Hepatitis B Immunization: a Strategy for Liver Cancer Prevention in Underserved Migrant Populations

This World Immunization Week, we call for increased hepatitis B virus (HBV) vaccination among underserved migrant populations in Europe and stress that health systems must ensure that vaccination policies and campaigns do not leave out the most vulnerable.

[This blog post was written by Aina Nicolàs, Camila Picchio, and Delfina Boudou.]

The European Commission updated Europe’s Beating Cancer Plan in 2021, setting out a series of initiatives and actions to address the entire cancer management pathway, from prevention to diagnosis, treatment, and care. Europe's Cancer Plan includes specific targets for the prevention of cancers caused by infections, in particular vaccine-preventable cancers such as liver cancer caused by hepatitis B virus (HBV) infection.

Chronic hepatitis B is a major public health problem, with an estimated 296 million people (in 2019) living with chronic hepatitis B infection and at increased risk of developing cirrhosis or liver cancer. More than 900,000 deaths, including 43,000 in Europe, are caused by HBV infection each year. In addition, HBV is responsible for more than half of all liver cancers worldwide. Despite the availability of a safe and effective vaccine to prevent HBV infection, its prevalence remains high: 15 million people in the European Region are living with HBV infection, and there are about 19 000 new HBV infections in the Region each year.

Photo: Jan Pilarcik

Vaccination against HBV has been included in European national immunization plans since it was first recommended by the World Health Organization (WHO) in 1991. As of December 2019, 94% of European countries provided universal routine vaccination against hepatitis B for all infants and children. However, major gaps in the availability and distribution of these vaccines remain in some regions, corresponding to those most affected by the HBV pandemic, including sub-Saharan Africa and South-East Asia. Most countries in these regions only started to include hepatitis B vaccination in their national immunization plans in the early 2000s, and many continue to face supply, financing, and distribution challenges.

Liver cancer caused by chronic HBV infection has already caused too many deaths in migrant and refugee communities worldwide. It is time to take action and address the urgent need to reach underserved communities and vaccinate these vulnerable populations against HBV infection.

Photo: Jan Pilarcik

Migrants from Regions with Intermediate or High HBV Prevalence

Migration can play a crucial role in the under-vaccination of people who have left their home countries and migrated to countries with different health policies or vaccine availability. Migration in the European Union (EU) has increased in recent years and migrants currently make up about 10% of the total EU population. The burden of disease, and therefore health needs, can vary greatly between migrant populations and communities living in Europe, and taking these differences into account is essential to ensure that health systems provide adequate health services to meet the needs of all.

For example, migrants from regions with intermediate or high HBV prevalence have a higher risk of HBV infection than their host population and are less likely to have been properly immunized against HBV. In this regard, our demonstration study, HBV-COMSAVA, reported a prevalence of HBV infection of 9.9% among more than 400 West African migrants living in Catalonia, Spain, which is significantly higher than the HBV prevalence in the general population of the region (0.52%). This may be partly due to competing health priorities in their home countries, lack of access to vaccination, and poor or late implementation of vaccination policies, especially among those born in rural areas. Therefore, preventive measures targeting migrant communities at increased risk, such as screening and tailored vaccination campaigns, are essential to reduce the burden of HBV infection in these populations.

VH-COMSAVAC is ready to work to overcome the barriers to healthcare faced by migrant and refugee communities in Europe through a direct and tailored community-based approach

Photo: Jan Pilarcik

VH-COMSAVAC, a Community-Based Care Model

The Multi-country Viral Hepatitis COMmunity Screening, Vaccination, and Care (VH-COMSAVAC) project is an ISGlobal-led initiative that addresses the complex challenges of viral hepatitis in migrant communities. The project aims to implement a community-based care model to scale up viral hepatitis screening and HBV vaccination in migrant and refugee communities in Spain, Italy, and Greece. The ultimate goal of VH-COMSAVAC is to reduce viral hepatitis-related morbidity and mortality in migrant and refugee communities by increasing HBV vaccination as a preventive tool against liver cancer caused by chronic HBV infection.

In addition, VH-COMSAVAC emphasizes the use of simplified diagnostic tools for viral hepatitis screening for early detection of liver cancer in combination with decentralized HBV vaccination in community settings and facilitates direct linkage to care for active viral hepatitis infections.

Photo: Jan Pilarcik

Liver cancer caused by chronic HBV infection has already caused too many deaths in migrant and refugee communities worldwide. It is time to take action and address the urgent need to reach underserved communities and vaccinate these vulnerable populations against HBV infection. VH-COMSAVAC is ready to work to overcome the barriers to healthcare faced by migrant and refugee communities in Europe through a direct and tailored community-based approach.