TACOMA, Washington — Hepatitis B is a liver infection caused by the hepatitis B virus. Untreated hepatitis B can lead to liver failure, liver cancer and death. Treatment for hepatitis B can include antiviral drugs and a liver transplant. Worldwide, 350 million people have chronic hepatitis B with 1 million deaths reported each year. The poorest 20% of the global population make up over a quarter of the total annual deaths.
Hepatitis B Infection in Developing Countries
Hepatitis B is a preventable disease thanks to a vaccine developed in 1981. Despite being preventable, hepatitis B is still prevalent, especially in developing regions. The Asian-Pacific islands, certain regions in India, sub-Saharan Africa and Central Asia all have high rates of hepatitis B.
Body fluids transmit hepatitis B, just like HIV. In areas of high prevalence, mother-to-child transmission occurs in 90% of the births from infected mothers. The earlier the infection, the higher the likelihood of chronic disease. Approximately 90% of infected infants develop chronic infection, while only one-third of children infected before age six do. Almost all children older than six recover completely. Since children are usually asymptomatic for hepatitis B, the infection is not diagnosed until later in life, when it is more dangerous.
Hepatitis B and Poverty
Unexpected medical costs put 150 million people into poverty every year. Treatment for chronic hepatitis B is expensive. One common treatment—the drug entecavir—can cost each patient $427 annually. There have been developments to make drug therapy cheaper. Tenofovir is an alternative drug that costs only $38 annually per patient and is as effective as entecavir. A 2015 study even found that generic entecavir could be manufactured at $36 annually per patient. However, even the less expensive options represent a lifelong cost to impoverished communities. The drugs are therapeutic, not a cure.
Liver transplant remains the only option for patients with end-stage liver disease due to hepatitis B. About 25% of patients with chronic hepatitis B will require a liver transplant, which can cost upwards of $163,438. Travel costs to actually receive a transplant are also high. Most developing countries suffer from poor medical infrastructure that requires patients to look elsewhere for treatment, which not all patients can afford. If they cannot afford treatment in the first place, it does not matter where the hospital is located. Where transplant programs exist, the long waiting lists increase the amount of time that the patient is sick and unable to work.
Even if a patient receives a transplant, they still face a year of post-transplant care, which can cost up to $12,560. Expensive transplant costs mean that many hepatitis B patients in developing countries have to choose between their health and their economic stability. At that point, their symptoms render them unable to work. Without a steady income, the patient cannot support themself or their treatment and can end up impoverished.
What Vaccines Can Do
The best way to treat hepatitis B is to ensure that a patient is never infected. A round of vaccinations is enough to grant lifetime immunity for those who are not already infected and eliminate the risk of transmission for those who have hepatitis B. Vaccination at birth followed by two boosters within the first year of life is the standard protocol for infants in developed countries. However, the immunization rate of infants is much lower in developing countries. Only 6% of infants are vaccinated at birth against hepatitis B in Africa.
NGOs like Gavi, the Vaccine Fund are fighting to change this. According to a study modeling the impact of vaccines for 10 diseases in 41 developing countries, vaccines will help prevent 24 million people in the world’s poorest countries from slipping into poverty by 2030. Of those 24 million, an estimated 14 million will avoid medical impoverishment because of the hepatitis B vaccine.
By using the pentavalent vaccine, which combines five vaccines for different infectious diseases into a single vial, the costs of equipment, delivery and disposal program are reduced. Governments are able to introduce the pentavalent vaccine into their national immunization programs as a cheaper and more convenient alternative to the usual nine shots. Since 2014, all of the world’s most impoverished countries have introduced the hepatitis B vaccine as part of the pentavalent vaccine. Thanks to Gavi’s buying power, the price of the pentavalent vaccine has dropped from $2.98 in 2010 to $0.90 in 2018.
Benefits of the Hepatitis B Vaccine
Vaccines do not just reduce medical costs for one generation; they represent a chance to break the cycle of poverty for the next generation. A vaccinated child is less likely to miss school due to chronic illness, so they are more likely to be successful later in life. Money that would have been put toward medical costs could instead be used on food and housing or put toward higher education for the child. Moreover, the child will not face any costs related to hepatitis B treatment and thus can better provide for their own future children.
For those already infected, the hepatitis B vaccine is not a cure. Getting it will not improve their health or reduce their treatment costs. However, it is still important they get vaccinated so that they cannot transmit the virus, keeping the people around them safe and healthy and letting them avoid medical impoverishment. Additionally, their children would not be at risk and could live free of chronic hepatitis B and the associated medical costs.
To break the cycle of medical impoverishment, vaccinations against every preventable disease—not just hepatitis B—need to be made available for all people in developing countries. The smallpox vaccine is an example of success in this area. The WHO inoculated hundreds of millions of people in developing countries against the disease. By 1977, 10 years after the launch of the Intensive Eradication Program, the last case of smallpox was recorded in Somalia. Eradication of this disease has improved the quality of life in developing countries and decreased medical impoverishment.
The process proves that universal vaccination is feasible, especially with technological advancements making vaccine distribution easier. Additionally, it is cost-effective since combination vaccines and advances in packaging have made vaccines cheaper and a good investment for national economies. A country free of epidemics is less at risk of overburdening their medical system, businesses save money when workers take fewer sick days and the economy grows because more people are healthy enough to work.