today's episode was edited and engineered by Dewey Thomas. Our editorial staff is led by Managing Editor Ari Weitzman, with Senior Editor Will K. Back and Associate Editors Hunter Casperson, Audrey Moorhead Bailey Saw Lindsay Knuth and Kendall White. Music for the podcast was produced by Diet75. To learn more about Tangle and to sign up for a membership, please visit our website@retangle.com.

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Marc Maron (38:40)

Hey, it's Marc Maron from WTF here to let you know that this podcast is brought to you by Progressive Insurance. And I'm sure the reason you're listening to this podcast right now is because you chose it well. Choose Progressives. Name your price tool and you could find insurance options that fit your budget so you can pick the best one for your situation. Who doesn't like choice? Try it@progressive.com and now some legal info. Progressive Casualty Insurance Company and affiliates price and coverage match limited by state law. Not available in all states.