By Ibrahim Sorie Koroma
Senior Health Promotion Officer
Health Education Programme – Ministry of Health
For a mother holding her newborn for the first time, the priority is to keep the baby safe, healthy and alive. But beyond the joy of childbirth lies an invisible threat that can follow a child for decades—Hepatitis B, a viral infection that can cause chronic liver disease, liver cancer and premature death.
Now, Sierra Leone is strengthening its fight against the disease by placing a powerful prevention tool where it can make the greatest difference, at birth. The Hepatitis B birth-dose vaccine is designed to protect newborns from infection, particularly transmission of the virus from mother to child. The vaccine has been available for decades and is highly effective. For Sierra Leone, the message is clear, every child deserves a healthy start, and vaccination at birth can help make the difference.
A silent threat to Africa’s children
Hepatitis B remains a major global public health challenge, but its burden is particularly heavy in Africa. An estimated 70 percent of hepatitis B infections occur in Africa. Yet, despite the availability of an effective vaccine, protection at birth has historically remained low across the continent. By 2021, only 14 of Africa’s 47 countries had introduced a routine hepatitis B birth dose, while only about 18 percent of African infants received a birth dose in 2022.
This gap is important because babies infected with hepatitis B are far more likely to develop chronic infection than adults. A child who becomes infected may appear perfectly healthy while the virus quietly damages the liver over many years.
Why the first 24 hours matter
The World Health Organization recommends that all infants receive their first dose of hepatitis B vaccine as soon as possible after birth, preferably within 24 hours. The reason is simple: the earlier a newborn is protected, the greater the opportunity to prevent infection acquired around the time of birth. The birth dose is therefore not just another injection. It is an early shield against a virus that can cause serious disease later in life. The United States Centers for Disease Control and Prevention has also strongly supported giving the hepatitis B birth dose to every newborn before discharge from a health facility so as to ensure no child is missed for vaccination.
A small dose with a big promise
The Hepatitis B vaccine requires only a single 0.5 ml dose at birth, followed by the remaining doses according to the routine immunization schedule. One dose can provide approximately 95 percent protections lasting at least 10 years, while completion of the three PENTA dose series provides 98–100 percent protection, with protection lasting at least 20 years and potentially for life. That means a simple intervention delivered during the first days of life can protect a child well into adulthood. Globally, high coverage with the birth dose followed by at least two additional
Every newborn counts
Sierra Leone’s goal is ambitious but straightforward, eliminate hepatitis B infection and reduce the burden of the disease among children under five. Every child born in Sierra Leone is eligible for hepatitis B birth-dose vaccination. The programme is designed to reach at least 95 percent of the targeted newborn population. The vaccine will be delivered through existing maternal, newborn and child health services, including labor rooms and postnatal wards. Trained professional nurses will administer the vaccine, allowing hepatitis B prevention to become part of the routine package of maternal and child health service delivery in the country.
Turning childbirth into an opportunity for prevention
The introduction of the hepatitis B birth dose also presents an important opportunity to strengthen other newborn health interventions. The vaccine can be integrated with essential newborn care and maternal health services; including existing interventions such as Vitamin K. Antenatal care provides another critical opportunity.
During pregnancy, health workers can educate mothers and families about hepatitis B and prepare them to ensure that the baby receives the vaccine immediately after birth. This means the conversation about hepatitis B does not have to begin when a baby is born. It can begin during pregnancy. Health workers, community leaders, parents and caregivers all have a role to play.
Protecting children and the next generation
The financial cost of the vaccine is relatively small compared with the human and economic cost of treating chronic hepatitis B, liver disease and liver cancer. Sierra Leone is therefore taking steps to ensure that vaccine access is supported through appropriate storage, transportation and distribution systems. The country has selected the 10-dose vial presentation, taking into consideration cold-chain capacity, affordability and vaccine availability across health facilities.
The Government of Sierra Leone is also committing resources to support the intervention, including approximately US$59,512 for vaccine-related support, with the Government financing the vaccine rather than relying on GAVI support. But vaccines alone cannot eliminate hepatitis B. Communities must understand why the birth dose matters. Parents and caregivers must know that the vaccine is safe and beneficial. Health workers must ensure that eligible newborns are vaccinated, and community leaders must help spread accurate information.
A promise to Sierra Leone’s children
Behind every vaccination statistic is a child. A newborn whose future should not be determined by a virus that can be prevented. A mother who should be able to leave a health facility knowing that her baby has received one more layer of protection. A family that should not have to face the devastating consequences of preventable liver disease years later. The fight against hepatitis B is therefore more than a vaccination campaign. It is an investment in Sierra Leone’s children and in generations yet unborn.