Should Hepatitis A Be Prioritised in India’s Universal Immunisation Programme?
A UPSC-Focused Analysis for (Prelims practice2026)
India is debating the inclusion of the Typhoid Conjugate Vaccine (TCV) in the Universal Immunisation Programme (UIP). But as public-health experts point out, Hepatitis A may deserve even greater priority due to changing epidemiology, rising outbreaks, and the availability of a highly effective indigenous vaccine.
This debate is extremely relevant for UPSC Prelims 2025, which frequently tests immunisation policy, disease epidemiology, and India’s vaccine programmes.
🧩 1. UIP: One of India’s Biggest Public-Health Success Stories
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Eradicate polio
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Reduce measles deaths
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Introduce Hepatitis B, rotavirus, and pneumococcal vaccines
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Achieve major improvements in child survival
But India’s health landscape is shifting — sanitation has improved, disease patterns have changed, and new vulnerable groups have emerged.
Therefore, immunisation priorities must also evolve.
🧪 2. Typhoid Conjugate Vaccine (TCV): The Current Debate
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WHO-prequalified
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Manufactured domestically
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Effective in reducing multi-drug-resistant typhoid
However, despite the strong case for TCVs, some experts argue that Hepatitis A deserves higher priority right now.
Why?
🟠 3. Hepatitis A: A Silent but Growing Threat
✔ Earlier: Mild childhood disease
Due to poor sanitation, most children were exposed early → mild illness → lifelong immunity.
✔ Now: Exposure delayed → severe disease
Improved hygiene means fewer children are exposed early, leaving:
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Adolescents and young adults vulnerable
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These groups suffer far more severe disease, including acute liver failure
✔ Outbreaks rising
Reported frequently from:
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Kerala
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Maharashtra
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Uttar Pradesh
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Delhi
✔ Falling immunity
Seroprevalence (protective antibodies) has dropped:
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>90% (2000s) → <60% (urban India today)
✔ No specific antiviral treatment
Management is supportive only → increases mortality risk.
Hepatitis A is now an emerging public health concern.
💉 4. The Vaccine Advantage: Hepatitis A Has a “Model Vaccine”
Hepatitis A vaccination ticks all major public-health criteria:
✔ Effective: 90–95% protection
✔ Long-lasting: 15–20 years, often lifelong
✔ Simple schedule: Single dose (live attenuated)
✔ Safe
✔ Indigenous success story
India's Biovac-A (Biological E) has been used for 20+ years with excellent results.
Unlike typhoid vaccines, Hepatitis A vaccines:
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Do not face issues of antibiotic resistance
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Do not have carrier-state concerns
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Do not show significant waning immunity
From a programmatic angle, Hepatitis A is low-hanging fruit.
⚖️ 5. Hepatitis A vs Typhoid: Which Should Come First in UIP?
Typhoid:
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High burden
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Antibiotic resistance rising
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Treatment available
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Vaccines slightly costlier; immunity wanes over time
Hepatitis A:
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Rising in previously immune populations
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No targeted treatment
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Affects adolescents/young adults → severe
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Excellent vaccine characteristics
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Single-dose, lifelong immunity
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Cost-effective & indigenous
By measurable criteria — disease burden, vaccine efficacy, durability, cost-effectiveness — Hepatitis A has the edge.
🛠 6. How India Can Introduce Hepatitis A in UIP (Expert Suggestions)
A phased, evidence-based rollout:
✔ 1. Start in states with repeated outbreaks
(Example: Kerala, Maharashtra, Delhi, UP)
✔ 2. Co-administer with existing boosters
Such as DPT or MR.
✔ 3. Use existing cold-chain/logistics of UIP
No major new infrastructure needed.
✔ 4. Conduct periodic serosurveys
To monitor immunity levels and guide expansion.
This mirrors UIP’s successful strategy for Hepatitis B, Rotavirus, and PCV.
📝 7. UPSC Prelims 2025 – High-Value Facts
Hepatitis A
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Caused by: HAV (RNA virus)
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Transmission: Feco–oral
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Treatment: No specific antiviral, supportive only
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Severity increases with age
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Outbreaks rising due to improved sanitation patterns
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Vaccine types: Live attenuated & Inactivated
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Indigenous vaccine: Biovac-A (Biological E)
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Vaccine schedule: Single dose (live)
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Protection: 15–20 years, often lifelong
Typhoid
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Caused by: Salmonella Typhi
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Vaccine: TCV
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India: Huge global burden, but treatable with antibiotics
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Antibiotic resistance is a concern
🧠 8. GS-II / GS-III Mains Angle (Value-added Analysis)
“India’s shifting disease ecology highlights the need to rethink immunisation priorities. Hepatitis A, once a childhood infection, has re-emerged due to reduced natural exposure, causing severe adult disease. With a safe, indigenous, long-lasting vaccine available, its inclusion in UIP would be a cost-effective, epidemiologically sound public-health decision.”
📌 9. Last-Minute Revision Table
| Parameter | Typhoid | Hepatitis A |
|---|---|---|
| Treatment | Antibiotics available | No specific treatment |
| Severity pattern | Children & adults | More severe in adolescents/adults |
| Immunity | Vaccine immunity may wane | Long-lasting; lifelong |
| Indigenous vaccine | Yes | Yes (Biovac-A) |
| Carrier state | Yes | No |
| Waning immunity | Possible | Minimal |
| Public health priority (current scenario) | High | Higher |
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