Vaccine Hesitancy Among the Top Barriers to Hepatitis Eradication


A global review demonstrates the potential depth of the impact of the COVID-19 pandemic on ongoing immunization delay and skepticism.

Hepatitis B virus (HBV) infection remains a significant global health concern, with nearly 300 million individuals chronically infected worldwide. To combat this public health challenge, the World Health Organization (WHO) has set a target for HBV elimination by 2030, emphasizing the importance of achieving 90% infant vaccine coverage. However, ongoing challenges with awareness and misinformation may hinder the agency’s efforts.

There’s no shortage of data demonstrating the effectiveness of the HBV vaccine in preventing infection, but additional benefits from the prevention of chronic infection have also been perceived, with reduced rates of liver failure, cirrhosis, and other related comorbidities. Still, questions have been raised over the past 30 years about long-term protection and vaccine-escape mutants. Many of these fears have been quelled, however, by persistent protection in most populations and most regions and no real ground gained by mutants.

Perhaps the most significant factor recently affecting HBV infection rates and vaccination status is the COVID-19 pandemic, and it’s still really too soon to know just how great of an impact it has had. Several studies have shown a reduction in vaccine confidence or increase in vaccine hesitancy in light of vaccination campaigns for COVID-19. This is apparent not just for the HBV vaccine but also other routine immunizations, with some models showing that a reduction of 20% vaccine coverage in 2020 would be associated with more than 500,000 additional infections of chronic HBV and increased mortality, especially in Africa and the western Pacific region. Although lockdown inhibited transmission in some populations, poor levels of HBV testing and vaccination post-pandemic haven’t helped quell new infections.

A recent update from the CDC showed that new HBV infections declined in 2020 and 2021, with a significant decrease observed in 2020 and an additional 14% decrease in 2021. The authors noted that although the 2 HBV indicators for new infections met the annual target for 2021, “it is difficult to determine to what degree the lower rates are attributable to true reductions in disease burden versus impact of the COVID-19 pandemic on access to health care, hepatitis testing, and health department capacity to perform viral hepatitis case investigations.”

Notably, historical case reports of adverse events, especially that of multiple sclerosis, have had a lasting impact on vaccination in some countries, including France and China. Although these associations have been unfounded, social media, especially through the COVID-19 pandemic, helped fuel the spread of disinformation. Another significant barrier is low birth dose coverage, which also saw an increase during COVID-19 due to vaccine hesitancy. Outside of the pandemic, access to infant vaccination remains a problem in Africa and Asia where maternal transmission is highest. Notably, data collected from populations in the US from 2018 through 2020 showed racial differences in HBV birth dose vaccination, with Asian Americans having the highest rate of vaccination compared with a high degree of vaccine hesitancy seen in African Americans.

“In contrast to COVID-19, there is no biological barrier that reduces the effectiveness of the HBV vaccine,” the authors concluded. “However, many barriers still exist to the effective eradication of this harmful disease, such as vaccine availability, and lack of awareness of the beneficial relationship between the risk of acquiring HBV and the benefits of getting vaccinated, and remaining [vaccine hesitancy].”

Much of this, according to the authors, can be addressed with appropriate education campaigns that have proven instrumental in overcoming vaccine hesitancy in other scenarios. Examples from various countries demonstrate the impact of targeted information dissemination via the internet and social media, particularly in marginalized communities, with cultural sensitivity and addressing language barriers being key to success.


Pujol FH, Toyé RM, Loureiro CL, Jaspe RC, Chemin I. Hepatitis B eradication: vaccine as a key player. Am J Transl Res. 2023;15(8):4971-4983.

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