OBJECTIVES: Until recently, there has not been a global focus on getting hepatitis A vaccines on country policy agendas.  Using a vaccine policy adoption framework, we sought to identify drivers and barriers of hepatitis A vaccine adoption in six countries. METHODS: We applied a four-part framework to identify the public vaccine adoption process and drivers and barriers for hepatitis A vaccine adoption:   1) evidence in support of hepatitis A vaccine adoption; 2) existence of supportive policies; 3) political priority of hepatitis A within the country; and 4) whether or not the stakeholders were empowered and willing to act.   Data were collected using a qualitative policy survey and a systematic literature review in Chile, India, Mexico, Russia, South Korea, and Taiwan between November 2011 and June 2012.     RESULTS: Because hepatitis A is more of a concern during periods of economic transition for most countries, and because it is often perceived as a non-serious illness, countries struggle to align all of the factors necessary for adoption.  Even where solid data exist, political support is often waning due to apparent transition to low endemicity for hepatitis A and a reduced threat.  Where data are lacking, other vaccines take priority.  Where economic studies exist, narrow perspectives fail to capture the broader threat of the disease to regional or country economies.  Hepatitis A vaccination policy is further complicated by the fact that as countries transition to lower endemicity, the major threat is in older age groups.  This trend leads to a subtle shift in stakeholders from the pediatric vaccine community to those more focused on the adult health community.  CONCLUSIONS: Although the vaccine adoption process is the same for hepatitis A as for other pediatric vaccines, this study suggests that drivers of hepatitis A vaccine adoption may come from sectors outside the traditional pediatric vaccine community.