The silent epidemic: Why adult hepatitis B vaccination in India can't wait

When it comes to hepatitis B, most Indians think of the vaccine as something for newborns and infants. Few realise that the virus—highly infectious and potentially deadly—poses an equal, if not greater, risk to adults who have never been immunised. 

 

And yet, adult vaccination against hepatitis B remains alarmingly low in India, even as the country battles a heavy burden of viral hepatitis and its long-term consequences.

 

India is home to nearly 40 million chronic hepatitis B cases, according to the World Health Organization (WHO). The virus attacks the liver and, in many cases, progresses silently over decades, ultimately leading to liver cirrhosis, failure, or cancer. What makes hepatitis B especially dangerous is that many infected people remain asymptomatic until irreversible damage is done.

 

Despite the scale of the problem, adult vaccination coverage remains marginal. “We see a huge gap in awareness and access when it comes to adults,” says a public health expert familiar with the National Hepatitis Control Programme. “The universal immunisation programme has helped protect children, but once you cross into adulthood, you're largely on your own unless you're part of a high-risk group.”

 

The hepatitis B vaccine was introduced into India’s Universal Immunisation Programme (UIP) in 2002 and expanded nationwide by 2011. Today, it’s given to infants in a three-dose schedule beginning at birth. 

 

Yet, many of those millennials and those adults before them are outside the vaccination net and hence vulnerable to contracting the virus. Especially those adults who fall in high-risk categories, which include healthcare workers, dialysis patients, those with multiple sexual partners, or family members of chronic hepatitis B patients.

 

Yet, there’s little push for catch-up vaccination among adults. Hepatitis B barely features in the adult public health conversation.

 

Part of the issue is a lack of targeted policy. While the National Viral Hepatitis Control Programme (NVHCP), launched in 2018, aims to eliminate hepatitis B and C by 2030, adult vaccination hasn’t received the attention it warrants. 

 

The programme focuses on screening and treatment of chronic infections and on infant immunisation, but stops short of actively promoting adult vaccination.

 

This gap leaves millions of adults at risk. As per a 2022 study published in the Journal of Clinical and Diagnostic Research, more than 30% of Indian healthcare workers surveyed were not vaccinated against hepatitis B. Outside of hospitals, the numbers are likely to be even starker.

 

While a full course of the hepatitis B vaccine is relatively affordable—about ₹100–₹150 per dose in government centres, it is not free for most adults unless they belong to a very specific high-risk group. In rural areas and smaller towns, vaccine access is compounded by logistical challenges and limited awareness among patients.

 

Dr Ameet Mandot, Director, Department of Hepatology and Liver Transplant Medicine, Gleneagles Hospitals Parel, Mumbai, confirms that many adults fail to get vaccinated for hepatitis B, even though it's important for lifelong protection and well-being. "Lack of awareness and not knowing it's needed after childhood are common reasons behind not taking the vaccine. This gap tends to put many adults at risk of serious liver infection. It is the need of the hour to take the vaccine as recommended by the doctor."

 

The global health community recognises hepatitis B vaccination as a key strategy to eliminate viral hepatitis. WHO recommends that all unvaccinated individuals should receive the three-dose hepatitis B vaccine series, especially in countries like India, where the disease burden is high. 

 

The urgency is growing. Hepatitis B remains a leading cause of liver cancer worldwide. According to the paper, 'Global burden of liver disease,' published in PubMed, a medical journal, liver disease accounts for two million deaths annually worldwide, and is responsible for 4 percent of all deaths, that is, 1 out of every 25 deaths worldwide. According to The Liver Foundation, India, HBV is the second most common cause of acute viral hepatitis after HEV in India. With a 3.7% point prevalence, India has over 40 million hepatitis B-infected patients (second only to China) and constitutes about 15% of the entire pool of hepatitis B in the world. 

 

On this World Hepatitis Day, with the theme 'Hepatitis can’t wait', the message is clear: India cannot afford to wait on adult hepatitis B vaccination any longer. 

 

Awareness drives must move beyond infant immunisation and talk to adults directly, experts tell THE WEEK. Additionally, vaccines must be made easily and freely available in government health centres, not just for infants but also for unvaccinated adults, especially in rural areas.

 

Hepatitis B may be silent, but India’s response to it doesn’t have to be. 

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