Why Hepatitis A deserves a place in India’s universal immunisation programme - Premium

As India debates the inclusion of the typhoid conjugate vaccine in its Universal Immunisation Programme, it is time to ask whether Hepatitis A — a growing cause of acute liver failure — deserves even greater priority. A safe, effective, and long-lasting indigenous vaccine already exists; what is missing is the policy decision. India’s Universal Immunisation Programme (UIP) has been one of the most successful public health initiatives in the developing world. It eradicated polio, curbed measles deaths, and saved millions of young lives. Yet as the country’s health landscape changes, so too must its immunisation priorities. A recent article in The Hindu made a strong case for introducing the typhoid conjugate vaccine (TCV) into the UIP. The argument is compelling: India bears half of the world’s typhoid burden, manufactures multiple WHO-prequalified TCVs, and yet has not included them in its national schedule. However, as we assess new vaccines for inclusion, scientific evidence and public-health impact must guide our choices. On these counts, Hepatitis A vaccination may deserve even higher priority. On Hepatitis A Hepatitis A, is a silent but mounting threat. For decades, the virus infected most Indians in early childhood, causing mild illness and conferring lifelong immunity. With improved sanitation and hygiene, that pattern has changed. Fewer children are exposed early, leaving many adolescents and adults unprotected—groups in whom the disease is far more severe. In recent years, multiple outbreaks in Kerala, Maharashtra, Uttar Pradesh, and Delhi have underscored this shift. Hospitals have reported clusters of acute liver failure and even deaths. Unlike typhoid, there is no specific treatment for severe Hepatitis A; recovery often depends on supportive care. Seroprevalence studies reveal a steady decline in protective antibodies—from over 90% two decades ago to less than 60% in many urban regions. The result is a growing pool of susceptible young people vulnerable to serious illness. Hepatitis A is no longer a benign childhood infection; it is an emerging public health concern. The vaccine The good news is that Hepatitis A is entirely preventable. Both live-attenuated and inactivated vaccines offer protection rates exceeding 90 to 95%, with immunity lasting for at least 15 to 20 years—often lifelong. India has its own indigenous success story here. Biological E’s Biovac-A, a live-attenuated vaccine developed domestically, has been used in the private sector for more than two decades with excellent safety and efficacy records. Unlike typhoid vaccines, Hepatitis A vaccines do not face issues of waning immunity, antibiotic resistance, or carrier states. A single dose of the live vaccine can confer durable, long-term protection. From a public health perspective, it is a model vaccine: safe, effective, long-lasting, and already made in India. Which deserves priority? Both typhoid and Hepatitis A cause significant illness, but their epidemiology and control prospects differ sharply. Typhoid mortality has declined with prompt antibiotic treatment and better sanitation, though antimicrobial resistance remains a concern. Hepatitis A, on the other hand, strikes indiscriminately across socio-economic groups, lacks specific treatment, and increasingly affects older children and young adults, where the disease is severe. When judged by measurable criteria—disease burden, vaccine efficacy, durability, cost-effectiveness, and programmatic simplicity—the balance tilts decisively toward Hepatitis A. It is the low-hanging fruit of vaccine-preventable diseases: a single-dose, long-lasting, with an indigenous product ready for universal use. Also Read: Hepatitis A outbreaks bring back focus on vaccination in Kerala The way forward India could begin by introducing Hepatitis A vaccination in States that have experienced repeated outbreaks or show declining antibody prevalence. The vaccine can be co-administered with existing boosters such as DPT or MR, using the same infrastructure. Periodic serosurveys can track population immunity and guide expansion. This phased approach aligns with the UIP’s proven model of gradual, evidence-based rollout. This is not an argument against typhoid vaccination; it is a plea for rational sequencing. Typhoid control is important, but Hepatitis A control is both easier and more cost-effective at this stage. The disease burden is substantial, the vaccine is home-grown, and the science is clear. India’s immunisation programme has repeatedly shown foresight—from the early inclusion of Hepatitis B to the introduction of rotavirus and pneumococcal vaccines. Adding Hepatitis A would be a natural next step in that continuum of progress. The tools are ready, the evidence is strong, and the need is urgent. The time to act is now. (Dr. Vipin M. Vashishtha is former national convener, IAP Committee on Immunisation. vipinipsita@gmail.com)