Viral hepatitis is the world’s seventh leading cause of mortality, killing an estimated 1.5 million people in 2013 from complications like liver cancer and cirrhosis. There are as many as 400 million HBV and HCV infections worldwide—10 times more people than are infected with HIV.
And yet while HIV prevention has made great strides over the past decade, the movement to eliminate hepatitis has only started to get off the ground. In July, WHO Director Margaret Chan assessed the situation astutely when she said, “The world has ignored hepatitis at its peril. It is time to mobilize a global response to hepatitis on the scale similar to that generated to fight other communicable diseases like HIV/AIDS and tuberculosis.”
Hepatitis can be a tricky disease to fight, partly because many chronic and asymptomatic infections remain undiagnosed for years. This increases the risk for onward transmission and hepatitis-related liver disease as untreated individuals may unknowingly pass on the virus to others and allow the infection to clinically progress further. And treating hepatitis-related disease is costly, ranging from $820 for early stage cirrhosis to $139,070 for a liver transplant; there is potential for severe economic consequences on health care systems.
The good news is that we have the tools to address this major disease globally. It’s just a matter of mobilizing a global response for hepatitis to employ these tools—just as we have done for other diseases, like HIV. Here’s what I believe the hepatitis community will need to do to address this health crisis, leaning heavily on lessons learned from the HIV response:
1. Strengthen the use of prevention and control tools. For HBV, this means increasing universal vaccination coverage, especially in areas of poor coverage, like the Africa region. Getting the initial dose of HBV vaccine to more infants at birth is essential, for example, by enabling health workers to administer vaccines after home births or stocking delivery rooms with vaccine. For HCV, a key barrier to epidemic control is treatment costs. An approach that has been successful in getting more people treated for HIV involves adjusting drug prices for low- and middle-income countries, voluntary licensing to produce generic medicines, and large-volume purchasing price discounts. Similar steps could reduce the high cost of HCV treatment overall. In addition, governments should follow the lead of Australia—on track to eradicate HCV by 2026—and invest in HCV treatment. Public health programs like blood donation screening, harm-reduction services, and expanded hepatitis testing within high-risk populations are also important.
2. Get policymakers and governments on board to ensure a strong public health response. Leadership must come from within governments to develop national plans against viral hepatitis; however, advocacy by civil society can instigate this action and help inform these plans. Civil society and the larger advocacy community should absolutely help drive the global hepatitis movement. Like HIV, hepatitis is not just a medical problem—it’s also a social one, influenced by factors like poverty, migration, and drug-use and affecting marginalized populations.
3. Create bold campaigns to drive action. Here, the hepatitis community can take notes from global HIV campaigns like UNAID’s Fast Track Strategy To End The AIDS Epidemic by 2030 and the ambitious treatment campaign 90-90-90 – which have done a superb job keeping HIV in the global health dialogue and continuing to drive action. World Hepatitis Alliance’s Nohep campaign is striving to make similar noise, calling for viral hepatitis elimination by 2030. And the WHO Global Health Sector Strategy on Viral Hepatitis has set forth bold goals to reduce infections and deaths from hepatitis and scale-up treatment and vaccination.
4. Secure financial support. Implementing WHO’s Viral Hepatitis Strategy would cost low-and middle-income countries alone $11.9 billion between 2016-2021, peaking at 4.1 billion annually in 2021. Currently, only $1.1 billion of development assistance for health in 2015 went to “other infectious diseases,” the category under which viral hepatitis would fall. HIV/AIDS, by comparison, received $11 billion. The global hepatitis response must find innovative funding sources to achieve its elimination goals.
The global hepatitis movement is growing and gaining momentum. It will need to utilize all of its tools—scientific, public health, policy, and advocacy—to finally get viral hepatitis the attention it deserves for the sake of the millions of people suffering from this disease around the world.
Jessica Taaffe, PhD, (@jessicataaffe) is a biomedical scientist working in the translation of science into global health policy and practice. She is principal consultant, Global Renaissance Enterprises. For extended discussion on this topic, please see Taaffe J, Wilson D. Mobilising a global response to hepatitis: Lessons learned from the HIV movement. Global Public Health. 2016:1-16. doi: 10.1080/17441692.2016.1233989.
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