Western Alaska, where almost all the residents are Indigenous, used to have the world’s highest rate of childhood liver cancer caused by hepatitis B. After decades of screenings and vaccinations, that problem has been eliminated; since 1995, only one person under the age of 30 has been diagnosed with hepatitis-caused cancer.

Now the Trump administration is seeking to end one of the key tools credited with accomplishing that goal: hepatitis B vaccinations of newborns.

The federal Advisory Committee on Immunization Practices on Friday voted to drop a longstanding recommendation for universal hepatitis vaccines for newborns. That is in accordance with the controversial views of U.S. Health Secretary Robert F. Kennedy Jr., a vaccine skeptic who fired all members of the previous committee and appointed like-minded members to replace them.

Current federal childhood hepatitis B vaccination guidelines recommend one dose of the vaccine at birth, followed by additional doses at intervals through 18 months. The recommendation for newborn vaccinations has been in place since 1991.

The advisory committee, part of the U.S. Centers for Disease Control and Prevention, determined that children under 2 months should not be vaccinated unless their mothers are infected or could be infected by hepatitis B.

Some vaccine critics in the administration, including Kennedy and President Donald Trump themselves, argue — contradicting medical experts and years of medical research — that hepatitis B vaccines for young children are unnecessary, claiming that it is spread primarily or exclusively through adult behavior like sex and sharing of needles for illegal drug use.

“Hepatitis B is sexually transmitted. There’s no reason to give a baby that’s almost just born hepatitis B. So I would say wait till the baby is 12 years old and formed and take hepatitis B,” Trump said at a Sept. 22 news conference.

Those claims are false, said Dr. Brian McMahon, medical and research director of the liver and hepatitis program at the Alaska Native Tribal Health Consortium.

There is no credible evidence of a link between the vaccine and autism of any other health problem, McMahon said.

And sexual transmissions accounted for only a tiny percentage of Alaska’s hepatitis B cases, he said.

Aside from mother-to-infant transmissions, which occur during childbirth, hepatitis B was predominantly spread in Western Alaska through normal daily activities. That is because, unlike the HIV virus or other hepatitis viruses, the hepatitis B virus can live for seven days on surfaces in schools and homes, like tables and personal-grooming items.

“The virus can be found all over, on school luncheon tabletops, counters and homes,” McMahon said. “Kids have open cuts and scratches from bug bites or anything else, and then they shed millions of particles of the virus on environmental surfaces. And then another kid comes along with an open cut or scratch.”

Such risks are exacerbated in rural Alaska, he said, where homes can be crowded and people pursue traditional subsistence lifestyles with a lot of outdoor activities.

“They’re hunting, fishing, cutting up meat, et cetera, and mosquito bites are real prominent,” he said.

Nationally, only 12.6% of chronic hepatitis B cases recorded from 2013 to 2018 were attributable to sexual transmission, according to a 2023 CDC study. Transmissions of all forms of hepatitis, including hepatitis B, are possible through contact sports like football, rugby and hockey, researchers have found.

Alaska’s disease and vaccination success

Before the past decades of vaccination and screening, hepatitis B was so prevalent in Western Alaska that it was classified as endemic there. It was the only part of the United States with such a classification. In some villages, 20% to 30% of the residents were infected, McMahon said.

Geography and ancient migration patterns accounted for historically high rates of the disease in Western Alaska, as well as other Indigenous regions of the Arctic.

Various strains have been carried from Asia to Alaska over millennia, according to scientists. And the remoteness of Indigenous communities meant isolation from medical services, making early diagnosis difficult in the past, allowing infections to linger and be passed down through generations, according to scientists.

In Alaska, children infected with the virus early in life had a high likelihood of winding up with chronic infections that caused serious complications later, such as liver failure. The worst cases resulted in cancer, and even death.

For McMahon, now in his 80s, treating cancer-stricken children in the Yukon-Kuskokwim region, where he worked in the 1970s, was harrowing.

One of his patients was a 17-year-old high school valedictorian. A few months earlier, she started having abdominal pains, but she ignored them.

“She was really busy with school, and she’d gotten a full ride scholarship and was excited about going to the University of Alaska, representing her community,” McMahon said.

The pains turned out to be cancer, caused by a hepatitis B infection that she had not known she had. Too sick to be flown home, she died in the Bethel hospital.

“It was horrible,” McMahon said.

Another patient was an 11-year-old boy, also diagnosed after he complained of similar abdominal pain. McMahon visited him at home, where the boy was “in horrible pain” and yellow from jaundice.

“He was just crying. He said, ‘I know I’m going to die. Just help me with my pain,’” McMahon said.

“My wife was with me. She was a public health nurse. She was in tears. The community health aide practitioner was in tears. I was fighting my tears and pulling everything I could out of my bag to try to help this patient sedate. It was just something I’ll never forget. Never,” McMahon said.

He has relayed these and other experiences to the vaccine advisory committee in hopes of persuading members to keep the infant recommendations in place.

“I said, ‘Do you want to be responsible for children getting liver cancer because of this decision?’” McMahon said. “So I’m probably not very popular right now.”

Alaska was one of the first places in the world where the hepatitis B vaccine was used as soon as it became available in 1981.

The pilot vaccination project was at the insistence of Alaska Native organizations, along with the state government and the Alaska congressional delegation. Under that pilot program, according to newly published study by McMahon and other researchers from ANTHC and the CDC’s Arctic program, tribal health organizations and their partners screened 53,860 Alaska Native people for infection and gave vaccines to 43,618 Alaska Native people who tested negative, along with starting the universal newborn vaccinations.

Health officials have followed the outcomes since then, and the new study lists several achievements 40 years after universal newborn vaccination started.

Since 1995, according to the study, there have been no new symptomatic cases of hepatitis B among Alaska Natives under 20 anywhere in the state. Since 2000, no new cases of hepatitis-related liver cancer have been identified among Alaska Natives of any age in the Yukon-Kuskokwim Delta, a region where prevalence was concentrated in the past, the study said. And follow-up surveillance has revealed that childhood hepatitis B vaccinations remain effective for at least 35 years, the study said.

Successes are also reflected in the trend of acute hepatitis, the form of infection that is short-lived and can be cleared from the body.

There have been no identified cases of acute hepatitis among Alaska Native children since 1992, according to Johns Hopkins University. The rate of acute hepatitis among Alaskans of all ages and ethnicities dropped from 12.1 cases per 100,000 people to 0.9 per 100,000 in the 2002-2015 period, according to the state Department of Health’s epidemiology section.

Alaska’s rate of chronic hepatitis B — the long-term and persistent infection that can lead to serious liver problems — remains higher than the national average. As of 2020, Alaska’s rate of chronic hepatitis B was 14.2 cases per 100,000 people, nearly triple the national rate of 5 cases per 100,000 people, according to a report by the state Department of Health’s epidemiology section.

McMahon said that is partly because of the legacy of infections in the older Native population, people whose childhood predated widespread vaccination, and prevalence among foreign-born residents who come from countries without widespread vaccination.

Debate over hepatitis B risks

This year, vaccine skeptics who are members of the Advisory Committee on Immunization Practices, however, along with people who are advising the committee, have argued that the risks of hepatitis B among children are too low to justify universal infant vaccination.

One of the officials making that argument at Thursday’s committee meeting was Dr. Cynthia Nevison, a vaccine skeptic hired as a CDC consultant. She contradicted McMahon’s description of children spreading the virus through casual contact with contaminated surfaces — a process known as “horizontal transmission.”

“There’s very little evidence that horizontal transmission has ever been a significant threat to the average American child, and the risk probably has been overstated,” she said at the meeting. Also overstated, she said, are the risks of “vertical transmission,” the viral transmission between mothers and their newborns.

The committee’s new recommendation must be approved by the CDC administrator before it becomes federal policy.

McMahon said that no matter how national policy might change, Alaska Native tribal health organizations will continue administering hepatitis B vaccines to newborns.

“I know they’re not going to stop. Even if they have to pay for it. They’re so aware of this,” he said.

His fears, he said, are for low-income families who depend on free vaccinations through state programs that might lose funding and for parents who are getting conflicting messages that may lead to conclusions that the vaccine is not necessary.

“It could be a real mess,” he said.

Originally published by the Alaska Beacon, an independent, nonpartisan news organization that covers Alaska state government.

SEATTLE — After two crippling IT outages this year, Alaska Airlines now says it is confident travelers won’t have to worry about tech problems interrupting their plans in the future.

While Alaska has some room to improve its tech systems, it does not have a “systemic” IT failure, Chief Financial Officer Shane Tackett said, citing a third-party review Alaska commissioned to study its IT infrastructure.

Alaska hired the consulting firm Accenture to look for ways to strengthen its system after an IT outage grounded its fleet for eight hours in October. That outage followed another hardware failure that grounded Alaska’s fleet for three hours in July.

The disruptions come amid a big year for Alaska, as it integrates Hawaiian Airlines after acquiring the company in 2024. This time last year, Alaska unveiled its long-term plan to capitalize on its acquisition and its newly inherited fleet of widebody planes, unveiling new Pacific routes and a goal to turn its Seattle hub into a global gateway.

Alaska said in a recent statement it is already seeing “meaningful progress” from its effort to integrate the two airlines. Company executives have said the IT outages are not related to its merger with Hawaiian.

Alaska did not share details on the scope of Accenture’s assessment, or what actions the company would take once the review was complete. Alaska has not released the initial results of that review but said in a statement it had “begun to implement recommendations.”

[How Alaska Airlines responds to wild weather, IT troubles and travel chaos]

Speaking at a Goldman Sachs conference Thursday, Tackett said Accenture found there are some actions Alaska can take, what he called “hygiene.” The airline can improve resiliency and redundancy, and increase daily checks of its systems. But the review did not find a large, systemic failure.

“We were open-minded to ‘Are we missing something on the architecture side of it? Have we just underresourced ourselves?’” Tackett said. “That’s not what they found. A lot of the things that we’re hearing that we should be doing are pretty quick-win types of things.

“We fully expect to be stable and resilient. … People can have confidence that we’re not going to have infrastructure, data center-related interruptions in our operations at all, Tackett continued.

It was one of the first times Alaska executives have spoken publicly about the company’s finances and operations since the IT outage in October.

Alaska’s system went down on the same day it reported its third-quarter financial results, and the company canceled a scheduled earnings call the following day.

In that time period, Alaska also had to navigate a 43-day government shutdown and a resulting order from the Federal Aviation Administration for major carriers to reduce flights.

In a financial filing Wednesday, Alaska Air Group, which owns Horizon Air and Hawaiian Airlines as well as its namesake carrier, said it would take a financial hit from the turbulent start to its fourth quarter, three months that include the recent IT outage, the government shutdown and a fire at a California refinery that is a major source of jet fuel for West Coast carriers. The airline lowered its expected earnings from 40 cents to 10 cents.

The government shutdown and resulting flight cancellations cost the airline about $30 million, Alaska said in its Wednesday statement. The October IT outage, as well as a Microsoft Azure cloud outage that impacted Alaska’s systems that same month, cost the airline $50 million.

But the airline is getting back on track, Tackett told analysts at the Goldman Sachs conference.

[Alaska Airlines to open new pilot base in San Diego and plans to hire hundreds]

West Coast jet fuel prices are back in line with other markets, Tackett said. Bookings and revenue have not fully returned to preshutdown levels, but they are still “better than 95% of the days we’ve observed this year,” he said.

“I don’t think the impacts are likely to linger into next year,” Tackett added.

Analysts from JP Morgan agreed that the events of the last few months wouldn’t impact the airline’s performance next year, except for the constant threat of volatile fuel prices. But in a note to investors summing up their reaction to Alaska’s recent financial disclosures, the analysts wrote, “a miss is a miss.”

A bumpy few months

A few weeks into the government shutdown, the FAA ordered major carriers to reduce operations at 40 airports across the country, an effort to ease the strain on air traffic controllers who had spent weeks working without pay and were starting to miss shifts in high volumes.

Alaska Air Group canceled about 600 flights during that period, impacting 40,000 travelers, the airline said in the Wednesday financial filing. Revenue has “not fully recovered to pre-shutdown trends,” the filing read.

Tackett clarified Thursday at the conference that the airline was more bullish than its filing may have led analysts to believe.

Before the mandated flight reductions, Alaska had been recovering from a drop-off in domestic bookings earlier this year, Tackett said. Bookings had “started to creep their way back up” to match the level of demand Alaska saw at the end of 2024 and into 2025.

“Then, like everybody else, bookings hollowed out,” he said.

Once the government reopened and the FAA reversed course on its directive, bookings bounced back quickly.

Delta Air Lines — the second-largest carrier at Seattle-Tacoma International Airport, after Alaska — said Wednesday it lost $200 million from the government shutdown, contributing to a quarterly loss of 25 cents in earnings per share.

Savanthi Syth, an airline analyst with financial services company Raymond James, estimated immediately after Alaska’s IT outage that it would trim about 15 cents from Alaska’s earnings per share, or about $26 million from its pretax income for the fourth quarter.

Alaska’s estimate Wednesday calculated a higher impact, estimating a loss of 25 cents in earnings per share. The government shutdown and higher fuel prices each trimmed 15 cents in earnings per share, Alaska said.

[Airline that planned to fly Alaskans to Asia shuts down]

The IT failures were not related to Alaska’s recent acquisition of Hawaiian Airlines and resulting changes to integrate the two airlines’ systems, Tackett emphasized.

But he did acknowledge that Alaska’s IT teams are “spread, maybe, a tiny bit thin,” as they work on integrating the platforms and other changes Alaska has introduced this year, including a joint loyalty program and a new premium credit card.

On the refinery front, Tackett said the airline is paying less for fuel today than it was before the fire, even though the refinery is not yet back online.

Still, he acknowledged the industry needed a long-term solution to make fuel prices “less volatile” on the West Coast. That could mean bringing more oil on ships from Asia directly to Seattle or Portland, which, in turn, would require local political buy-in.

“It’s not a novel idea,” Tackett said. “We just have to execute it up in Seattle.”

The fate of Hawaiian’s A321s

At the Goldman Sachs conference, Tackett also shed light on Alaska’s thinking about its aircraft fleet, which now includes a mix of planes from Boeing and its European competitor Airbus.

The last time Alaska had a mixed fleet — when it acquired Virgin America in 2016 — it shed the inherited Airbus planes because it was cheaper and more efficient to operate aircraft from just one manufacturer.

Tackett said the airline has that same thinking today about its narrowbody fleet, which includes Boeing’s 737 MAX and Hawaiian’s fleet of 17 in-service Airbus A321s. But Alaska hasn’t yet decided what it will do.

“There really isn’t a reason in our mind to have two pieces of equipment that do the same thing; if you can get one, it has much better economics,” Tackett said. “The number of A321s we have is too few — you need double that number or zero.”

On the widebody front, Alaska plans to keep operating both manufacturers “as far as we can see into the future,” Tackett said.

Alaska doesn’t have the same cost concerns as it would with its narrowbodies because it will operate the widebody A330s out of Hawaiian’s Honolulu headquarters, where the airline already has the right equipment for service and maintenance, and pilots and flight crews are already trained on operating that model.

Alaska is “extending leases and buying out of leases” for the A330, Tackett continued, and has the option to buy five more Boeing 787 widebody planes.

With Hawaiian’s Airbus fleet now in its fold, Alaska also has to deal with any Airbus challenges. On Thursday, Tackett acknowledged that the airline may “have to go down a couple lines of flying” due to an issue with the Pratt and Whitney engine on the A321.

Hawaiian’s operations were not affected by a recent software issue on Airbus’ A320 family, the airline said last week.

WASHINGTON (KTUU) – Sen. Lisa Murkowski, R-Alaska, warned Wednesday that Alaska faces some of the “most extremes of the extremes” when it comes to skyrocketing healthcare costs. Nearly 28,000 Alaskans could see their insurance premiums spike by as much as 295% if Congress fails to extend Affordable Care Act subsidies by the end of the month.

“My home state of Alaska appears to suffer some of the most extremes of the extremes when we’re talking about these high costs,” Murkowski said at the Health, Education, Labor and Pensions Committee Wednesday. “People are expecting us to come up with a solution.”

The warning comes as Alaska ranks among the hardest-hit states in the nation for premium increases, according to the Kaiser Family Foundation, after the crisis was highlighted during the 43-day government shutdown—the longest in U.S. history—that ended in November when eight Senate Democrats broke ranks to reopen the government.

As part of that deal, Republicans promised a vote on extending the enhanced premium tax credits by the middle of December. Alaska’s senators say they’re still working on extensions, but they only have until December 31.

Senate Democrats will be forcing a vote next week on a plan to extend enhanced premium tax credits, or the subsidies in question, for three years, NBC’s Sahil Kapur reports.

“Republicans have one week to decide where they stand: Vote for this bill and bring health care costs down, or block this bill and send premiums skyrocketing,” Sen. Chuck Schumer, D-New York, said on the Senate floor Thursday. “That’s what’s at stake when we vote next week. It’s going to be one of the most important votes we take.”

Across the aisle, though, its chances to survive a filibuster seem unlikely.

“I haven’t seen yet what the Dems are proposing. I don’t think we’re close to a 60-vote threshold yet,” Senate Majority Leader John Thune, R-South Dakota, told NBC News on Tuesday.

In a statement to Alaska’s News Source, Murkowski, too, said she was dubious of its chances in the chamber.

“We have two problems in front of us that we need to resolve: the immediate spike in premiums Alaskans will face if we do not allow for some limited extension before the end of this year, and the need to address the ever-escalating cost of receiving basic health care,” she said.

“These are policy considerations that will take us more than a week to resolve. I’ve been working to bring my colleagues to the table to develop both short- and long-term solutions before Alaskans feel the impact of these premium increases in the new year.”

Sen. Dan Sullivan, R-Alaska, said at an Anchorage Chamber of Commerce forum in November he supports “tapering down” the subsidies over time rather than an abrupt end.

“Senator Sullivan is working relentlessly with his Senate colleagues on both sides of the aisle to extend ACA subsidies with necessary reforms before the end of the year,” spokesperson Amanda Coyne told Alaska’s News Source Thursday. “Senator Sullivan recognizes that because of the high cost of health care delivery in Alaska, thousands of small business owners, fishermen, entrepreneurs, and others across the state rely on those subsidies.”

Coyne did not say whether Sullivan supports the Democrats’ three-year extension plan.

All the while, President Donald Trump has backed a plan to send funding to individuals instead of insurance companies.

“THE ONLY HEALTHCARE I WILL SUPPORT OR APPROVE IS SENDING THE MONEY DIRECTLY BACK TO THE PEOPLE, WITH NOTHING GOING TO THE BIG, FAT, RICH INSURANCE COMPANIES, WHO HAVE MADE $TRILLIONS, AND RIPPED OFF AMERICA LONG ENOUGH,” Trump said in a social media post last week. “Congress, do not waste your time and energy on anything else.”

That plan, touted by Sen. Bill Cassidy, R-Louisiana, proposes individuals receive credits, “directly to patients and empower them to manage their own health care decisions,” according to a press release from his office.

Alaska’s News Source contacted the entire delegation for comment Thursday. A spokesperson for Begich did not respond to multiple requests over several days.

Alaska impact

Healthcare premiums for about 28,000 Alaskans, roughly 4% of the state, could skyrocket if the subsidies expire, according to data from the Kaiser Family Foundation and Alaska’s Division of Insurance.

House Minority Leader Hakeem Jeffries, D-New York, told CNN Wednesday Alaska would be one of ten states hardest hit by the funding cut.

“We’re talking about tens of millions of people, including in many red states across the country,” Jeffries said. “In fact, the states that will be most impacted if the Affordable Care Act tax credits expire, are Republican run states. We’re talking about West Virginia, Wyoming, Alaska…”

Alaska’s News Source reached out to Jeffries’s office for specifics on his claim, though the request was made after his office hours in D.C.

Jeffries statements align with data from a Nov. 24 study from the Kaiser Family Foundation, showing that in many cases, Alaska, on average, has some of the highest percentage increases to how much premiums will cost if the subsidies expire.

The study shows 60-year-old Alaskans earning just above 401% of the federal poverty line ($78,396 annually) could see their premiums increase by 295%. The average premium without these subsidies would become $2,192 monthly, consuming 34% of their yearly income.

In this age and income group, Alaska is the fourth highest increase, the first being Wyoming at 421%, West Virginia at 413% and Connecticut at 316%.

“I think we’re going to need to have a short-term extension‚” Murkowski said at the Wednesday committee meeting. “But I think we can put reasonable caps on it … But we’ve got to be looking longer term to how do we ultimately reduce these costs of care.”

The enhanced premium tax credits, which provide more generous subsidies than the original Affordable Care Act and extend eligibility, began during the pandemic and were extended in 2022. They are set to expire at the end of 2025 if Congress does not extend them again.

The subsidies were at the core of the recent 43-day government shutdown, with Senate Democrats forcing the closure to try and extend the credits. Alaska’s entire congressional delegation has publicly said they support extending the subsidies.

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