The Global Alliance for Vaccines and Immunization (GAVI) supports Hepatitis B immunization in India in better-performing states, where the Indian government has introduced a program that follows the standard DTP immunization schedule. While only one out of four deliveries in India takes place in hospital, Indian health authorities have decided to provide birth doses of Hepatitis B vaccine for hospital deliveries only. This fails to address the key challenge of transmission of Hepatitis B from

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... ther to child at birth. The introduction of routine antenatal screening for Hepatitis B would facilitate selective immunization with birth doses of Hepatitis B vaccine to high-risk infants born to mothers who are chronic carriers. Routine screening could simultaneously provide important data on Hepatitis B prevalence and transmission in Indian populations, which is necessary in order to make well-informed decisions on immunization schedules and accurate estimates of disease burden. Word count: 5,560 2 Abstract: In cooperation with Indian health authorities, the Global Alliance for Vaccines and Immunization (GAVI) is introducing Hepatitis B vaccination into the national immunization programme of India. This article describes the concerns and interests of major stakeholders in the programme, including GAVI partners and the Indian government, and summarizes Indian debates that have emerged in reaction to the planning and implementation of the pilot phase of the project. It also discusses the plans for the second phase of the project, to introduce Hepatitis B vaccination into the immunization programmes of eleven 'better performing' Indian states. In conclusion, this article suggests as an alternative approach to combating Hepatitis B in India to introduce routine antenatal screening on a nationwide basis, and provide birth doses of the Hepatitis B vaccine to infants most at-risk, i.e. those born to mothers who are Hepatitis B carriers. It also suggests that in a populous country such as India, where there may be large variations in prevalence and transmission of Hepatitis B among different populations, it is ill-advised to use country-level figures as guidelines for recommendations on the administration of birth doses of Hepatitis B vaccine. 3