On 28 July every year World Hepatitis Day is marked across the globe, including in the WHO South-East Asia Region. It is an occasion to raise awareness of viral hepatitis, including its signs and symptoms and how it can be prevented, treated or cured, and to advocate for key changes in policy alongside greater investment in lifting the disease’s burden.
Notably, it is a day of optimism: 28 July is the birthday of the Nobel prize-winning scientist Dr Baruch Blumberg – the scientist who first discovered the hepatitis B virus, developed a powerful vaccine against it and saved millions of lives in the process. That is an important point to reflect on and embrace as we consider the theme of this year’s World Hepatitis Day – ‘Test. Treat. Hepatitis.’
Indeed, despite recent progress, every year viral hepatitis is responsible for an estimated 410 000 deaths across the South-East Asia Region – more than HIV and TB combined. An estimated 40 million people Region-wide live with chronic hepatitis B and an estimated 10 million live with chronic hepatitis C. Together hepatitis B and C account for around 90% of hepatitis-related mortality. The rest is caused by hepatitis A and E. Importantly, less than one in 10 infected people are estimated to know their status, while less than 10% of those who do know their status are receiving appropriate treatment. This lack of awareness and treatment leads to progressive liver damage and can cause life-threatening conditions such as fibrosis and cancer of the liver. It also allows the virus to spread.
Despite the challenges we face, with urgent, high-level commitment we can find the missing millions, test and treat them, and reach the time-bound targets of WHO South-East Asia’s Regional Action Plan for Viral Hepatitis. That means ensuring at least 50% of infected people know their status by 2020 and at least 75% of those diagnosed with the disease are provided treatment by the same deadline. Moreover, given that a substantial proportion of new hepatitis B infections occur through mother-to-child transmission and during early childhood, it is essential that 90% or more of newborns receive the hepatitis B vaccine’s birth dose and at least 95% of children complete the vaccine’s three-dose schedule. Increased injection safety in health facilities is likewise critical to prevent iatrogenic infections – those which occur in medical facilities.
Achieving these outcomes is crucial if the Region is to eliminate viral hepatitis as a public health threat by 2030, as envisaged in WHO’s Global Health Sector Strategy on Viral Hepatitis. To reach our targets, enhancing knowledge and awareness of viral hepatitis among high-risk groups, civil society and the public more generally is key, especially given that hepatitis is often asymptomatic. Health authorities Region-wide should deploy clear messaging regarding the disease’s signs and symptoms, where they can get tested and treated, and how hepatitis infection can be prevented (for example by vaccination for hepatitis B, and safe sex and safe needle usage for hepatitis B and C). Not only will these interventions help stop the disease’s transmission; they will also ensure more people are aware of their status. Health authorities should also build health workers’ capacity to better detect hepatitis’ signs and symptoms and ensure each and every suspected case is tested.
To do that, health workers must have access to quality point-of-care diagnostics and laboratory testing. All testing kits, for example, should be affordable and quality assured. Results should meanwhile be communicated to individuals confidentially and without prejudice or stigma – outcomes that require targeted health worker education and sensitization programmes. Significantly, viral hepatitis testing should be integrated with HIV, antenatal care and cancer screening and treatment services. It should also occur under a clear set of national viral hepatitis testing guidelines.
Where individuals test positive for hepatitis B or C, access to effective and affordable treatment is vital. While treatments have existed for hepatitis B for some time, Directly-acting antiviral drugs can now cure hepatitis C in up to 95% of cases. In recent years the cost of these treatments has dramatically reduced, making them more accessible than ever, while most are now registered and licensed in each of the Region’s countries. To further increase access, Member States should make full use of flexibilities in global trade agreements, at the same time as ensuring all effective treatments are registered and licensed.
Today, on World Hepatitis Day, it is imperative our optimism is focused on the possible – that we take stock of the challenges we face, the tools at our disposal and our ability to act with decisive efficiency. Though the stakes are high and the burden immense, with urgent, high-level commitment we can find, test and treat the missing millions and reach each of the Regional Action Plan’s targets. Indeed, we can eliminate viral hepatitis as a public health threat by 2030 and – precisely as Dr Blumberg did – save millions of lives and avert needless suffering in the process.