Overview: Hepatitis A and India’s UIP debate
Hepatitis A, a preventable liver infection caused by the Hepatitis A virus, has re-emerged as a public health concern in parts of India. Outbreaks have highlighted gaps in immunity, particularly among adolescents who may no longer have strong natural protection from early exposure. Public health experts are calling for vaccines to be included in the Universal Immunisation Programme (UIP) to curb transmission, reduce hospitalizations, and prevent severe outcomes.
The case for inclusion in the UIP
India’s UIP has been successful in delivering life-saving vaccines to children across the country. However, Hepatitis A vaccination is not universally funded or administered in the same way as vaccines for polio, measles, or hepatitis B. Experts argue that adding Hepatitis A to the UIP could:
– Ensure equitable access for all children and at-risk groups, regardless of geography or socioeconomic status.
– Strengthen herd immunity, limiting outbreaks in schools, urban centers, and densely populated areas.
– Protect adolescents and young adults who may have waning natural immunity due to reduced exposure in childhood.
– Reduce healthcare costs associated with hepatitis A outbreaks, including hospital stays and time off work for caregivers.
Scientific and epidemiological rationale
Hepatitis A infection is usually mild in children but can be more severe in older children and adults. A robust vaccination program can keep community transmission low and prevent severe disease, liver failure, or rare fulminant hepatitis. Seroprevalence studies suggest that natural immunity diminishes as children grow into adolescence in certain regions, creating a vulnerability that vaccines can safely address. Vaccination coverage through UIP would complement existing immunisation schedules and align with global health goals to reduce hepatitis-related morbidity and mortality.
Lessons from other countries
Several countries have integrated Hepatitis A vaccination into their national immunisation schedules with positive outcomes, including fewer outbreaks and reduced hospitalizations. The experience demonstrates that systematic vaccination, paired with public awareness campaigns, can shift the epidemiological curve and protect vulnerable populations. India could adapt best practices—such as cold-chain logistics, phased rollout in high-risk districts, and school-based vaccination campaigns—to fit its diverse landscape.
Implementation considerations
For successful incorporation into the UIP, policymakers will need to address several factors:
– Cost-effectiveness and budgeting within the national health framework.
– Supply chain resilience to maintain vaccine availability across urban and rural areas.
– Target population delineation, including routine childhood immunisation and catch-up programs for adolescents and at-risk groups.
– Public communication strategies to overcome vaccine hesitation and misinformation.
– Monitoring, evaluation, and pharmacovigilance to ensure safety and track impact on hepatitis A incidence.
Vaccination delivery models
Potential delivery models include integrating Hepatitis A with existing immunisation visits, school-based campaigns for adolescents, and outreach programs in health sub-centres. A combination approach would help reach children in remote areas while maintaining high coverage in urban centers where outbreaks have been reported.
What it means for the public
Incorporation into the UIP could mean easier access to a vetted, proven preventive measure, reducing the burden on families who must navigate out-of-pocket vaccination costs. For teachers, healthcare workers, and families, standardized vaccination could translate into fewer outbreaks in schools, more stable attendance, and improved overall community health. The move would also signal India’s commitment to aligning with international health standards and protecting its younger generations from preventable liver disease.
Next steps
Stakeholders—including government health ministries, public health researchers, and non-governmental organisations—need to collaborate on feasibility studies, pilot programs, and phased rollout plans. Community engagement will be essential to address concerns and ensure broad acceptance. If Hepatitis A vaccination is added to the UIP, clear milestones and transparent reporting will help sustain momentum and demonstrate impact.
