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Goldwater Microbiology Department, Women’s and Children’s Hospital, Adelaide Abstract Recognition of the high prevalence of and the problems caused by the hepatitis B virus (HBV) infection in the North Island of New Zealand is largely due to the observations and work of one man, Alexander Milne. This article outlines the history of the events that led up to the culmination of his team’s work-a national hepatitis vaccination strategy for New Zealand children. The situation in Australia is reassessed in the light of the New Zealand example with data based on benefit-cost analysis of various vaccination strategies. (Awt J Public Health 1993; 17: 221-5) e need for safe, effective and cheap preven- tion of hepatitis B infection in infants and chd- T“ dren in the Bay of Plenty, Central North Island district of New Zealand became apparent in 1977 when Alexander Milne, chief technologist at Whakatane Hospital, observed that disproportionate numbers of children in Whakatane were positive for hepatitis B surface antigen and the numbers admit- ted to hospital with acute hepatitis B were a cause for concern. This led him to perform a population-based study of the problem.’ Because funding from the Medical Research Council (now Health Research Council) of New Zea- Correspondence to Dr Paul N. Goldwater, Senior Consultant Clinical Microbiologist, Microbiology Department, Women’s and Children’s Hospital, North Adelaide, SA 5006. Fax (08) 204 7459. This paper, in abridged form, was presented to the Public Health Association of Australia meeting ‘Public health and micro- biology: international and national zyxwvutsrq aspects’ in Melbourne on 29 May 1992. land was slow in materialising, timber industry unions financed him to survey the population of the town of Kawerau. It was a remarkable feat to obtain a blood sample and collect demographic data from almost everyone (94 per cent) in the town of 8550. He showed a very high prevalence of hepatitis B markers in the community, and on the basis of the age distri- bution of the infection, concluded that horizontal transmission of the hepatitis B virus (HBV)was taking place in preschool and school children at an alarming leveL2 At the time, plasma-derived hepatitis B vaccine cost NZS150 per three-dose course of 3 x 20pg, that is, $75 for three paediatric doses. This cost placed the vaccine beyond the reach of local, hospital, or national health budgets. Another solution had to be found. It was at this stage that Sandy Milne and the authorjoined forces following an international work- shop organised by him in Whakatane in June 1982. The invited participants included Palmer Beasley and Lu Yu Hwang who had conducted the original neo- AUSTRALIAN JOURNAL OF PUBLIC HEALTH I993 VOL. 17 NO. 3 22 1