Hepatitis B vaccine at birth – GAVI responds to MSF

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GAVI responds to Médecins Sans Frontières and civil society organisations' open letter

Geneva, 20 June 2014 - The GAVI Alliance shares recently published MSF concerns about the slow implementation of the WHO recommendation to deliver a dose of hepatitis B vaccine immediately after birth. 

WHO estimates that hepatitis B causes around 260,000 deaths each year in GAVI-eligible countries, mostly in older men. Thanks to GAVI’s support for infant hepatitis B vaccination since 2000 - now included in the pentavalent vaccine and in routine use in 72 of 73 GAVI-supported countries - this number is expected to fall significantly in the future.

GAVI agrees that greater use of a birth dose of hepatitis B vaccine would be valuable in line with the WHO recommendation.  Therefore, the Alliance recently re-assessed the relative value of GAVI financial support for birth dose hepatitis B vaccine as part of the new Vaccine Investment Strategy. This evaluated fifteen vaccines looking at relative value of and feasibility of GAVI support. Based on these analyses and extensive consultations, the GAVI Board decided not to pursue offering financial support for countries wishing to introduce birth dose hepatitis B vaccine.  A detailed analysis is available on this page.

The key points that factored into the decision were:

  • Consultations with experts and stakeholder highlighted implementation challenges as the primary barrier to adoption, rather than price of the vaccine.
  • The cost per dose of hepB birth dose is around $0.20, which is equivalent to the minimum amount of co-financing that all GAVI-eligible countries contribute to GAVI-supported vaccines.
  • A key driver of uncertainty in estimating the impact of a possible investment in hepatitis B birth dose was the coverage that can be achieved within the narrow window of 24 hours after birth for institutional births. Many births in GAVI-eligible countries do occur outside health facilities. Indeed, coverage of hepatitis B birth dose in many countries delivering this intervention is low.

Although GAVI is not providing direct financial support for the birth dose hepatitis B vaccine, as the Investment Strategy analysis and consultations concluded that the Alliance should focus its limited resources on other high-impact vaccines, GAVI would be very pleased to discuss how we might collectively work to encourage greater use of the vaccine.  GAVI would also hope that such discussions could be channelled through the CSO mechanism already established by the GAVI Board.

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