This letter was originally posted in the Lancet Gastroenterology and Hepatology Journal. 

View the original letter

Each year over a quarter of a million children acquire chronic hepatitis B at birth.1 Tens of thousands will go on to lose their lives prematurely from liver cancer or other forms of liver disease.1 These deaths could have been prevented if they had received the hepatitis B birth dose vaccine.

Gavi, the Vaccine Alliance, is an international partnership created to improve access to new and underused vaccines for children living in the world’s poorest countries. Their work has been pivotal in preventing many diseases. From 2000–21, they estimate that their programmes averted over 15 million deaths.2 By supporting hepatitis B birth dose vaccination, they could avert even more.

Under their 2018 vaccine investment strategy,3 Gavi committed to provide support to countries for the introduction of hepatitis B birth dose from 2021. However, in 2020, at the start of the COVID-19 pandemic, the Gavi board agreed that the implementation of hepatitis B birth dose programme would be deferred and reassessed after the acute phase of the pandemic.4 Since then, the programme has remained on hold.

In advance of Gavi’s executive board meeting, we the undersigned global health organisations call on Gavi to immediately commence their hepatitis B birth dose vaccine programme to prevent hepatitis B shortening the lives of another generation.
Almost a million lives are lost each year to liver cancer and other liver diseases caused by chronic hepatitis B infection.5 Around 70% of hepatitis B infections worldwide occur in Africa,6 but fewer than one in five children in the region receive the vaccine at birth.7 This is distressingly far below the 90% target set by WHO.8

With each additional year of delay in supporting hepatitis B birth dose vaccination programmes, hundreds of thousands more children will acquire hepatitis B at birth and will face an uncertain future with the ever-present threat of developing liver cancer and end-stage liver disease.

Like the HPV vaccine that Gavi supports to prevent cervical cancer, hepatitis B birth dose vaccine is highly effective at preventing liver cancer, thus also contributing to Sustainable Development Goal target 3.4 to reduce premature mortality from non- communicable diseases by a third by 2030.9

The birth dose programme would also support the commitment of the Global Fund, UNICEF, WHO, and other agencies to the global strategy for the triple elimination of mother-to-child transmission of HIV, hepatitis B, and syphilis by 2030.10 The impact of achieving this goal will be transformative to the health of children around the world.

Gavi must act now. We urgently call on Gavi to honour the commitment they made to these children and immediately start the implementation of their hepatitis B birth dose programme. Only then will it truly fulfil its mission to “save lives and protect people’s health by increasing equitable and sustainable use of vaccines”. Hepatitis B birth dose vaccination can’t wait.

CDA Foundation; Coalition for Global Hepatitis Elimination; Hepatitis Australia; The Hepatitis Fund; Hepatitis B Foundation; Médecins Sans Frontières Access Campaign; PATH; TREAT Asia/amfAR, The Foundation for AIDS Research; Union for International Cancer Control; World Hepatitis Alliance [email protected]


Open letter to Gavi.(PDF)


  1. Razavi-Shearer D. The impact of HBV vaccination programs in Gavi vs non-Gavi countries. World Hepatitis Summit 2022. June 7, 2022. https://youtu.be/PmP6cFm_KiQ 
    (accessed Nov 25, 2022).
  2. Gavi. Facts and figures. Statistics measuring our impact on global immunisation. https://www.gavi.org/programmes-impact/our-impact/facts-and-figures (accessed Nov 25, 2022).
  3. Gavi. Vaccine investment strategy. https://www.gavi.org/our-alliance/strategy/vaccine-investment-strategy (accessed Nov 25, 2022).
  4. Gavi. Gavi Alliance update. https://www.unicef.org/supply/media/5936/file/Gavi-Alliance-update-Hein-VIC-2020.pdf  (accessed Nov 25, 2022).
  5. World Hepatitis Alliance, WHO. World Hepatitis Summit 2022 urges action to eliminate viral hepatitis as unexplained hepatitis cases in children rise globally. https://www.who.int/news/item/07-06-2022-world-hepatitis-summit-2022-urges-action-to-eliminate-viral-hepatitis-as-unexplained-hepatitis-cases-in-children-rise-globally (accessed Nov 25, 2022).
  6. WHO Africa. 91 million Africans infected with Hepatitis B or C. https://www.afro.who.int/news/91-million-africans-infected-hepatitis-b-or-c  (accessed Nov 25, 2022).
  7. WHO. Hepatitis B vaccination coverage. https://immunizationdata.who.int/pages/coverage/HEPB.html?CODE=AFR&ANTIGEN=HEPB_ (accessed Nov 25, 2022).
  8. WHO. Combatting hepatitis B and C to reach elimination by 2030. Advocacy brief. https://apps.who.int/iris/bitstream/handle/10665/206453/WHO_HIV_2016.04_ eng.pdf (accessed Nov 25, 2022).
  9. United Nations. Sustainable development indicators. https://unstats.un.org/sdgs/metadata/?Text=&Goal=3&Target=3.4  (accessed Nov 28, 2022).
  10. WHO. Elimination of mother-to-child transmission of HIV, syphilis and hepatitis B. https://www.who.int/initiatives/triple-elimination-initiative-of-mother-to-child-transmission-of-hiv-syphilis-and-hepatitis-b (accessed Nov 25, 2022).