COPENHAGEN, July 28: It is possible to eliminate viral hepatitis as a public health threat by 2030 if leaders, particularly in highly affected countries, act now, says WHO Europe
Globally, one person dies every 30 seconds from a hepatitis-related illness, so even in the current COVID-19 crisis, we can’t wait to act on viral hepatitis. This year’s World Hepatitis Day campaign, with its message of ‘Hepatitis Can’t Wait’, urges leaders and policy-makers to accelerate the hepatitis response, encouraging people to get advice on hepatitis prevention, testing and treatment.
WHO Regional Director for Europe, Dr Hans Henri P. Kluge, said:
“Countries in the WHO European Region have pledged to eliminate viral hepatitis as a public threat by 2030. This is possible even if COVID-19 may have set us back. We know the science and we have the tools – with renewed political commitment, clear targets and funding, we can prevent hundreds of thousands of unnecessary deaths.”
Here are four important steps to take if we are to reach the goal by 2030:
Improve access to diagnosis and treatment
There are 14 million people in the Region living with chronic hepatitis B and 12 million with hepatitis C, and a majority are unaware of their infection. Chronic hepatitis infections are often asymptomatic, slowly leading to advanced liver disease – cirrhosis and liver cancer. When symptoms of these conditions appear, it is often too late. People living with hepatitis should not have to wait for testing and treatment until their chronic liver disease reaches an advanced stage. Diagnostics for hepatitis need to be accessible now, so people can be linked to care in a timely manner and receive life-saving treatment.
Provide vaccination against hepatitis B to all children and prevent mother-to-child transmission
There are effective measures to prevent mother-to-child transmission of hepatitis B: vaccination of the child with the first dose of hepatitis B vaccine in the first 24 hours of life, followed by 2 or 3 doses; testing of pregnant women – now recommended for all pregnant women; and targeted prevention that may include treating infected pregnant women to further decrease the risk of transmitting the infection to the newborn, which is also an important measure.
End stigma and discrimination
Hepatitis infections carry different types of stigma. Hepatitis C is often associated with intravenous drug use, although everyone is at risk because they may have been exposed due to unsafe health care. People from marginalized populations are doubly stigmatized, both because they are part of a risk group and because they may have hepatitis C. In some countries, medical workers and other professionals may be fired from work if they have hepatitis B or C. Instead, they should be offered treatment and allowed to work. Experience from countries that are pioneers in hepatitis response demonstrate that hepatitis elimination is only possible by ensuring that no-one is left behind.
Set national hepatitis targets for elimination and fund hepatitis services
There is often a perception that the rollout of hepatitis testing and treatment programmes is very costly, but the costs can be brought down considerably through reducing the price of drugs and simplifying the delivery of hepatitis services. Eliminating hepatitis is cost-effective. Prevention of viral hepatitis can be integrated with other country health programmes, including universal infant immunization, improving blood safety and infection prevention and control in the healthcare setting, and harm reduction for people who use drugs. Simple tools allow for testing and treating people with chronic hepatitis, thus preventing liver cirrhosis and cancer. The treatment of these conditions costs much more than prevention – both financially and in terms of human lives.
CASE STUDY: Uzbekistan
A pilot project in Uzbekistan has demonstrated that trained and empowered primary health care professionals help increase testing and improve management of chronic viral hepatitis.
Hepatitis B and C virus infections are highly prevalent in Uzbekistan and are a priority for the government. In 2016, an estimated 2.5 million people were living with hepatitis B and 1.3 million with hepatitis C infection in the country.
In December 2019, the Center for Disease Analysis Foundation (CDAF) launched a 1-year pilot programme in the capital city Tashkent, in partnership with Uzbekistan’s Research Institute of Virology and Ministry of Health. The pilot allowed general practitioners to carry out testing and treatment at the primary health care level, resulting in patients gaining access to free testing and affordable treatment.
Nurses participating in the programme were trained on the use of rapid diagnostic tests, motivational interviewing and patient registration. Doctors were trained on the interpretation of laboratory results and treatment and management of uncomplicated cases of chronic hepatitis B and C.
Of the many patients who benefited from the pilot project, one offered this testimony: “As my family physician offered free testing, I got tested and learned that I was infected with the virus. Under my doctor’s guidance, I can count on a full recovery in due course. The project also benefited my family budget because the diagnostics was free of charge, and the medications were affordable”.
The project in Uzbekistan is one of many examples of ways in which countries across the WHO European Region are successfully tackling viral hepatitis.