Closing Hepatitis B vaccination gap: barriers and solutions for underserved groups

Abstract Hepatitis B vaccination is a proven measure to protect against cirrhosis and liver cancer, yet large gaps persist among migrants, refugees, prisoners and other underserved groups in Europe. This presentation distils the main concepts that explain why the standard three-dose series still fails to reach all adults and outlines actionable levers for change. Barriers operate at four interlocking levels. (1) Structural: residence-permit rules, fragmented insurance, out-of-pocket fees and absent adult catch-up laws decide whether the vaccine can be claimed at all; (2) Organizational: long waits, complex registration, siloed records and weak feedback loops fracture continuity between doses; (3) Community: mobility, precarious work, unstable housing and periods of detention interrupt appointments and reduce perceived priority; (4) Individual: limited knowledge, cultural and linguistic barriers, distrust, fear of side-effects and competing survival needs suppress demand. Our experience shows that when vaccination is free at point of care and offered outside of traditional healthcare settings, first-dose uptake is around 90%. Conversely, charging money and enforcing proof of residency drives completion rates towards zero. Solutions must mirror each barrier tier: universal health coverage statutes that explicitly include undocumented people and inmates; task sharing with outreach nurses, pharmacists and civil-society teams to decentralise first-dose delivery; interoperable immunisation registries, SMS reminders and case management to safeguard follow-up; and peer champions, culturally tailored materials and modest incentives to rebuild trust and motivation. Closing the adult HBV vaccination gap therefore demands aligning legal entitlements, service design and community support under an equity lens.