opinion: canadians’ access to the infant hepatitis b vaccine shouldn’t be a lottery
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in british columbia, infants receive a combination vaccine protecting against six diseases including hepatitis b, whereas ontario provides infants with a combination vaccine against five diseases with the hepatitis b vaccine given much later.
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what is a canadian’s risk for developing an incurable chronic hepatitis b infection? the answer depends partly on the province or territory where they were born.
first introduced in the 1980s, the hepatitis b vaccine was the world’s first anti-cancer vaccine, helping to prevent a virus that is the leading cause of liver cancer worldwide. by the time i reached high school, all canadian provinces and territories had implemented hepatitis b vaccination programs for students.
these programs have dramatically decreased the rate of new hepatitis b cases among adolescents in canada by 90 per cent between 1990 and 2008.
the effectiveness of these programs is not in question. the timing is.
when hepatitis b is acquired in adulthood, most people can clear the virus. but when infection occurs in childhood, the outcomes are starkly different.
about 90 per cent of infants who acquire hepatitis b, and 20 to 30 per cent of children infected between the ages of one and five, develop incurable chronic hepatitis b. this leads to a lifetime of monitoring, treatment and – for some – progression to liver cancer or failure.
this is why the timing of vaccination is crucial. the most effective intervention is a birth dose, given shortly after birth.
and children can be exposed. hepatitis b can be spread through close household contact – sharing a toothbrush or nail clippers, or through contact with small amounts of blood. no matter what hygiene practices we teach our kids, parents know that sometimes these risks just can’t be avoided.
yet only three jurisdictions – nunavut, the northwest territories and new brunswick – currently offer universal birth dose vaccination, the gold standard of prevention. yukon, alberta, british columbia, quebec and prince edward island begin vaccination at two months of age. and in the rest of the country, the first routine hepatitis b vaccine isn’t offered until adolescence.
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this patchwork approach means that many canadian infants remain unprotected when they are most vulnerable.
the evidence for change is clear. in nunavut, hepatitis b exposure fell from nearly 20 per cent among people born before 1980 to under two per cent among those born after 1980, coinciding with the introduction of a universal birth dose vaccination program. british columbia’s infant vaccination program led to sharp declines in new infections, outpacing provinces that rely on adolescent vaccination alone. and a canadian analysis found that infant or birth dose vaccination not only reduces new cases but lowers long-term healthcare costs by preventing liver cancer and liver-related deaths.
that is why canadian liver specialists now recommend universal infant vaccination, ideally starting at birth.
so why haven’t all provinces and territories caught up?
part of the challenge is an outdated understanding of hepatitis b epidemiology. adolescent vaccination programs were started when hepatitis b was mostly viewed as a sexually transmitted infection. we now have a better understanding of household transmission and the more severe health consequences of acquiring hepatitis b during infancy and early childhood.
another factor is bureaucracy. immunization schedules are complex, and changes require coordination, logistics, funding and political will. but we have updated other vaccination schedules when the evidence evolved, and hepatitis b should be no different.
canada prides itself on equitable healthcare. yet a canadian child’s protection against hepatitis b – and against a preventable cancer – currently depends on their province or territory. this turns their likelihood for liver cancer into a lottery, with their ticket determined based on where they were born.
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the solution is straightforward. every province and territory should implement universal infant hepatitis b vaccination, ideally at birth, integrated into routine newborn care. this approach is already standard in many countries and in half of canada. it is feasible, cost-effective and supported by strong evidence.
every child in canada deserves to be protected, no matter where they were born.
jody jollimore is executive director of catie, canada’s source for hiv and viral hepatitis information.
this article was originally published in the sudbury star on april 26, 2026.
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