The Maldives has achieved hepatitis B control, the World Health Organization (WHO) announced on Wednesday after an expert panel verified that the country, along with neighbouring Sri Lanka, has consistently high coverage of hepatitis B vaccine doses in infants and a low prevalence of the deadly disease, corroborated through surveys conducted in both countries recently.

“I congratulate and commend Maldives and Sri Lanka on their achievement which once again demonstrates the earnest efforts being made by the health leaders and officials, health workers and the people of these countries towards health and well-being of communities,” said Dr Poonam Khetrapal Singh, Regional Director WHO South-East Asia.

The Expert Panel for Verification of Hepatitis B Control in WHO South-East Asia Region reviewed childhood immunisation data from Maldives and Sri Lanka that showed consistent over 90 percent coverage with Hepatitis B vaccine doses provided during infancy over the past many years. The experts also reviewed the findings of national surveys conducted among children in the countries in 2022-2023.

“Based on the evidence presented to it, the Expert Panel concluded that the standards required for verification of Hepatitis B control have been met in both these countries and hence recommended that this important public health target has been achieved in Maldives and Sri Lanka”, said Dr Supamit Chunsuttiwat, chairperson of the Regional Expert Panel for verification of Hepatitis B control in South-East Asia.

The Maldives and Sri Lanka join Bangladesh, Bhutan, Nepal and Thailand, who achieved control status in 2019.

Preventing Hepatitis B infection in infancy substantially reduces chronic infections and cases of liver cancer and cirrhosis in adulthood, the WHO said.

Hepatitis control continues to be an important public health initiative in the South-East Asia Region of WHO that comprises of 11 countries and is home to a quarter of the world’s population. The Region has an estimated 60 million people living with chronic hepatitis B and 218,000 dying every year of hepatitis B and C. Of the persons eligible for antiviral treatment only about 10 percent know their status and less than five percent are on treatment.

In 2016, the South-East Asia Regional Immunization Technical Advisory Group endorsed a regional goal of hepatitis B control with a target of reducing hepatitis B prevalence to less than one percent among children aged at least five years.

Hepatitis B vaccine, as a part of the pentavalent vaccine, has been included in the national childhood immunisation schedule of all countries of the region, with three doses of the vaccine provided to children during their first year of life. Eight countries also have a policy of providing a birth dose of Hepatitis B vaccine to newborn babies.

The region made good progress in improving immunisation coverage of the pentavalent vaccine until 2019. However, there was a decline in the coverage in several countries in 2020 and 2021 following the COVID-19 pandemic.

Intensive efforts in countries have resulted in the revival of childhood immunisation coverage to pre-pandemic levels in several countries and the WHO and UNICEF estimates for 2022 show that the overall coverage of the third dose of pentavalent vaccine has recovered to the pre-pandemic level of 91 percent, a sharp increase from 82 percent coverage reported in 2021.

Dr Khetrapal Singh said that countries also need to focus on improving the hepatitis B vaccine birth doses which continue to have a relatively slow uptake with an estimated coverage of only 58 percent in 2022. One of the key barriers for achieving high hepatitis B vaccine birth dose coverage regionally remains the high proportion of home deliveries, that do not allow timely access of the Hepatitis B vaccine to these newborns, she said.

Inequities in immunisation service delivery, suboptimal awareness and training of health staff at birthing facilities; particularly in terms of false contraindications or fear of adverse events following immunisation also contribute to sub-optimal coverage of Hepatitis B vaccination coverage, the Regional Director said.

The control of hepatitis B through immunisation is a priority for the region and achieving the control goal is a critical step as progress is made towards the elimination of mother to child transmission of the hepatitis B virus, she said.

WHO’s “triple elimination initiative” encourages countries to simultaneously commit to such elimination together with HIV and syphilis – further pushing the agenda for integrated service delivery.

“Hepatitis must be prevented and treated. In addition to vaccination, continued efforts are needed to scale up other preventive measures such as safe injection, safe blood and infection prevention and control,” the Regional Director said.