Vaccine utilization rather than disease mitigation is the target. Response to Should Europe have a universal hepatitis B vaccination programme?

BMJ 2013;347:f5187 doi:

Jacob Puliyel

Vaccine utilization rather than disease mitigation is the target
8 August 2013

Including vaccines in the routine immunization programmes of countries has become a kind of fetish with the WHO – disconnected from its purpose of reducing disease. Thus the WHO has recommended Hepatitis B vaccine for all countries. It has recommended that at least 3 doses of the vaccine must be used in each person regardless of whether it is given at birth, in infancy or during adolescence. (1) Vaccinating adolescents does not prevent chronic hepatitis B infection in children due to vertical transmission from mother to child, nor child to child horizontal transmission. It appears that the WHO is appeased as long as 3 doses of the vaccine are consumed per person.

7700 new cases of chronic hepatitis B infection are detected each year in the UK. Only 300 of these are infections are acquired in the UK, whereas the remaining 7400 are identified in persons entering the country from other countries. (2) Vaccinating 700,000 newborns at a cost of £21 million each year (3) will, at best, prevent 300 cases of chronic hepatitis.

The UK government has so far adopted a targeted approach to prevent these 300 cases. Testing mothers and vaccinating babies of carriers is particularly effective because otherwise, infected newborn babies have a 90% chance of becoming chronic carriers. Vaccinating other high risk groups is less effective, but they also have a much lower chance of becoming chronic carriers after getting infected.

Unlike universal immunization, this targeted approach will not help consume 2.1 million doses of the vaccine in the UK each year. This may be the problem. Vaccine utilization rather than disease mitigation is the target. It will be interesting to see for how long the UK government’s evidence-based, logical approach, can survive against the onslaught demanding mindless conformity with WHO guidelines.

1. WHO Prevention and control of hepatitis infection; framework for global action, 2012. /hepatitis/en/index.html.

2. Pollard AJ Hepatitis B vaccination BMJ. 2007;335(7627):950.

3. News extra. Foundation calls for universal hepatitis B vaccination in UK infants. BMJ 2004;329:.940.8