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In a significant shift that has sparked controversy, the Centers for Disease Control and Prevention (CDC) has reduced the number of vaccines recommended for U.S. children, removing the hepatitis B vaccine from its list. This decision comes at a time when many countries are intensifying efforts to secure this vital vaccine, which is crucial for preventing a virus that devastates the liver.

Health Secretary Robert F. Kennedy Jr. has long questioned the safety and efficacy of the newborn dose of the hepatitis B vaccine, even making unfounded links to autism. Last month, he described the U.S. as a "high outlier" in terms of immunization recommendations, a rationale used to justify the removal of the hepatitis B vaccine from newborn protocols. However, a memo from the Department of Health and Human Services indicates that 20 peer nations, excluding Denmark and Finland, recommend that all children receive the hepatitis B vaccine either at birth or later in life.

In the United States alone, public health experts attribute over 1,800 deaths annually to hepatitis B. "It's just really sad," says Dr. Samuel So, a surgeon specializing in hepatitis B at Stanford Medicine, who treats patients with liver cancer caused by the virus. "This has done so much damage to the reputation of the CDC." Experts warn that this change will likely lead to a decrease in vaccination rates among children.

Meanwhile, countries like Ghana are racing against time to secure life-saving vaccines. With nearly one in ten Ghanaians suffering from chronic hepatitis B and about 10,000 new infections reported each year in the nation of 35 million, the stakes are high. The CDC estimates that the U.S. sees around 20,700 new infections annually, emphasizing the global nature of the hepatitis B crisis.

The risks associated with the virus can lead to severe health complications, including cirrhosis and liver cancer. In Ghana, deaths from complications of hepatitis B have surged, with 14,000 fatalities recorded in 2022 alone. "The cost that it brings onto the patient themselves, their family, and the health system is quite huge," explains Charles Adjei, the executive director of the Hepatitis Alliance of Ghana, noting the financial burdens of out-of-pocket treatment costs that many families face.

The silent spread of hepatitis B is particularly alarming in regions like Ghana, where mother-to-child transmission remains a significant challenge. "It's a big misconception that you only get hepatitis B from using drugs or unprotected sex," Dr. So clarifies. The risk of transmission to infants born to infected mothers ranges from 10% to 90%, and about 95% of infected infants will carry the virus for life. This leads to a lifetime of stigma and health complications, as So indicates: "When the virus flares up, it could cause life-threatening liver disease."

Timely vaccination is vital in reducing mother-to-child transmission. The first dose of the vaccine must be administered within 24 hours of birth, followed by two additional doses for long-term protection. Studies show that this initial jab is the most cost-effective prevention method, with effectiveness rates ranging from 75% to 95%. Unfortunately, despite the World Health Organization's 2009 recommendation for universal newborn vaccination, Ghana has struggled to implement this protocol consistently.

While Ghana has made strides in its national hepatitis B vaccination efforts, achieving coverage rates as high as 95% with the pentavalent vaccine, the critical newborn vaccine is often delayed until around one month of age. This timing is typically too late to prevent infection during birth or in utero, where studies suggest that even a seven-day delay can increase the risk of infection ninefold. "That baby has to be protected right when they're born," says Dr. Yvonne Ayerki Nartey, a physician in Cape Coast, Ghana.

Moreover, the cost of the hepatitis B immunoglobulin shot, which offers only temporary protection, is prohibitive. At $50, it's unaffordable for many families in a country where the average monthly income is just $240. Many mothers are unaware of their hepatitis B status due to limited access to testing, which is often not free, adding another layer of complexity to the fight against the virus.

Ghana faces significant challenges in its battle against hepatitis B. The country has one of the lowest health spending rates in the world at about $82 per person, and the lack of budgetary support hampers the rollout of a newborn vaccination program. "We haven't taken that bold step yet," Adjei states, stressing the need for support from organizations like Gavi, which funds immunizations for lower-income countries but has not historically backed the newborn hepatitis B vaccine.

Despite persistent advocacy efforts, including public pressure and the involvement of cultural figures like Ghanaian rapper Kwame Nsiah-Apau, known as Okyeame Kwame, the path to a national vaccination program has been fraught with delays. Gavi agreed to support hepatitis B birth doses in 2021, but the COVID-19 pandemic stalled those plans. By 2024, Gavi announced funding for newborn vaccines, yet Ghana's government has been slow to act on this initiative.

Though Adjei is cautiously optimistic about the future, noting that the government plans to introduce the vaccine in September 2026, uncertainty looms. "It was very unpleasant, and at a point, it was very irritating," he remarks about the ongoing delays. "You keep on reminding the government almost every day about the need to have this on the priority table." However, he remains dedicated to his cause, believing in the eventual success of a hepatitis B-free Ghana.

As the global community continues to grapple with the hepatitis B epidemic, experts like Dr. Nartey express hope for a future where every child is vaccinated at birth. "It's a good feeling to see that you are doing something to reduce the burden of the largest cause of cancer mortality in your country," she notes. "When I see that they've been vaccinated, I know that they're not going to die."