Time for a bold advance to defeat hepatitis B

National Adult Hepatitis B Vaccination Awareness Day was designated by the U.S. House and Senate on April 30, 2019, to raise awareness of the public health threat of hepatitis B and the urgent need for widespread adult vaccination. Two years later, much work remains in our nation’s efforts to scale up vaccination against a silent epidemic that is leaving millions of lives at risk. 

For too long, our nation has fallen short in addressing the ominous danger of hepatitis B. A viral infection spread through contact with infected blood or other bodily fluids, hepatitis B can be a silent and insidious killer. A newly released study from the Hepatitis B Foundation estimates that about 2.4 million U.S. residents may be infected with the disease. Hepatitis B is the leading cause of cirrhosis and liver cancer — debilitating diseases that take the lives of nearly 30,000 Americans annually. Since chronic hepatitis B can take up to 30 years to show symptoms, the virus can slowly damage a person’s liver without them knowing. Only one out of five persons diagnosed with liver cancer survives beyond five years.

Hepatitis B has converged with our nation’s escalating opioid crisis to create an even greater risk to our adult population. The increasing rate of unsafe injection drug use throughout the U.S. is fueling a rise in new cases of acute hepatitis B, particularly among adults 30 years and older because they were not vaccinated as children, according to the U.S. Department of Health and Human Services (HHS).

Why are we tolerating the severe consequences of hepatitis B when we actually have the tools to eliminate this potentially fatal virus? Hepatitis B is vaccine-preventable. Safe and effective vaccines have been available for four decades and are the basis of our nation’s quiet hepatitis B elimination strategy. Unfortunately, this strategy has been a slow bottom-up approach, focused on vaccinating all children who will take their immunity with them when they reach adulthood. In contrast, after the age of 19, hepatitis B vaccination recommendations are risk-based: Only those in a list of high-risk groups, such as people with diabetes, are eligible to receive the vaccine. It is acknowledged that doctors and nurses cannot keep a long list of vaccine-eligibles in mind, so the majority of eligible adults go unvaccinated.

Both the increasing rate of hepatitis B infection — exacerbated by the opioid crisis — and the current low vaccination rate among adults are stark indicators that our existing hepatitis B vaccination strategy is not just outdated; it’s failing badly. Today, 75 percent of adults in the U.S. remain unprotected against hepatitis B, many of whom were born before the vaccine became a routine health care standard among children. The universal immunization of children has been a great success, essentially eliminating the infection among persons under the age of 19. The path forward requires a long-overdue health policy reset that also extends this benefit of prevention to all adults.

In June, the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) will again convene to continue its ongoing dialogue on a range of critical topics in our national vaccine policy. Among the major public health issues on the ACIP’s radar is an important question: Should all unvaccinated adults receive hepatitis B vaccination?

Count me among the many public health professionals who believe a policy shift by the ACIP toward universal hepatitis B vaccination for adults beyond the age of 19 is needed. A new policy recommendation by the ACIP would have powerful implications for public health. It would help address the low hepatitis B vaccination rate and consequently protect more adults from the deadly risk of liver cancer. In that sense, we would be maximizing the true potential of the hepatitis B vaccine as the world’s first anti-cancer vaccine.  

Moreover, a firm recommendation from the ACIP would create consensus around a renewed collective determination to truly eliminate hepatitis B. Doctors would likely align behind universal hepatitis B vaccination as the new standard of care. An expanded ACIP policy would also facilitate greater accessibility to the hepatitis B vaccine by ensuring its coverage by both private health insurers and government-financed vaccination programs. Enhanced access would be a real game changer in the fight to eliminate hepatitis B.

I am encouraged by the ACIP’s initial discussions from earlier this year and look forward to continued progress. Ensuring that every adult is vaccinated against hepatitis B is a bold advance our nation needs to save lives. 

William Schaffner, MD, is professor of preventive medicine and the Department of Health Policy and a professor of medicine at the Division of Infectious Diseases at Vanderbilt University School of Medicine.