US President Donald Trump has said he will sue the New York Times for $15bn (£11bn) over what the US president calls defamation and libel.

“The New York Times has been allowed to freely lie, smear, and defame me for far too long, and that stops, NOW!” Trump posted on his social media platform, Truth Social, on Monday.

He singled out the Times’ endorsement of Kamala Harris in the last presidential election in 2024, saying it had become a “mouthpiece for the Radical Left Democrat Party”.

Trump added that his lawsuit was being launched in Florida, a Republican stronghold. The BBC has reached out to the newspaper for a comment.

Trump has long expressed displeasure at what he bills left-leaning media outlets unfavourable to his presidency.

In a post late on Monday, Trump took issue at the Times’ endorsement of his election rival, saying: “Their Endorsement of Kamala Harris was actually put dead center on the front page of The New York Times, something heretofore UNHEARD OF!”

In the post he also accused other media outlets or TV programmes of “smearing” him through “a highly sophisticated system of document and visual alteration”.

ABC News and Paramount’s CBS News both agreed to multimillion-dollar payouts to Trump to settle lawsuits brought by the president in recent months.

He has also launched a case against the Wall Street Journal over its reporting on the Epstein scandal.

This is not the first time Trump has sought to sue the New York Times.

In 2023, a judge has dismissed a lawsuit filed by him, then an ex-president, against the New York Times, saying the claims in the lawsuit “fail as a matter of constitutional law”.

The $100m (£79m) lawsuit accused the newspaper and Trump’s estranged niece, Mary Trump, of “an insidious plot” to obtain his tax records.

It was filed in 2021 and relates to a Pulitzer Prize-winning series on Trump’s financial affairs.

Trump also lost another defamation bid in 2023, when he sought in vain to sue CNN for allegedly likening him to Adolf Hitler. A federal judge later threw out the $475m (£369m) lawsuit.

Clarification: This story has been updated to include the lawsuits against ABC News and Paramount which ended with settlements in Trump’s favour.

Editor’s note: This article is part of The Athletic NFL Power Rankings. Every​ week, Josh Kendall and Chad Graff rank and analyze all 32 teams from first to worst.

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We’re only two weeks into the NFL season. The most prudent thing to do with the limited amount of data we have at this point is to proceed cautiously.

But the Power Rankings won’t be doing that this week. We’re overreacting about pretty much everything from the tush push to Ben Johnson to the Super Bowl-bound Indianapolis Colts (OK, that last one was too far.).

1. Green Bay Packers (2-0)

Last week: 2

Thursday: Beat Commanders 27-18

Overreaction: Dan Quinn shouldn’t have hired Matt LaFleur

The Packers head coach was Notre Dame’s quarterbacks coach when Quinn hired him in 2015 to be part of an Atlanta Falcons staff that included Kyle Shanahan and Mike McDaniel. LaFleur has led the Packers against a team coached or coordinated by Quinn four times since 2019. His quarterbacks have thrown 12 touchdown passes against zero interceptions and had a 144.7 passer rating in those games, all of which were wins. Some thanks, huh?

Up next: at Browns, Sunday, 1 p.m. ET

2. Philadelphia Eagles (2-0)

Last week: 1

Sunday: Beat the Chiefs 20-17

Overreaction: It’s boring football

There, we said it. The Eagles choked the life out of the Chiefs anaconda-style. It was as tedious as it was ruthless. Philly averaged 3.7 yards per play and tush-pushed its way to its final touchdown and the first-down conversion that sealed the victory. At least A.J. Brown had five catches this week, albeit for a mere 27 yards! The Eagles are 3-0 in the last two years when passing for fewer than 100 yards.

Up next: vs. Rams, Sunday, 1 p.m. ET

3. Buffalo Bills (2-0)

Last week: 3

Sunday: Beat Jets 30-10

Overreaction: James Cook should have gotten more money

The Bills’ fifth-year running back had to hold in to get a four-year, $48 million contract extension. He’s fourth in the league with 176 rushing yards after a 132-yard, two-touchdown effort Sunday, including a 44-yard score in the second quarter. Cook’s five 40-plus-yard touchdown runs since 2022 lead the NFL, and he’s sixth in the league in rushing since the start of the 2023 season (2,307 yards).

Up next: vs. Dolphins, Thursday, 8:15 p.m. ET

4. Los Angeles Chargers (2-0)

Last week: 4

Monday: Beat Raiders 20-9

Overreaction: A Greg Roman body double is calling plays

When Roman was the Baltimore Ravens’ offensive coordinator from 2019 to 2022, his team led the NFL in rush percentage (51.1). When he was the offensive coordinator for the San Francisco 49ers from 2011 to 2014, his team was second in the league in rush percentage (50). After Monday night’s win, the Chargers are 17th in rush percentage (42.1), according to TruMedia. Until midway through the fourth quarter, when the Chargers simply wanted to drain the clock, Justin Herbert had thrown 25 passes against just 17 run plays. It’s working. This team looks like a contender.

Up next: vs. Broncos, Sunday, 4:05 p.m.

5. Baltimore Ravens (1-1)

Last week: 8

Sunday: Beat Browns 41-17

Overreaction: This team will set the NFL points record

The 2013 Denver Broncos hold that title with 606 points. Baltimore is on pace for 689 after its second straight 40-point game to start the season. It did that despite gaining only 242 yards of offense. Lamar Jackson had his 12th career game with four or more touchdown passes and is now the NFL’s all-time leader in passer rating (102.65), according to CBS Sports.

Up next: vs. Lions, Monday, 8:15 p.m. ET

6. Detroit Lions (1-1)

Last week: 14

Sunday: Beat Bears 52-21

Overreaction: Ben Johnson’s not that great

We were all a little worried when the Lions scored 13 points in Week 1 without Johnson coordinating the offense, but Detroit made a statement by putting 511 yards and 52 points on Johnson’s new team, the Chicago Bears. Jared Goff had five passing touchdowns and a passer rating of 156, his second highest as a Lion. It’s the fifth time a Goff-quarterbacked team has topped 50 points.

Up next: at Ravens, Monday, 8:15 p.m. ET

For those who track the Next Gen Stats, this is pretty much a Picasso. @NextGenStats pic.twitter.com/0uTogZlVuT

— Peter Schrager (@PSchrags) September 14, 2025

7. Los Angeles Rams (2-0)

Last week: 7

Sunday: Beat Titans 33-19

Overreaction: Davante Adams will top 1,200 receiving yards

The 32-year-old hasn’t reached that mark since 2022, but he looks good paired with Matthew Stafford. On Sunday, Adams had 106 yards on six catches (and 13 targets). He also had his first touchdown in Los Angeles. Adams and the defense made the Rams look like the NFC West favorites.

Up next: at Eagles, Sunday, 1 p.m. ET

8. Tampa Bay Buccaneers (2-0)

Last week: 11

Monday: Beat the Texans 20-19

Overreaction: Baker Mayfield is the toughest QB to play against

If there were an advanced stat for Opponents Aggravated per Dropback, Mayfield would lead the NFL. He is adding 4.35 expected points per game with his scrambling this year, which ranks third in the league. On Monday night, with under two minutes remaining, he scooted 15 yards to convert a fourth-and-10 on the game-winning 80-yard touchdown drive, somersaulting to the turf at the end. He has picked up first downs on 75 percent of his scrambles this year, and he’s tied for third with five passing touchdowns and ninth in EPA per dropback (0.23). Cleveland and Carolina would love to have him back.

Up next: vs. Jets, Sunday, 1 p.m. ET

9. San Francisco 49ers (2-0)

Last week: 6

Sunday: Beat Saints 26-21

Overreaction: Mac Jones is the next Sam Darnold

Darnold’s return from The Land of the First-Round Bust started with one start in San Francisco in 2023. On Sunday, Jones was 26-for-39 for 279 yards, three touchdowns and no interceptions in his first stint since fill-in duty last season in Jacksonville, where he landed after being dumped by New England. He was eighth in the NFL in passer rating in Week 2 (113.1). The 15th pick in the 2021 draft will get another shot somewhere if he does this another time or two before Brock Purdy returns.

Up next: vs. Cardinals, Sunday, 4:25 p.m. ET

10. Indianapolis Colts (2-0)

Last week: 16

Sunday: Beat Broncos 29-28

Overreaction: This is the AFC South favorite

Indianapolis has scored on 14 of its 16 possessions this season, and Daniel Jones is third in the league in EPA per dropback (0.35). And then there’s this: Jonathan Taylor had 165 yards on 25 carries against a defense that gave up 71 rushing yards in Week 1. Shane Steichen is in the way-too-early conversation for Coach of the Year.

Up next: at Titans, Sunday, 1 p.m. ET

11. Washington Commanders (1-1)

Last week: 5

Thursday: Lost to Packers 27-18

Overreaction: Jayden Daniels is headed for C.J. Stroud’s Year 2

After Stroud carried the Texans on a surprising playoff run as a rookie in 2023, he was expected to have a huge 2024. He finished 30th in the league in EPA per dropback (minus-0.03). After Thursday night, when he suffered a knee injury, Daniels is 29th in EPA per dropback (minus-0.09) and is completing less than 60 percent of his passes. (Seriously, though, Quinn never should have hired LaFleur.)

Up next: vs. Raiders, Sunday, 1 p.m. ET

12. Cincinnati Bengals (2-0)

Last week: 9

Sunday: Beat Jaguars 31-27

Overreaction: Joe Burrow should have sat out until Week 8

The last few seasons, Cincinnati held Burrow out of the preseason to avoid any chance of an injury. This summer, the quarterback saw action in the first two exhibition games in the hope that it would help the team get off to a faster start. Well, the Bengals are 2-0, but Burrow is expected to be out at least three months because of a turf toe injury. If Burrow can’t return, this will be the third season-ending injury of his six-year career.

Up next: at Vikings, Sunday, 1 p.m. ET

13. Kansas City Chiefs (0-2)

Last week: 10

Sunday: Lost to Eagles 20-17

Overreaction: The dynasty is over

Kansas City has lost three straight games. Patrick Mahomes is 29th in the NFL in completion percentage (58.8) and 22nd in yards per attempt (6.5). The offense is 25th in scoring (19.0 ppg). The defense is 19th in points allowed (23.5) and 23rd in defensive EPA (minus-7.1 per 100 snaps). OK, Kansas City probably isn’t finished, but this team no longer rules the AFC.

Up next: at Giants, Sunday, 8:20 p.m. ET

14. Denver Broncos (1-1)

Last week: 15

Sunday: Lost to Colts 29-28

Overreaction: Troy Franklin will have a breakout year

After totaling 28 catches as a rookie, Franklin has 12 through two games. Eight of those came against the Colts and went for a career-high 85 yards. He added one carry for 11 yards. Also, Pat Surtain is still Pat Surtain. He had 11 tackles in Indy.

Up next: at Chargers, Sunday, 4:05 p.m. ET

15. Seattle Seahawks (1-1)

Last week: 18

Sunday: Beat Steelers 31-17

Overreaction: The Seahawks are the league’s rudest guests

Seattle stole the show in Pittsburgh, dancing and singing on the sideline in the fourth quarter when Styx’s “Renegade” was played, which is generally a cue for the Steelers to get amped up. The Seahawks also remembered they have Kenneth Walker, giving him the ball 13 times and getting 105 rushing yards and the game-clinching touchdown out of it.

Up next: vs. Saints, Sunday, 4:05 p.m. ET

16. Atlanta Falcons (1-1)

Last week: 23

Sunday: Beat Vikings 22-6

Overreaction: The Falcons have a pass rush

Over the last 20 years, Atlanta is last in the NFL with 576 sacks. Over the last five years, the Falcons are last in the league with 119. Last year, they were 31st with 31 sacks. On Sunday night, they sacked J.J. McCarthy six times. Adding Jalon Walker, James Pearce Jr. and Leonard Floyd in the offseason was a good decision.

Up next: at Panthers, Sunday, 1 p.m. ET

17. Pittsburgh Steelers (1-1)

Last week: 13

Sunday: Lost to Seahawks 31-17

Overreaction: This is a bad defense

Houston is the only NFL team paying more to its defense this year, and the $173.8 million the Steelers are giving out does not seem like money well spent. Seattle had 395 yards of offense Sunday after finishing with 230 in Week 1. Meanwhile, a New York Jets team that put 42 points and 394 yards on Pittsburgh last week totaled just 10 points and 154 yards against the Bills in Week 2. Pittsburgh is 29th in the league in scoring defense (31.5 ppg allowed) and 31st in defensive success rate (50.4 percent).

Up next: at Patriots, Sunday, 1 p.m. ET

18. Arizona Cardinals (2-0)

Last week: 21

Sunday: Beat Panthers 27-22

Overreaction: Calais Campbell isn’t human

The 39-year-old is in his 19th NFL season. He had two sacks and five tackles Sunday and sealed the win by pulling Bryce Young down with one arm. It was Campbell’s second straight five-tackle game, and he’s now fourth in the NFL in sacks since joining the league in 2008 (112.5). Arizona is eighth in the league in scoring defense (17.5 ppg allowed).

Up next: at 49ers, Sunday, 4:25 p.m. ET

19. Jacksonville Jaguars (1-1)

Last week: 19

Sunday: Lost to Bengals 31-27

Overreaction: Liam Coen is the real Ben Johnson

Maybe this is going too far, especially after a loss, but we are here today to overreact. While Johnson has yet to get the Bears going, Coen’s new team leads the league in rushing EPA (0.17 per carry), and Travis Etienne leads the league with 214 rushing yards. This is the same player who had 558 rushing yards in 15 games last season. Trevor Lawrence and Brian Thomas Jr. don’t seem to be getting along, but this team can run the ball.

Up next: vs. Texans, Sunday, 1 p.m. ET

20. Las Vegas Raiders (1-1)

Last week: 20

Monday: Lost to Chargers 20-9

Overreaction: Brock Bowers should demand a trade

The second-year tight end was third in the league with 112 catches as a rookie. He was sixth in targets with 153 and was targeted on 25.9 percent of his routes. This year, Bowers has 10 catches. On Monday night, he was targeted eight times and had five catches, but he’s still just 31st in the league in receptions. Bowers has played 56 snaps this year, while second tight end Michael Mayer has played 54. The Raiders must get Bowers even more involved.

Up next: at Commanders, Sunday, 1 p.m. ET

21. Dallas Cowboys (1-1)

Last week: 22

Sunday: Beat Giants 40-37 (OT)

Overreaction: Punters will soon be obsolete

Between the new touchback rules, more aggressive fourth-down decisions around the league and the astounding range of kickers these days, we’re seeing fewer punts. Brandon Aubrey hit a 64-yard field goal to send the game to overtime, where he then hit a 46-yard game-winner. Aubrey has hit three 60-plus yarders since the start of 2024. In that same period, he’s 17-for-20 from between 50 and 59 yards.

Up next: at Bears, Sunday, 4:25 p.m. ET

22. Minnesota Vikings (1-1)

Last week: 12

Sunday: Lost to Falcons 22-6

Overreaction: They should have kept Sam Darnold (or Kirk Cousins)

The Vikings sent two perfectly good quarterbacks packing the last two years and put everything on the shoulders of J.J. McCarthy, who was overwhelmed by the Falcons in his second NFL start. McCarthy has taken the second-most time to throw of any QB in the league, taking three seconds to get the ball out, and he was sacked six times because of it on Sunday night. McCarthy’s EPA per dropback (minus-0.54) is the worst in the league by a good distance. With McCarthy now dinged up, Minnesota will likely turn to Carson Wentz.

Up next: vs. Bengals, Sunday, 1 p.m. ET

23. New England Patriots (1-1)

Last week: 28

Sunday: Beat Dolphins 33-27

Overreaction: TreVeyon Henderson is a bust

Sorry, that was uncalled for. The real story is that Rhamondre Stevenson isn’t done yet. After all the deserved hype about the rookie running back during training camp, the 27-year-old Stevenson led New England in rushing (11 carries, 54 yards) and receiving (five catches, 88 yards) in Sunday’s win in Miami. Henderson has 37 rushing yards on eight carries so far this season.

Up next: vs. Steelers, Sunday, 1 p.m. ET

24. Houston Texans (0-2)

Last week: 17

Monday: Lost to Buccaneers 20-19

Overreaction: C.J. Stroud’s slump is concerning

The Texans have failed their young quarterback with a bad offensive-line plan, but Stroud is not blameless. In his first 20 games as a pro, he threw 30 touchdown passes against eight interceptions, had a 100.2 passer rating and averaged 0.10 of EPA per dropback. In the 14 games since, he has 14 touchdown passes versus 10 interceptions, has an 81.4 passer rating and is averaging minus-0.09 of EPA per dropback. That divide dates to Week 5 of 2024, which was also his last 300-yard passing game.

Up next: at Jaguars, Sunday, 1 p.m. ET

25. Chicago Bears (0-2)

Last week: 24

Sunday: Lost to Lions 52-21

Overreaction: Rome Odunze has turned a corner

The No. 9 pick from the 2024 draft had seven catches for a career-high 128 yards and two touchdowns to provide the only silver lining to the Bears’ dark cloud Sunday. It was just the third 100-yard game of his career and his first since Week 8 last year. Odunze is tied for the league lead with three receiving touchdowns after two weeks. (We won’t talk about the No. 1 pick from the 2024 draft just yet.)

Up next: vs. Cowboys, Sunday, 4:25 p.m. ET

26. New York Jets (0-2)

Last week: 25

Sunday: Lost to Bills 30-10

Overreaction: The Justin Fields optimism is over

Week 1 was so promising, but Fields struggled before leaving the game against the Bills with a concussion and is questionable for Week 3. Fields was in the pocket at the time of his injury, but it illustrates the danger of using him to the fullest extent of his potential. Fields has 12 carries for 97 yards and two touchdowns this season, but exposing him to that number of collisions with his concussion history is dangerous. He was 3-of-11 passing for 27 yards before the injury, so that might not be the answer either.

Up next: at Buccaneers, Sunday, 1 p.m. ET

27. Cleveland Browns (0-2)

Last week: 26

Sunday: Lost to Ravens 41-17

Overreaction: It’s time to start a rookie

Joe Flacco is not the problem, but he’s not solving anything either. Flacco is 31st among quarterbacks in EPA per dropback (minus-0.24) and 27th in yards per attempt (5.4) after two weeks. Backup Dillon Gabriel came in for mop-up duty Sunday and was 3-for-3 with a touchdown pass. Why not give Gabriel, and maybe even Shedeur Sanders, a chance? This season isn’t going anywhere either way.

Up next: vs. Packers, Sunday, 1 p.m. ET

28. New Orleans Saints (0-2)

Last week: 30

Sunday: Lost to 49ers 26-21

Overreaction: Alvin Kamara is aging backward

Derrick Henry is the only running back in the NFL defying Father Time more effectively. The 30-year-old Kamara is seventh in the league in touches this year (40), and he totaled 99 rushing yards and 21 receiving yards against the Niners. Since 2018, Henry is the only player to touch the ball more (2,249 to 1,955).

Up next: at Seahawks, Sunday, 4:05 p.m. ET

29. Tennessee Titans (0-2)

Last week: 27

Sunday: Lost to Rams 33-19

Overreaction: Tony Pollard might lead the league in carries

Pollard had 20 carries for 92 yards in Week 2 and, according to Next Gen Stats, forced a career-high 14 missed tackles. Pollard is fourth in the league with 38 carries after two weeks and is the only thing working for the offense right now because rookie quarterback Cam Ward is completing a league-low 50.8 percent of his passes.

Up next: vs. Colts, Sunday, 1 p.m. ET

30. New York Giants (0-2)

Last week: 31

Sunday: Lost to Cowboys 40-37 (OT)

Overreaction: Brian Daboll can’t keep getting away with this

New York lost for the 13th time in its last 14 games Sunday, and it can’t blame Russell Wilson this time. The 36-year-old quarterback had 450 passing yards, three touchdowns and an interception against the Cowboys. It was his best game since 2022 as measured by EPA (0.46 per dropback) and the eye test, and the Giants still lost. Our bet is Daboll is still itching to start rookie Jaxson Dart to increase his own job security, though.

Up next: vs. Chiefs, Sunday, 8:20 p.m. ET

31. Carolina Panthers (0-2)

Last week: 29

Sunday: Lost to Cardinals 27-22

Overreaction: The wide receiver decisions make no sense

No. 8 pick Tetairoa McMillan looks like a good pick. He’s eighth in the league in receiving yards (168) after two weeks. Everything else is a mess. Last year’s first-round pick, wide receiver Xavier Legette, has four catches for 8 yards. Why exactly did Carolina trade Adam Thielen to Minnesota? Did he guilt them into it?

Up next: vs. Falcons, Sunday, 1 p.m. ET

32. Miami Dolphins (0-2)

Last week: 32

Sunday: Lost to Patriots 33-27

Overreaction: Mike McDaniel won’t coach Week 4

A short week may be the only thing saving McDaniel this week. The Dolphins showed some life Sunday, but McDaniel’s offense contributed only two touchdowns. Defensive coordinator Anthony Weaver interviewed for head coaching jobs in Chicago and New Orleans earlier this year, and he might get to be Miami’s interim head coach soon if the Bills embarrass the Dolphins on Thursday night.

Up next: at Bills, Thursday, 8:15 p.m. ET

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A key federal vaccine advisory panel whose members were recently replaced by Health Secretary Robert F. Kennedy Jr. is expected to vote to recommend delaying, until age 4, the hepatitis B vaccine that’s currently given to newborns, according to two former senior officials at the Centers for Disease Control and Prevention.

“There is going to likely be a discussion about hepatitis B vaccine, very specifically trying to dislodge the birth dose of hepatitis B vaccine and to push it later in life,” said Demetre Daskalakis, the former director for the National Center for Immunization and Respiratory Diseases. “Apparently this is a priority of the Secretary’s.”

The vote is expected to take place Thursday during the next meeting of the CDC’s Advisory Committee on Immunization Practices, or ACIP. The meeting is scheduled for September 18-19 at a CDC office in Atlanta, Georgia.

For more than 30 years, the CDC has advised that infants get the first of three shots of the hepatitis B vaccine at birth. In that time, the potentially fatal disease has been virtually eradicated among American children. Between 1990 and 2022, case rates plummeted 99 percent among people age 19 and younger.

Pediatricians warn that waiting until age 4 to begin vaccination opens the door to more children contracting the virus.

“Age four makes zero sense,” said pediatrician Eric Ball, who practices in Orange County, California. “We recommend a universal approach to prevent those cases where a test might be incorrect or a mother might have unknowingly contracted hepatitis. It’s really the best way to keep our entire population healthy.”

In addition to the hepatitis B vaccine, the panel will also discuss and vote on recommendations for the combined measles, mumps, rubella, and varicella vaccine, and COVID vaccines.

Pediatricians worry changes to the schedules of these vaccines will limit access for many families, because ACIP’s recommendations generally determine whether insurance plans and federal programs pay for the vaccines.

Typically, ACIP would undertake an analysis of the data before recommending a change to vaccine guidelines. As of the end of August, this process had not begun for the hepatitis B vaccines, Daskalakis and another former official said.

“This is an atypical situation. There’s been no work group to discuss it,” Daskalakis said.

The second former official spoke to NPR and KFF Health News on condition of anonymity.

In an email, a Health and Human Services spokesman, Andrew Nixon, wrote, “ACIP exists to ensure that vaccine policy is guided by the best available evidence and open scientific deliberation. Any updates to recommendations will be made transparently with gold standard science.”

The draft agenda for the upcoming ACIP meeting was released to the public Sunday, only a few days before the meetings are scheduled to begin.

At the last ACIP meeting in June, chairman Martin Kulldorff, one of the new members handpicked by Kennedy, questioned the need to vaccinate every newborn, citing only two of the many ways the virus can spread.

Kulldorff is a former Harvard Medical School professor who became known for opposing some public health measures during the COVID-19 pandemic.

“Unless the mother is hepatitis B positive, an argument could be made to delay the vaccine for this infection, which is primarily spread by sexual activity and intravenous drug use,” Kulldorff said.

The infection requires direct exposure to infected bodily fluids like blood and semen. The disease has no cure and can lead to serious conditions like cirrhosis and liver cancer later in life. The CDC advisory panel may maintain the recommendation to inoculate newborns whose mothers are considered at high risk of the disease, the former officials said.

Protection From Birth

In 1991, federal health officials determined it was advisable for newborns to receive their first dose of the hepatitis B vaccine within 24 hours of birth, which blocks the virus from taking hold if transmitted during delivery.

While parents may opt out of the shots, many daycare centers and school districts require proof of hepatitis B vaccination for enrollment.

The prospect of altering the recommendation has left some people living with the virus deeply unsettled.

“I am goddamn frustrated,” said Wendy Lo, 52, who lives in the San Francisco Bay area. Lo says she has probably had hepatitis B since birth. Years of navigating the psychological, monetary, medical and social aspects of chronic hepatitis B has impacted almost every aspect of her life.

“I would not want anyone to have to experience that if it can be prevented,” she said.

Lo only learned she had the disease due to a routine screening in order to study abroad in college as a young adult.

Lo credits the vaccines with protecting all the members of her close family from infection.

“I shared with my partner, ‘if you get vaccinated, we can be together,'” she said. He got the vaccine, which protects him from infection, “so I’m grateful for that,” she said.

The CDC estimates half of people with hepatitis B do not know they are infected. It can range from an acute, mild infection to a chronic infection, often with few or no symptoms.

Most people with chronic hepatitis B were born outside of the U.S. Asians and Pacific Islanders, followed by Black people, have the highest rates of newly reported chronic infections.

When her children were born, Lo was adamant that they receive the newborn dose, a decision she says prevented them from contracting the virus.

The earlier an infection occurs, the worse the lifetime consequences, according to the CDC. When contracted in infancy or early childhood, hepatitis B is far more likely to become a chronic infection, silently damaging the liver over decades.

Those who become chronic carriers can also unknowingly spread the virus to others and face an increased risk of long-term complications including cirrhosis and liver cancer, which may not become evident until much later in life.

Treatments like the antivirals Lo now takes weren’t available until the 1990s. Decades of the virus replicating unchecked damaged her liver. Every six months she gets scared of what her blood tests may reveal.

“Now I’m in my 50s, one of my big concerns is liver cancer. The vaccine is safe and effective, it’s life-saving, and it protects you against cancer. How many vaccines do that?” Lo said.

Thirty Years of Universal Vaccination

After a vaccine was approved in the 1980s, public health officials initially focused vaccination efforts on so-called “high-risk” adults.

“I, and every other doctor, had been trained in medical school to think of hepatitis B as an infection you acquired as an adult. It was the pimps, the prostitutes, the prisoners, and the healthcare practitioners who got hepatitis B infection. But we’ve learned so much more,” said William Schaffner, professor of infectious diseases at the Vanderbilt University School of Medicine and a former voting member of ACIP.

As hepatitis B rates remained stubbornly high in the 1980s, scientists realized an entire vulnerable group was missing from the vaccination regime – newborns. The virus is often spread from an infected mother to baby in late pregnancy or during birth.

“We may soon hear ‘let’s just do a blood test on all pregnant women.’ We tried that. That doesn’t work perfectly either,” Shaffner said.

Some doctors didn’t test, he said, and some pregnant women falsely tested negative, while others acquired hepatitis B later in pregnancy, after they had already been tested. In 1991, Schaffner was a liaison member to the ACIP group that voted to recommend universal vaccination for hepatitis B before an infant leaves the hospital.

“We want no babies infected. Therefore, we’ll just vaccinate every mom and every baby at birth. Problem solved. It has been brilliantly successful in virtually eliminating hepatitis B in children,” he said.

In 1990, there were 3.03 cases of hepatitis B per 100,000 in those 19 years old and under in the U.S., according to the CDC.

Since the federal recommendation to vaccinate all infants, cases have dramatically decreased. CDC data shows that in 2022, the rate of cases among those ages 19 was less than 0.1 per 100,000.

While hepatitis B is often associated with high-risk behaviors such as injected drug use or multiple sexual partners, health experts caution that it is possible for the virus to be transmitted in ordinary situations, especially among young children.

The virus can survive for up to seven days outside the body. During that time, even microscopic traces of infected blood on a school desk or playground equipment can pose a risk.

If the virus comes into contact with an open wound or the mucous membranes of the eyes, an infection can occur. This means that unvaccinated children who are not considered “high risk” can still be exposed in everyday environments.

Future Access Uncertain

If the CDC significantly alters its recommendation, health insurers would no longer be required to cover the cost of the shot if given before the new recommended age. That could leave parents to pay out of pocket for a vaccine that has long been provided at no charge.

Children who get immunizations through the federal Vaccines for Children program would lose free access to the shot as soon as any new ACIP recommendations get approved by the acting CDC director.

The two former CDC officials said that plans were underway to push back the official recommendation for the vaccine as of August, when they both left the agency, but may have changed.

Schaffner is still a liaison member of ACIP, and hopes to express his support for universal newborn vaccination at the next meeting.

“The liaisons have now been excluded from the vaccine work groups. They are still permitted to attend the full meetings,” he said.

He intends to speak up if he can, because he’s worried about the next generation of babies and the doctors who care for them.

“We’ll see cases of hepatitis B once again occur. We’ll see transmission into the next generation,” he said. “And the next generation of people who wear white coats will have to deal with hepatitis B, when we could have cut it off at the pass.”

This story was produced in partnership with KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF.

NPR Health Correspondent Will Stone contributed to this story.