Geographic disparities in hepatitis B vaccine coverage across Africa: Implications for targeted interventions and 2030 goals.

BACKGROUND & AIMS: Hepatitis B virus (HBV) remains a leading cause of liver-related morbidity and mortality in Africa. Reaching the World Health Organization (WHO) target of ≥90% third-dose (HepB3) coverage by 2030 demands precise, subnational intelligence. We mapped hepatitis B vaccination coverage, dropout, and projected trends.

METHODS

We analyzed 245,168 child vaccination records from 89 nationally representative household surveys (2010-2022) covering 51 African countries. Bayesian geostatistical models were used to produce 5 × 5 km estimates of first-dose (HepB1) and HepB3 coverage, as well as relative and absolute dropout rates. Spatiotemporal graph convolutional networks projected HepB3 coverage trajectories through 2030.

RESULTS

Continental HepB3 coverage rose from 68.06% in 2010 to 69.42% in 2022, with pronounced spatial disparities. Coverage remained below 40% across much of the Sahel, the Democratic Republic of the Congo, Angola, and northern Mozambique; eight countries contained districts below half their national average. Relative dropout declined from 15.32% to 13.58% but exceeded 25% in parts of Mali, Chad, and northeastern Kenya. Projections place mean coverage at 76.89% by 2030; only Rwanda, Eritrea, Eswatini, Burkina Faso, Zimbabwe, and Niger are on track, leaving nearly half of second-level administrative units short of the 90% goal.

CONCLUSIONS

Incremental gains in HepB3 uptake and widening subnational inequities threaten HBV elimination across administrative levels in Africa. High-resolution coverage and dropout maps can guide precision immunization strategies to close persistent gaps and accelerate progress toward 2030 targets.

IMPACT AND IMPLICATIONS: This study provides the first continent-wide, fine-scale atlas of hepatitis B vaccination coverage in Africa, delivering an unprecedented view of where progress is occurring and where gaps persist. By mapping HepB1, HepB3, and dropout rates at high spatial resolution, the analysis offers governments and global health partners a practical, data-driven foundation for targeting resources, improving equity, and strengthening routine immunization systems. These insights can directly support national planning, guide micro-targeted interventions, and help monitor progress toward the 2030 HepB3 coverage target. Ultimately, the work advances precision public health and contributes to long-term HBV control across the region.