Publisher’s Platform: Hepatitis A and the Food Service Industry: A Case for Universal Vaccination

I read in the Lancet today about the need for universal Hepatitis A vaccination for children to prevent what can be a devastating illness.  However, under the current US Centers for Disease Control and Prevention (CDC) regime this safe and effective vaccination was removed from recommended childhood vaccinations. Another move putting politics before public health.

I have spent the better part of three decades in courtrooms, fighting for people who were sickened — sometimes catastrophically — by preventable foodborne illness. I have sat across from families who lost loved ones to E. coli, Salmonella, and Listeria. But few pathogens frustrate me more than Hepatitis A, because we have had a safe, effective vaccine against it since 1995, and we still can’t seem to get it into the arms of the people who need it most.

Hepatitis A is a liver disease spread primarily through contaminated food and water, and through the fecal-oral route. It is, in plain terms, a disease of hygiene and poverty. It thrives where handwashing is inadequate, where workers can’t afford to call in sick, and where access to healthcare is limited. That description fits far too many American food service workers.

Consider what happens when a single infected restaurant employee handles food before symptoms appear — because Hepatitis A is most contagious in the two weeks before a person feels sick. A single outbreak can expose hundreds, sometimes thousands, of customers. I have litigated cases involving fast food chains, buffet restaurants, catered events, and grocery store delis. The pattern is always the same: one unvaccinated worker, one lapse in handwashing, and suddenly the local health department is scrambling to offer post-exposure prophylaxis to an entire community. The cost — human, financial, and reputational — is enormous.

The economic argument alone should be compelling. A full course of the Hepatitis A vaccine costs somewhere between $100 and $200. A single outbreak investigation, combined with the medical costs of infected patrons and the near-certain loss of business for the restaurant involved, can run into the millions. The lawsuits that follow are expensive for everyone. I know, because I file them.

But this is bigger than economics. Hepatitis A disproportionately strikes the most vulnerable — older adults, people with liver disease, the unhoused, and communities with inadequate sanitation infrastructure. When a food service worker unknowingly carries the virus, they become an unwitting bridge between a contagious disease and a dining public that has no reason to suspect the guacamole is dangerous.

Some states have moved toward requiring Hepatitis A vaccination for food handlers. That is progress, but it is patchwork. We need a consistent national standard. Employers in the food service industry should be required — not merely encouraged — to ensure their workers are vaccinated, and they should bear the cost. These are the same businesses that profit from public trust. Maintaining that trust is part of the cost of doing business.

I also want to be clear: food service workers are not the villains here. They are often working without sick leave, without health insurance, and without anyone explaining that a free vaccine could protect them, their families, and every customer they serve. The failure is systemic. It belongs to employers who cut corners, to legislators who resist mandates, and to a public health infrastructure chronically starved of resources.

In the past we vaccinated children against Hepatitis A as part of the standard childhood immunization schedule – and, hope most still do. However, the question is why we are willing to protect our children but not the workers who handle their food.

The vaccine exists. The science is settled. The outbreaks are predictable and preventable. What we lack is the political will to act. I have seen the consequences of that inaction. They are not abstract — they have names, medical records, and in some cases, headstones.

Vaccinate food service workers. Vaccinate everyone. This is not a radical position. It is simply the logical conclusion of everything we know about this disease. And, by the way – fire RFK Jr. and his anti-vaccination mafia.

Bill Marler is a food safety attorney and managing partner at Marler Clark, the nation’s leading law firm representing victims of foodborne illness outbreaks. William “Bill” Marler has been a food safety lawyer and advocate since the 1993 Jack-in-the-Box E. coli Outbreak which was chronicled in the book, “Poisoned” and in the recent Emmy Award winning Netflix documentary by the same name. Bill work has been profiled in the New Yorker, “A Bug in the System;” the Seattle Times, “30 years after the deadly E. coli outbreak, A Seattle attorney still fights for food safety;” the Washington Post, “He helped make burgers safer, Now he is fighting food poisoning again;” and several others.