World Hepatitis Day is marked on 28 July. It is one of only four days dedicated to a specific infectious disease by the World Health Organisation (WHO).

Of the five types of viral hepatitis (named alphabetically: hepatitis A, B, C, D and E), hepatitis B in particular is a serious public health problem in sub-Saharan Africa.

What makes hepatitis B different is that we can prevent it with a safe and effective vaccine. Combatting viral hepatitis is one of the United Nations Sustainable Development Goals. WHO has a widely accepted plan to eliminate viral hepatitis as an important public health threat by 2030. This will require governments, public health officials, funders and civil society to prioritise this disease.

Worldwide 257 million people have chronic hepatitis B infection. The disease is responsible for 880 000 deaths each year, an impact greater than that of tuberculosis, malaria or HIV. Sub-Saharan Africa and Asia carry the highest burden of disease. Although it rarely kills children, infection early in life tends to become chronic, causing problems such as liver cancer later in life. Mortality is seen in young men and women, the parents of young children and the breadwinners for young families, at the most economically active time of their lives. 

Most chronic hepatitis B infections occur because of infection at birth – through mother-to-child transmission – or in early childhood. The vast majority of infections can be prevented by vaccinating infants within 24 hours of delivery (HepB-BD vaccine), followed by further doses of vaccine over the next months. Even though HepB-BD vaccine is highly cost-effective, the reality is that we have failed to make this vaccine available to the infants who need it – only 11 (20%) of 54 African countries offer the HepB-BD vaccine, and only 10% of African babies receive the vaccine within 24 hours of birth.  

From April 2019, HepB-BD vaccination was implemented in South Africa and we should celebrate this. Modelling studies suggest that this will reduce perinatal HBV infections by 60%, at a cost of less than R11 per infant vaccinated. 

Today, while we celebrate this success, we should be cognisant of the impact that this highly prevalent disease continues to have on our continent. We need to continue to encourage the changes in policy needed to make HepB-BD vaccine a reality in all of Africa, and to ensure the elimination of mother-to-child transmission of hepatitis B.