The hepatitis B vaccine is impressively effective when provided within 24 hours of birth. When followed up with at least two more doses of the vaccine during the first year of life, the birth dose protects newborns from mother-to-child transmission of the liver-wasting disease, and also guards against infection during a period when the virus is most damaging to future health.
That newborns across the WHO South-East Asia Region are going without the birth dose represents a missed opportunity. Hepatitis B kills around 350,000 people in the region every year. That's more than AIDS and malaria combined, and second only to tuberculosis among life-threatening communicable diseases. Approximately 100 million people across the region, meanwhile, suffer from the disease's chronic form, which can cause debilitating fatigue, jaundice and abdominal pain. It also results in increased health costs and limits workforce participation.
Hepatitis B kills around 350,000 people in the region every year. That's more than AIDS and malaria combined...
Though many newborns are deprived of the birth dose due to lack of attendance by a skilled worker at birth, even in institutional settings it is estimated that up to half of neonates go without. This is due primarily to a shortfall in skills, knowledge, resources and regulation. For some countries in the region, the hepatitis B birth dose has no place at all in standard early post-natal care, meaning the benefits are missed entirely.
There are several ways we can turn this around and ensure every newborn receives the birth dose and is given the best chance possible to avoid hepatitis B.
First, every country in the region should make the birth dose an essential component of its early post-natal care regime. By aligning national practice with international guidelines, health service providers will know what is expected, meaning there can be no excuse for a lapse in coverage.
Second, where the birth dose is part of the immunization schedule, health care providers must be adequately trained and educated on the importance of the vaccine's early delivery. Well-structured training backed by frequent follow-up support will increase confidence among health workers administering the dose, and will also enhance the likelihood of it becoming a routine part of post-natal care.
Third, technologies vital to the dose's provision must be made available at all levels of the health system, including at the community level. Though all efforts to encourage institutional delivery must be made, in hard-to-reach areas novel storage systems can allow health workers to provide the dose outside of a health care setting. As in all aspects of public health, advancing equity and access must be a priority.
For some countries in the region, the hepatitis B birth dose has no place at all in standard early post-natal care, meaning the benefits are missed entirely.
Finally, health systems and those working in them must engage with communities to advance knowledge of the birth dose and emphasize its benefits. Fear of adverse effects remains a source of resistance to the vaccine among parents, while traditional practices -- such as the custom of sequestering a newborn -- provide their own challenges. Health workers must deal with these barriers sensitively and in a way that empowers parents. Just as health workers must be trained to provide the vaccine, so too must parents be given the information necessary to drive demand.
Still, as vital as the birth dose and completing the vaccination schedule is, interrupting the disease's transmission will require complementary public health interventions. These interventions can help interrupt other forms of viral hepatitis, including hepatitis A, C, D and E.
Alongside efforts to increase early childhood and adult vaccination, for example, harm-reduction programs such as needle exchanges can help halt the spread of hepatitis B and C, as well as other blood-borne diseases among injecting drug users. Safe practices related to injections, blood transfusions and other medical procedures can similarly diminish the spread of hepatitis B and C among health care consumers, and will also promote better health facility management. Stronger enforcement of food safety regulations, safe water, sanitation and hygiene can similarly aid in reducing the risk of hepatitis A and E among the general public.
For those already suffering chronic hepatitis B and C, access to high-quality, safe and affordable treatment must be guaranteed at all levels of the health system.
Countries across the region must no longer fight hepatitis with one arm tied. Every newborn should receive the hepatitis B birth dose.
While political commitment to the birth dose and other means of combating viral hepatitis are growing, resolve must be fortified. Countries across the region must now devise and implement national hepatitis action plans built on sound strategic and financial principles. And they must do so as a matter of priority: If delayed, the global goal of ending hepatitis as a public health problem by 2030 will be unfulfilled. Millions of people across the region will continue to suffer needlessly.
Not always in public health do we have the tools, knowledge and resources to rout a disease effectively. But when it comes to tackling hepatitis B we are well-positioned. The vaccine, and especially its birth dose, is an exceptionally efficient method of interrupting transmission and keeping millions of people safe from the life-threatening disease. We just need to use it. Countries across the region must no longer fight hepatitis with one arm tied. Every newborn should receive the hepatitis B birth dose.