Ghana continues its efforts to introduce the hepatitis B birth dose vaccine in 2026 while the United States removes the same immunization from its recommended childhood vaccination schedule, highlighting divergent approaches to public health policy across nations.
Charles Adjei, Executive Director of the Hepatitis Alliance of Ghana, expressed confidence that the national immunization campaign will launch in 2026 despite a delayed September 2025 rollout. The vaccine targets mother-to-child transmission of hepatitis B, a virus that causes approximately 14,000 deaths annually in Ghana and infects nearly one in ten Ghanaians with chronic disease.
The Centers for Disease Control and Prevention (CDC) reduced the number of vaccines recommended for all American children on 6 January 2026, removing the three-dose hepatitis B series typically first given at birth. United States Health Secretary Robert F. Kennedy Jr. has questioned the safety and efficacy of the newborn dose, linking an ingredient to autism without citing evidence. According to a Department of Health and Human Services memo released on 3 January, 20 peer nations except Denmark and Finland recommend all children receive the hepatitis B vaccine, either at birth or later in life.
Ghana’s vaccination journey reflects decades of advocacy led by health professionals, civil society organizations, and an unexpected champion: renowned hiplife rapper Kwame Nsiah-Apau, known by his stage names Okyeame Kwame and Rap Doctor. The 49-year-old artist has partnered with health groups for years to raise awareness about hepatitis B patients and reduce stigma surrounding the disease.
Adjei’s organization began amplifying calls in 2015 to prioritize the birth dose vaccine. The sustained advocacy eventually reached the Global Alliance for Vaccines and Immunization (Gavi), the organization that funds immunizations for lower-income countries. In 2018, Gavi’s board agreed to start supporting hepatitis B birth doses in 2021, but the COVID pandemic stalled those efforts.
Ghana has maintained a robust vaccination program since 2002 using the pentavalent vaccine, which protects against hepatitis B and four other infections. The country achieved coverage rates as high as 95 percent, with consistent maintenance of DPT one and DPT three coverage above that threshold. However, the pentavalent vaccine is first administered at approximately one month of age, often too late to prevent transmission that typically occurs during birth or in the uterus.
Studies estimate that even a seven-day delay in vaccination can increase the risk of infection ninefold. Research from Sierra Leone found that more than half of children with hepatitis B had received the three-dose pentavalent series yet still contracted the infection, demonstrating the critical importance of the birth dose administered within 24 hours.
Dr. Yvonne Ayerki Nartey, a physician based in Cape Coast who conducts hepatitis B research, emphasized the urgency of closing the protection gap. She noted that babies must be protected immediately at birth to prevent mother-to-child transmission, which poses risks ranging from 10 percent to 90 percent depending on the severity of the mother’s infection. Approximately 95 percent of infants who contract the virus develop lifelong chronic infections.
The birth dose vaccine demonstrates effectiveness rates between 75 percent and 95 percent in preventing transmission from infected mothers. About a quarter of infants gain lifelong protection from a single shot alone, while follow-up doses strengthen immunity. The second dose confers long-term protection to approximately two-thirds of babies, with the third raising that figure to 95 percent.
Dr. Samuel So, a surgeon specializing in hepatitis B at Stanford Medicine who treats patients with liver cancer caused by the virus, described the American policy change as damaging to the CDC’s reputation. He noted that transmission patterns differ significantly between nations. While unprotected sex and injection drug use drive transmission in the United States, mother-to-child transmission represents a particularly dangerous route in countries like Ghana when birth dose protection is absent or delayed.
Ghana received approval from Gavi in 2024 to co-purchase mass quantities of the birth dose vaccine. Gavi CEO Dr. Sania Nishtar announced in May 2025 that vaccines would arrive in Ghana by September 2025, alongside the introduction of the human papillomavirus (HPV) vaccine targeting cervical cancer prevention. The government committed to introducing the hepatitis B birth dose by the end of 2025 with Gavi’s support, but the September rollout did not materialize.
Implementation faces significant logistical challenges. The vaccine must be administered within 24 hours of birth, but more than one-fifth of births in Ghana occur outside hospital settings. Additionally, many mothers remain unaware of their infection status because testing access is limited, and hepatitis B sometimes presents no symptoms. Some pregnant women reportedly pay for testing services that should be free.
Economic constraints compound these difficulties. Ghana’s health budget remains squeezed by inflation and debt, with the country maintaining one of the lowest levels of health spending as a share of Gross Domestic Product (GDP) worldwide at approximately $82 per person. Before Gavi’s involvement, the birth dose would have cost patients $3.50 per dose compared to the free pentavalent vaccine.
Gavi initially declined to fund the birth dose because the organization co-finances vaccines through a process where countries typically pay at least 20 cents per dose. When the newborn vaccine cost just 20 cents, countries would have paid the full price without Gavi subsidies. By 2014, Gavi decided to focus limited resources on other high-impact vaccines, leaving Ghana without external support for the birth dose program.
The alternative intervention involves a shot of concentrated hepatitis B antibodies providing temporary instant protection, but this costs approximately $50, an insurmountable expense for Ghanaians earning an average of $240 monthly. Health programs do not widely cover this treatment.
From January to July 2025, the Hepatitis Foundation of Ghana led a nationwide advocacy and awareness initiative supporting birth dose implementation. Activities included a National Stakeholders’ Forum mobilizing commitment from the Ministry of Health, Ghana Health Service, professional associations, civil society, and media. The organization developed educational materials distributed through social media platforms and conducted mass media advocacy through radio and television programs.
A December 2025 Stakeholders’ Forum marked a transition from planning to action, aligning with Ghana’s triple elimination goals for HIV, syphilis, and hepatitis B by 2030. Discussions covered prevalence data, vaccine administration protocols, data systems, awareness campaigns, and collaborative approaches to ensure universal newborn coverage. Cascade training programs were implemented to prepare healthcare workers from national to community levels.
Health Minister Kwabena Mintah Akandoh welcomed Gavi’s endorsement, emphasizing the significance of new vaccines in strengthening Ghana’s public health system. He acknowledged that Gavi’s support will not continue indefinitely, describing the eventual transition as a sign of national growth. Ghana aims to transition from Gavi aid by 2030, requiring increased national ownership of immunization financing.
The World Health Organization (WHO) recommended in 2009 that all countries administer the hepatitis B vaccine at birth, updating previous guidance from 2004. Currently, 14 countries in sub-Saharan Africa, including Gambia and Nigeria, have rolled out national birth dose programs. However, these nations have achieved birth dose coverage rates of only approximately 17 percent, according to recent data.
Adjei expressed frustration with delays despite clear mortality figures from the vaccine-preventable condition. He described years of reminding government officials about the need for prioritization, stating that advocates became exhausted and angry at times. Nevertheless, he maintains optimism that the extended battle will eventually succeed, supported by a global community of hepatitis advocates extending assistance despite being based outside Africa.
Okyeame Kwame shares that optimism and stands ready for government calls to assist with the new campaign. He described the effort as a coalition working together to curate unified messaging, emphasizing that all parties must join forces to push hepatitis into elimination.
Concerns about Gavi’s future funding add uncertainty to the program. With funding dollars already reduced, advocates worry the newborn hepatitis B vaccine might face cuts. However, Gavi continues planning ahead to maintain support for participating countries.
Nartey continues envisioning a Ghana free from hepatitis B, finding satisfaction in efforts to reduce the burden of the largest cause of cancer mortality in the country. She expresses hope seeing vaccinated infants, knowing they will not face death from preventable disease. The physician emphasizes that even countries with established birth dose programs continue struggling with implementation challenges, underscoring the complexity of achieving universal coverage.
The Ghana Health Service declined to provide updated information about the current status of the vaccination rollout. Meanwhile, public health experts in the United States attribute more than 1,800 deaths to hepatitis B annually, with the CDC estimating 20,700 new infections each year in a nation that has now removed the birth dose from its recommended childhood immunization schedule.
