According to estimate of the Global Coalition for Hepatitis Elimination, before the introduction of hepatitis B vaccination, 3.9% of the total population in Belarus had chronic hepatitis B.[1][2] This posed a significant challenge to the nation's healthcare system. To address this, Belarus initiated a Hepatitis B Virus (HBV) vaccination programme in 1993, continuously refining its strategy in collaboration with the World Health Organization (WHO). In 2018, Belarus revised its hepatitis B prevention strategy, adopting a 4-dose vaccination schedule that included multicomponent vaccines. This approach started with a monovalent vaccine dose at birth, followed by three doses of a combined vaccine containing a hepatitis B component, in line with the national immunization schedule. To assess the programme's impact, evaluation efforts, including a serosurvey, were implemented. Data showed that the vaccination campaigns had proved highly effective: In 2000, 70 percent of children under 1 year of age were fully vaccinated against hepatitis B.[3]  By January 2023, the country vaccinated against hepatitis B 47 percent of total population, with a commendable >90 percent fully vaccinated children (0 to 17 years) and young adults (20 to 24 years), aligning with WHO recommendations.[4] This led to a substantial decline in acute hepatitis B cases, falling to 0.30 per 100 000 by 2022, a dramatic 55 and 31-fold decrease from the rates in 1996 and 2000 respectively.[5] Furthermore, chronic hepatitis B in children aged 6-12 years has been nearly eliminated, with a current prevalence of just 0.03 percent.[6][7]

How did Belarus, with the support of WHO, achieve this?

Belarus launched its hepatitis B vaccination initiative in 1993, initially focusing on high-risk groups. By 2000, the programme had expanded into a comprehensive strategy that included universal vaccination for all newborns. This expansion included a policy to vaccinate newborns within 24 hours of birth, introduced in 2000 and further tightened to within 12 hours from 2006. The country also implemented catch-up vaccination of adolescents aged 13-year-olds, specific professional groups, and those involved in viral parenteral hepatitis outbreaks, adhering to WHO guidelines.[8][9]

Throughout this period, the World Health Organization (WHO) played a crucial role in bolstering Belarus’s national immunization efforts, especially for hepatitis B. The WHO Regional Office for Europe significantly empowered the National Immunization Technical Advisory Group (NITAG), enhancing its ability to provide evidence-based recommendations and influence immunization policies. This support encompassed training workshops for NITAG chairs, members, and secretariats, and promoting networking among NITAGs in various countries to share best practices. Within Belarus, WHO facilitated critical discussions among regional immunization programme managers, aiming to achieve regional immunization objectives and address prevailing challenges.

^{Veronika Vysotskaya, Head of the Epidemiology Department at the Republican Center for Hygiene, Epidemiology, and Public Health in Belarus, delivers a presentation at the WHO Immunization Programme Managers Meeting in Tbilisi, Georgia, from 15-17 November 2022.}
Photo credit: Ms Veronika Vysotskaya

WHO's technical assistance in recent years has been instrumental in aligning Belarus’s vaccination strategy with The European Immunization Agenda 2030 and the regional action plans for ending AIDS and the epidemics of viral hepatitis and sexually transmitted infections 2022–2030.[10][11]

In 2022, WHO provided essential technical and financial support for a representative national serosurvey in Belarus to evaluate the impact of Hepatitis B vaccination programme. This collaboration involved developing study protocols, assisting with sampling, guiding data analysis, and funding laboratory resources. The serosurvey demonstrated that Belarus's successful implementation of hepatitis B vaccination programme led to virtual elimination of chronic hepatitis B among children born in post-vaccination period, significantly improving public health and laying a foundation for future health advancements. The European Technical Advisory Group of Experts recognized this progress by awarding Belarus a Validation Certificate for meeting regional hepatitis B control targets, marking a significant stride towards eliminating viral hepatitis as a public health concern in the WHO European Region.

In November 2023, Belarus participated in the “Assessing population immunity to vaccine-preventable and other current infections” project, which included hepatitis B testing. This study, a collaboration with the Russian Federation’s Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, highlighted their continued dedication to fighting infectious diseases.

This is a clear example of WHO’s extensive and decades-long support to Belarus, which in recent years has included providing resources and building national capacity, in turn delivering on “United Action for Better Health – a strategy for collaboration between the WHO Regional Office for Europe and Member States in the WHO European Region.

Looking to the future, the Belarus Ministry of Health is considering the validation of WHO’s triple elimination initiative, an endeavour that seeks to eliminate mother-to-child transmission of HIV, syphilis, and hepatitis B.[12] To facilitate this, a comprehensive proposal entitled “Requirements for the procedure for identifying, organizing, and carrying out sanitary and anti-epidemic measures aimed at preventing the occurrence and spread of parenteral viral hepatitis and HIV infection” has been prepared, marking another proactive step towards advancing public health and disease prevention in Belarus.