To the editor:

In your report “Side benefits sway developing nations to choose unneeded vaccines”1, it is stated that the World Health Organization (WHO) regional office recommends that the hepatitis B vaccine only be included in routine immunization when disease prevalence exceeds 2%. I would like to make the following clarification.

Everyone should be protected against hepatitis B–related diseases through vaccination. This vaccine should be offered on the basis of sound scientific information on disease burden, cost-effectiveness and safety that exist for all prevalence settings. Hepatitis B infection occurs worldwide, and it is estimated that more than 2 billion people are currently infected. Of these, about 360 million are chronically infected and at risk for serious illness and death from cirrhosis and hepatocellular carcinoma, diseases that are estimated to cause 500,000–700,000 deaths worldwide each year.

In 1992, the World Health Assembly passed Resolution 45.17, which called for Member States “to integrate cost-effective new vaccines, such as hepatitis B vaccine, into national immunization programs in countries where it is feasible.” In 2004, the WHO released its position paper on hepatitis B vaccines2. This paper stated that “routine vaccination of all infants against hepatitis B virus infection should become an integral part of national immunization schedules worldwide.”

The Global Alliance for Vaccines and Immunization is supporting the least-developed countries in introducing hepatitis B vaccines into their national immunization programs by 2007. According to WHO/UNICEF data, 153 of 192 (80%) WHO Member States reported having introduced the hepatitis B vaccine into their routine infant immunization schedules as of 2004. This fivefold increase in the number of countries from 1992 is the result of global advocacy, decreasing vaccine prices and the availability of resources to the poorest countries. But despite this significant progress, less than one-half of the world's infants (48%) received three doses of the vaccine by the end of 2004.

The availability of the vaccine to the world's children is having a significant impact on hepatitis B–related diseases. For infants born in 2003, it is estimated that hepatitis B vaccination will prevent about 600,000 deaths during the lifespan of the vaccinated cohort3. Continued efforts to introduce this vaccine in all countries and sustained high vaccine coverage will prevent millions of deaths and deserves continued global support.