Uganda rolls out the hepatitis B birth dose vaccine, to protect the youngest and most vulnerable
Hepatitis B is far more likely to turn chronic if the infection is contracted at birth, and mother-to-child transmission is common in highly-endemic regions. But the birth dose vaccine can block that pathway.
- 31 October 2025
- 6 min read
- by John Musenze
Sarah Ankunda, 28, is battling chronic hepatitis B. She recalls how a simple test administered at a university health camp in 2019 changed her life.
“We went for voluntary testing because they offered vaccinations, and many health check-ups,” she recalled in an interview with VaccinesWork. “When the results came out, I had tested hepatitis B-positive. I did three more confirmatory tests including one in a big government hospital, but all were positive.”
Ankunda’s first instinct was to question how she had contracted the virus. She had never fallen sick, and had had a sexual relationship with just one person.
“Science says hepatitis B is majorly sexually transmitted, so I thought my boyfriend was responsible,” she admitted. “I even forced him to test, but he was negative. That’s when I realised this wasn’t as straightforward as I thought because he was the only man I had slept with entirely.”
“If I did not get it sexually, doctors have told me I might have gotten it during birth,” she explains. In fact, mother-to-child transmission during birth is the most common way the virus spreads in highly endemic parts of the world. It’s also one of the most dangerous routes of transmission, because young children are at far higher risk of developing chronic infection following exposure, than adults.
“Luckily, my viral load is okay [because] the virus has been suppressed, that is why I cannot transmit it to anyone I sleep with. But the burden goes beyond that,” says Ankunda.
Living with Hepatitis B goes beyond just liver damage and illness. For many, it’s associated with expensive treatments and social discrimination. This is exactly what Ankunda is battling with.
“I have lost my marriage because the man who was ready to marry me left the moment I disclosed to him my status. We had even set dates. Many organisations locally do not employ hepB positive workers so I live in fear at every work I get. I missed out getting an international job abroad because the health requirement was to be hepB negative,” she said. Testing to satisfy workplace requirements can also be costly, as can treatment. “Many hospitals, including government ones, do not have treatment plans for hepB patients. In government hospitals, results can take months,” she explained.
Safe from day 1
With Uganda launching the hepatitis B “birth dose” – a dose of the vaccine given within the first 24 hours of life – as part of the national routine immunisation programme this September, Ankunda hopes the next generation will not have to endure what she has faced.
“Our mothers never had this chance, never had the vaccines and this knowledge, but we do,” she urged. “The best a mother can [do] is to never leave a hospital without getting this dose now that its fully available. This is the only way to stop the pain and stigma I’ve gone through. We can have a hepatitis-free Uganda if we use this opportunity.”
That would represent a colossal stride forward. According to the World Health Organization, in 2022, some 1,250 Ugandans died of hepatitis B complications, and around 6% of Uganda’s population remains chronically infected with the virus.
Alice Aloyo, a 50-year-old former village health worker (VHW) and a resident of Acholi Bur in Pader District, is likewise filled with optimism that future generations of her family will not endure the same heartbreak she has suffered, having lost her mother and two siblings to hepatitis B.
“My brother did not live long because he had the virus, and was taking both alcohol and smoking. We did not have a vaccine by then, and we stayed far from the hospital, so getting treatment was hard for any of them.”
Even information about hepatitis was hard to come by back then, Aloyo says, and many understood the virus’s danger only after it had killed their loved ones.
“The adult vaccination is costly – around $50 – and for children it’s free. Treatment is very expensive and it’s not at every hospital, so if one has the disease, they suffer a lot. I have instructed my daughter-in-law to vaccinate my grandson and I am confident he is safe. My daughter in-law feels happy too.”
Hardest on the youngest
According to Anthony Bateyo, a Senior Nursing Officer and Hepatitis B Focal Person at the Ministry of Health’s National Hepatitis Programme, hepatitis B is particularly devastating in children under five, because the infection is largely asymptomatic during the acute phase. When symptoms do appear in the acute phase, these tend to mimic common childhood illnesses such as malaria, leading to frequent misdiagnosis.
And up to 95% of infected children in this age group progress to chronic hepatitis B, he explains – compared to just 5% of adult infections.
Chronic disease is defined by persistent hepatitis B surface antigen positivity for more than six months. It is this chronic stage that eventually leads to liver cancer and cirrhosis, both of which impose a heavy clinical and economic burden on families and the health system.
Vaccination is already paying off
But vaccination is already making a difference in Uganda’s youngest cohort, Bateyo said. The introduction of the three-dose pentavalent vaccine in 2002, which includes the hepatitis B antigen, reduced the virus’s prevalence among children, he said.
“Vaccination has been transformative. Without it, we would be registering far higher hepatitis B infection rates among children.
“However, the major transmission route among under-five-year-old children today is mother-to-child, and this is where the hepatitis B birth dose becomes a critical intervention. It’s a game changer in preventing infections occurring between birth and six weeks, a point at which pentavalent vaccine starts to be given,” he noted.
Bateyo underscores that the birth dose administered within 24 hours is essential because it interrupts perinatal transmission which is the leading cause of chronic hepatitis B in Uganda. He added that after the birth dose, all children should be taken back to the nearby health facility or immunisation outreach at 6, 10 and 14 weeks to receive the three doses of pentavalent vaccine.
“The hepatitis B birth dose is the most powerful shield we have in the first hours of life. If Uganda scales up coverage to 95%, we have a realistic pathway to eliminate the hepatitis B epidemic by 2030,” Bateyo noted with conviction.
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Need for widespread screening
At the launch of the national birth dose programme in Pader district, northern Uganda on September 5 2025, Acting District Health Officer Benson Opiyo called on residents to get screened.
Pader is one of the hardest-hit areas in Uganda and still, the majority of population are unaware of their status, he said. Recent community outreaches in the district had screened over 5,300 people and returned 244 positives.
“Fifty percent of the positive cases were female and 49% were male, mostly aged between 24 and 40. Many of the people are silently living with this disease, and they are unaware. Hepatitis is silently progressing and will cause damage to their liver that may progress to death,” he warned.
“It’s been hard for us to go to the field so this birth dose will help us in prevention,” he added, noting that Pajule Health Centre IV – the major health facility in the area – sees 120 births a month.
Health Minister Jane Ruth Aceng addressed residencts at the same event. “Prevention is the way to go,” she said. “The eastern region is at 4.8% [prevalence], western region is at 2.6%, and yet the national prevalence is at 4.4% – so that means that Northern Uganda has to put in extra effort to bring down the prevalence of this public health problem.”
The campaign, which began with 200,000 doses from Gavi, was initiated in Northern Uganda where the burden is the highest, reaching 9%, according to the health ministry.
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