Misinformation, Access Gaps Threaten Hepatitis B Elimination Goals

Misinformation, inadequate patient and provider education, and systemic access barriers are the central obstacles preventing the US from meeting hepatitis B virus (HBV) elimination goals for its chronically infected adult population, even as the nation nears elimination benchmarks in children.

While infant vaccination has driven a 99% reduction in pediatric HBV infections,¹ shifting federal guidance, persistent treatment gaps, and structural inequities are putting that progress at risk and leaving the adult chronic disease burden largely unaddressed.

Where the US Stands on Elimination

In December 2025, the Advisory Committee on Immunization Practices (ACIP) voted to allow shared clinical decision-making on whether to administer the hepatitis B birth dose to infants born to HBV-negative mothers, moving away from universal birth-dose guidance for the first time in more than 30 years.² The CDC formally adopted the change on December 16, 2025.³

A comprehensive review published in Pediatrics in early 2026 reaffirmed the vaccine's safety and efficacy at birth, finding no serious adverse events attributable to neonatal vaccination and warning that when vaccines move from universal to optional, coverage rates frequently decline and the decline is often permanent.¹

For adults living with chronic HBV, the gaps are more acute. Helen Nde, MPH, data and project management consultant at the Center for Disease Analysis Foundation, said the work that remains is concentrated in the chronically infected population, particularly around reaching the mortality reduction targets embedded in elimination goals.

"I believe that is where work needs to be done and [ties into] misinformation about the virus—patients not being clear about whether or not they need to be on treatment, or if they know that they need to be on treatment, then clearing the hurdles for access to care," said Nde.

Why Treatment Gaps Persist

Those hurdles are well documented. A cross-sectional study published in JAMA Network Open in November 2025 found that among US patients eligible for HBV treatment, only about 25% received it.⁴ The study, which used data from approximately 75.2 million patients across 56 health care organizations, also found that treatment odds were lower for Black patients and women of reproductive age and that women of childbearing age with untreated HBV face an unaddressed risk of mother-to-child transmission. The researchers concluded that clinician education on HBV management and targeted interventions to address treatment disparities are urgently needed.

Chronic HBV treatment, as Nde described it, is a substantial long-term commitment. Daily antiviral therapy is required indefinitely, with annual or biannual blood tests and periodic liver imaging to monitor disease progression. For patients with limited health insurance, inconsistent access to transportation, or constrained work schedules, those requirements create compounding barriers that can derail engagement with care at multiple points.

The stakes are high. Chronic HBV infection carries a 10% to 25% lifetime risk of hepatocellular carcinoma, and untreated disease is linked to higher rates of all-cause and liver-related death.⁴ Globally, HBV kills more than 800,000 people each year.

"This is a disease that kills over 800,000 people every year, but it has a highly effective and relatively affordable vaccine, and it has a treatment that is effective," Nde said. "If you know what you need to do and your provider knows what needs to be happening, then there is a way forward for you."

Education as the Linchpin

Nde and a growing body of public health evidence converge on the same conclusion: Education at the patient, provider, and systems levels is what stands between current gaps and meaningful progress. The World Health Organization (WHO) has emphasized that most people living with chronic hepatitis are unaware of their infection and that testing and early diagnosis are critical precisely because they unlock access to life-saving treatment and liver cancer prevention.⁵

The shift in federal vaccination guidance makes that educational imperative even more urgent, Nde argued. Even absent a universal recommendation, informing patients and providers about what is at stake with HBV, including its role as a cancer-causing virus and its link to liver cancer, could be what drives uptake.

"Whatever the recommendation context might be, education—educating providers, educating people who are at risk—would be the game changer," Nde said.

The WHO's 2026 Global Hepatitis Report cited more than 4900 new HBV and hepatitis C virus infections globally each day in 2024, underscoring that 2030 elimination targets remain out of reach without accelerated institutional action.⁶

Nde remained cautiously optimistic, noting that dedicated providers and patient navigators willing to do door-to-door outreach in underserved neighborhoods demonstrate that progress is achievable, even if the scale of the work is significant.

"We know what the problems are; they are well studied, well documented," she said. "It's a huge lift, but it's not insurmountable."

References

1. Ulrich AK, Fleming DF, Smith EA, et al. Hepatitis B vaccination at birth: safety, effectiveness, and public health benefit. Pediatrics. Published online February 5, 2026. doi:10.1542/peds.2025-075783

2. Halpern L. ACIP votes to end universal hepatitis B vaccination recommendation for infants. Pharmacy Times^®. December 5, 2025. Accessed June 16, 2026. https://www.pharmacytimes.com/view/acip-votes-to-end-universal-hepatitis-b-vaccination-recommendation-for-infants

3. Fact sheet hepatitis B immunization. CDC. December 16, 2025. Accessed June 16, 2026. https://cdc.gov/media/releases/2025/fact-sheet-hepatitis-b-immunization.html

4. Wong RJ, Telep LE, Wentworth CE, et al. Hepatitis B virus treatment gaps in the US. JAMA Netw Open. 2025;8(11):e2542744. doi:10.1001/jamanetworkopen.2025.42744

5. World Hepatitis Day 2025. World Health Organization. Accessed July 25, 2025. http://who.int/campaigns/world-hepatitis-day/2025

6. Efforts to eliminate hepatitis deliver gains but more action needed to meet 2030 targets. News release. World Health Organization. April 28, 2026. Accessed June 16, 2026. https://www.who.int/news/item/28-04-2026-efforts-to-eliminate-hepatitis-delivers-gains-but-more-action-needed-to-meet-2030-targets