Global HepB3 Coverage Reaches 81.8%, but Regional Gaps Persist

aGlobal coverage of the third dose of the hepatitis B vaccine (HepB3) increased from near zero in 1980 to 81.82% in 2023, but some countries continue to fall well short of the World Health Organization (WHO) 90% coverage target recommended for disease elimination, according to a recent analysis published in Human Vaccines & Immunotherapeutics.¹

Understanding Global Trends in HepB3 Vaccine Coverage

Since the launch of the WHO’s Expanded Programme on Immunization in 1974, childhood immunization has contributed to substantial declines in morbidity and mortality from vaccine-preventable diseases. Therefore, vaccines have saved millions of lives, reduced health care costs, improved child survival, and supported herd immunity by both limiting disease transmission and protecting vulnerable populations.

Among routine vaccines, hepatitis B vaccination prevents chronic hepatitis B virus infection and its long-term complications, including cirrhosis, liver failure, and hepatocellular carcinoma. Completion of HepB3 in infancy is considered a key indicator of immunization system performance, reflecting sustained access to health care services and adherence to vaccination schedules.

Despite decades of progress, global HepB3 coverage remains below the 90% target needed for disease elimination, with substantial disparities across and within countries due to health care access barriers, socioeconomic inequalities, conflict, vaccine hesitancy, and disruptions from the COVID-19 pandemic.

To better understand the HepB3 vaccine coverage gaps, investigators analyzed global and regional spatiotemporal trends from 1980 to 2023. They used the Global Burden of Disease (GBD) 2023 estimates, which determined HepB3 vaccine coverage in 204 countries and territories during that time period.

Early Gains in HepB3 Vaccine Coverage Have Slowed Worldwide

Using the GBD 2023 estimates and linear mixed-effects regression to account for repeated country-level observations, the researchers found that HepB3 vaccine coverage increased by an average of 2.50% annually from 1980 to 2023 (95% CI, 2.41%-2.59%; P < .0001).

Specifically, coverage was essentially flat through the early 1980s, consistent with the limited commercial availability of recombinant hepatitis B vaccines before 1986. The steepest gains followed the 2000 launch of the Global Alliance for Vaccines and Immunization and the rollout of the pentavalent combination vaccine in low-income countries. By 2002, median coverage had reached 71.75%, meaning more than half of all countries had achieved high coverage, defined as levels above 70%.

However, progress then plateaued. From 2011 through 2023, the global mean fluctuated between 78.6% and 82.1%, suggesting that the strategies that drove early gains, primarily donor financing and vaccine introduction, have not been sufficient to close remaining gaps. By 2023, 171 countries (83.8%) were classified as high coverage, 26 (12.7%) as moderate, and 7 (3.4%) as low.

Albania had the highest mean coverage at 98.2% over 30 years of data, reflecting a well-funded, centralized immunization program. By contrast, Somalia's 14.0% mean coverage over 11 years reflected the cumulative effects of prolonged armed conflict, the collapse of health infrastructure, and persistent poverty.

Notably, 4 high-income countries, namely Denmark, Finland, Hungary, and Iceland, recorded 0% coverage throughout the study period, which the authors attributed to possible data gaps or deliberate policy decisions against universal HepB3 vaccination given the low endemic disease burden, a reminder that coverage gaps are not exclusively a function of resources.

Looking more broadly, by continent, Asia recorded the highest average coverage in 2023 at 86.7% (median, 92.5%), whereas Africa had the lowest average coverage at 76.5% (median, 82.0%). Only 15 of 47 WHO African region member states had adopted universal hepatitis B birth-dose programs as of 2022; the researchers emphasized that this is especially worrisome given the continent's disproportionate burden of hepatitis B.

Of the 51 African countries assessed, only 6 were projected to be on track to meet the 90% target by 2030: Rwanda, Eritrea, Eswatini, Burkina Faso, Zimbabwe, and Niger. This may be due to persistent structural barriers such as inadequate cold chain infrastructure in Africa, high rates of out-of-facility births, and shortages of skilled birth attendants.

US Policy Shifts Contrast With Global Recommendations

The study arrives as US hepatitis B vaccination policy moves in the opposite direction of its core recommendation to strengthen, rather than loosen, immunization systems. In December 2025, the Advisory Committee on Immunization Practices voted to shift the newborn hepatitis B birth dose from a universal recommendation to shared clinical decision-making between provider and parent, a change the CDC formally adopted that same month.²

Public health researchers have warned that coverage declines following a shift from universal to optional vaccine recommendations are often difficult to reverse, a concern that echoes the current study's finding that sustained political commitment, not just initial vaccine introduction, separates high- and low-performing immunization programs.¹

The stakes of that infrastructure were also illustrated in a separate cohort study, which linked childhood hepatitis B vaccination to lower rates of hepatitis B virus coinfection decades later among people living with HIV, crediting routine childhood immunization programs for that protective effect.³ Taken together, the domestic and global data point to a common variable: sustained investment and policy consistency, rather than vaccine availability alone, appear to determine whether coverage gains hold.

Findings Support Targeted Strategies to Close HepB3 Coverage Gaps

The authors acknowledged several limitations of their study, including that the analysis relied on estimates from the GBD 2023 dataset rather than primary country-level surveillance data¹; the quality and accuracy of the estimates depend on the availability and completeness of underlying data sources, which vary considerably across settings. Also, because the study focused on national-level estimates and did not examine subnational variation, within-country disparities in HepB3 vaccine coverage may have been masked.

Still, they suggested ways to improve HepB3 vaccine coverage based on their findings. Specifically, the authors called for accelerated introduction of hepatitis B birth-dose vaccination across Africa, targeted outreach in low-coverage districts, and integration of hepatitis B vaccination with maternal and child health services. To sustain progress toward the WHO's 2030 elimination goal, they also emphasized the need to strengthen vaccine confidence through culturally appropriate communication strategies that address misinformation, alongside continued international financing partnerships.

“Sustained commitment from national governments, global health institutions, and development partners will be essential to ensure that every child, regardless of geography or circumstance, benefits from the life-saving protection afforded by hepatitis B vaccination,” the authors concluded.

References

1. Akingbola A, Adegbesan A, Benson EA, et al. Global spatiotemporal analysis in hepatitis B third dose vaccine coverage from 1980-2023 across 204 countries and territories. Hum Vaccin Immunother. 2026;22(1):2709267. doi:sl
2. Joszt L. Misinformation, access gaps threaten hepatitis B elimination goals. AJMC^®. June 18, 2026. Accessed August 7, 2026. https://www.ajmc.com/view/misinformation-access-gaps-threaten-hepatitis-b-elimination-goals
3. McCormick B. Childhood hepatitis B vaccination tied to lower coinfection in patients with HIV. AJMC. July 31, 2026. Accessed August 7, 2026. https://www.ajmc.com/view/childhood-hepatitis-b-vaccination-tied-to-lower-coinfection-in-patients-with-hiv