Hepatitis B vaccine support

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From 2000-2011, 296 million children immunised against hepatitis B thanks to Gavi support

Threefold increase in hepatitis B coverage in Gavi's first decade


Spectacular acceleration

The very first hepatitis B (hepB) vaccines funded by Gavi were administered to over one million babies in Mozambique in 2001.

Thanks to Gavi's new and underused vaccine support (NVS), many other low-income countries quickly introduced the vaccine, spurring a spectacular acceleration of hepB immunisation coverage.

By 2004, 50% of low-income countries had included hepB vaccines in their routine immunisation programmes. This occurred 22 years after the very first hepB introduction in Italy - but only six years after high-income countries had reached the same 50% threshold.

Soon, low-income countries had surpassed high-income countries in terms of the proportion introducing hepB vaccine; by 2009, Haiti and Somalia were the only low-income countriest that had not yet introduced hepB vaccines into their national routine immunisation programmes.

Hepatitis B vaccine introduction in high and low-income countries

Hepatitis B vaccine introduction in high- and low-income countries 

Second Gavi Evaluation Report

Gavi's Second Evaluation Report (2010) shows that the average number of country introductions per year of hepB vaccines increased by three-fold following the introduction of Gavi support. Over 80% of countries reached peak coverage within two years of vaccine introduction.

The report concludes that fewer countries would have introduced these vaccines in the absence of Gavi.

The easy-to-administer five-in-one pentavalent vaccine, which also protects children from diphtheria-tetanus-pertussis (DTP) and Haemophilus influenzae type b, has played a significant part in the increase of hepB uptake.

China's dramatic fall in hepatitis B infections

A decade ago, barely 40% of children in China’s poorest areas were immunised against hepB. Today, after an eight year partnership between China and GAVI, only 1% of under 5’s are chronic carriers of hepB.

Read more

China Hepatitis B video screenshot

By the late 1990s, the hepatitis B vaccine had been on the market for two decades, but was not reaching enough poor countries

Disease burden

Vaccinating against hepatitis B (hepB) is an important investment in a country's future. While infections occur mostly in young children, the deadly consequences of the virus usually strike later in life as liver disease, including cirrhosis and liver cancer.

An estimated two billion people alive today have been infected with hepB virus and 350 million people worldwide are chronically infected. Of those, approximately 600,000 will die of cirrhosis or cancer of the liver.

Transmission of the virus from mother to newborn infant is a major contribution to disease in regions such as Asia and the Pacific Rim, where infection is widespread.

Hepatitis B claiming 900,000 lives in 2000

By the late 1990s, the hepB vaccine was taking longer than the average 15 years usually required for a new vaccine to reach large numbers of the world's poorest children.

HepB vaccines had become available in 1981, with Italy becoming the first high-income country to introduce the vaccine into its national immunisation programme only a year later.

Yet it was 1985 before Zimbabwe became the first developing country to follow WHO's 1992 recommendation that childhood hepB vaccination be included in all immunisation programmes

By 2000, the infection was claiming an estimated 900,000 lives each year, most of them in developing countries. Yet only 22 low-income countries had access to the hepB-containing vaccine.

Gavi support offers poor countries access to Hepatitis B

Eligibility criteria

As soon as Gavi was established in 2000, hepatitis B (hepB) became one of three 'underused vaccines' immediately made available for routine infant immunisation through its flagship new and underused vaccine programme.

In Gavi's latest 2011 round of applications, any country with DTP3 (three doses of diphtheria, tetanus and pertussis) coverage above 50% (WHO-UNICEF estimates for 2009) was considered for hepB support, as long as the hepB vaccine is not currently part of their routine immunisation programme and funded with government funds. Support is not available for a 'catch-up' campaign.


Initially, Gavi provided support for hepB monovalent. However, in December 2005, the Gavi Board decided to only accept new applications for hepB support through the combination vaccines (eg, tetravalent and pentavalent)

The five-in-one pentavalent vaccine, administered in a three-dose schedule, offers low-income countries the added incentive of providing protection from hepB at the same time as immunising their children against four other diseases: diphtheria, tetanus, pertussis (DTP3) and Haemophilus influenzae type b (Hib).

Pentavalent also brings savings in cost of equipment, delivery and disposal programmmes.

Map of countries approved for Gavi's Hepatitis b vaccine support

Countries approved for HepB support 

Putting hepB vaccine on the agenda

Gavi has helped put the long available but little used hepB vaccine on the agenda of low-income countries. To help health ministries make a case for introducing the hepB vaccine into their national immunisation programmes, Gavi provides WHO recommendations and vaccine introduction guidelines.

Gavi also provided financial assistance to WHO to develop lab surveillance and conduct serosurveys for hepatitis.

WHO recommendations on hepatitis B vaccines

routine immunisation worldwide
2004:first dose within 24 hours of birth in countries where a high proportion of infections acquired perinatally

5 -> 16

From 5 to 16 vaccine manufacturers supplying Gavi – from 1 to 10 based in emerging markets.

2001: 5 vaccine manufacturers - 1 based in an emerging market;
2014: 16 vaccine manufacturers– 10 based in emerging markets.


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