Hepatitis B virus is a substantial threat to global health, with 360 million people chronically infected and more than 500 000 deaths each year from fulminant hepatitis, cirrhosis, and liver cancer.1 2 After a call by the World Health Organization for the global introduction of vaccine prevention programmes by 1997,3 82% of countries in the world had introduced universal hepatitis B immunisation by 2005, and at least 55% of the world's children are now receiving three doses of the vaccine.4

To date, the United Kingdom has not offered universal immunisation, so most of its citizens are susceptible to infection. At the June 2007 annual representatives meeting, the BMA voted in favour of adding its voice to those of other expert groups in the UK calling upon the Department of Health “to introduce the hepatitis B vaccine into the childhood schedule without further delay.”

The main argument against introducing universal immunisation is the relatively low incidence of disease in the UK compared with other countries.5 However, 180 000 people in the UK are chronically infected with hepatitis B …