Challenges to implementing mandatory hepatitis B vaccination: bridging immunization gaps among health workers in sub-Saharan Africa.

Abstract

Hepatitis B virus (HBV) poses a major occupational risk for healthcare workers (HCWs) in sub-Saharan Africa (SSA), where endemicity and resource limitations hinder effective prevention. Mandatory Hepatitis B vaccination (HepB) policies for HCWs are critical to addressing vaccination gaps, yet their implementation is challenged by dosing inconsistencies, lack of post-vaccination immunity testing, and ethical considerations. In many countries in SSA, adults are given a four-dose pediatric formulation of the vaccine due to limited access to adult formulations that require fewer doses, creating logistical challenges and increasing the risk of incomplete immunization. In addition, the absence of routine post-vaccination immunity testing undermines efforts to ensure adequate protection, leaving vaccinated HCWs potentially vulnerable to HBV infection. Ethical issues, including inadequate informed consent, out-of-pocket vaccination costs, and inequities in access, further complicate mandatory vaccination programs. Addressing these barriers requires a multi-sectoral approach, including increased access to adult formulations of vaccines, integration of immunity testing into vaccination protocols, subsidized vaccine costs, and culturally tailored education campaigns. These strategies are essential for ensuring that vaccination policies are effective, equitable, and ethical. Protecting HCWs against HBV not only safeguards their health but also strengthens healthcare systems and public health outcomes in SSA.