It is possible to eliminate viral hepatitis as a public health threat by 2030 if leaders, particularly in highly affected countries, take action now.
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.
“Countries in the WHO European Region have pledged to eliminate viral hepatitis as a public threat by 2030,” says WHO Regional Director for Europe, Dr Hans Henri P. Kluge. “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.”
Below are some of the important steps to take if we are to reach the goal in the next 9 years.
1. 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.
Although many countries in the Region have made considerable progress in the last 5 years in improving access to treatment, challenges remain with finding those who are infected but asymptomatic and linking them to care.
2. Provide vaccination against hepatitis B to all children and prevent mother-to-child transmission
In countries where hepatitis B is not very common, new infections often occur among sexually active adults. However, the global burden of chronic hepatitis B is largely associated with infections acquired in early childhood, especially from an infected mother to her children, before the introduction of the hepatitis B vaccine.
If infected in the first years of life, hepatitis B usually becomes chronic and may cause cirrhosis or liver cancer later in life.
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.
3. 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.
Stigma and discrimination, including self-stigma and shame, create barriers preventing people from seeking testing and treatment. Stigmatizing and marginalizing people who are vulnerable to hepatitis, such as people in prisons and people who use drugs, often leads to their exclusion from prevention, testing and treatment services.
Experience from countries that are pioneers in hepatitis response demonstrate that hepatitis elimination is only possible by ensuring that no-one is left behind.
4. Set national hepatitis targets for elimination and fund hepatitis services
Since 2016, many countries have adopted national hepatitis elimination plans and many also have dedicated specific funding for hepatitis services, especially for treatment. However, there are still a number of countries lagging behind mainly because of a lack of political commitment.
There is often a perception that the rollout of hepatitis testing and treatment programmes is very costly, but in reality 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 which costs much more – both financially and in terms of human lives.
Experiences of countries in the WHO European Region
Many countries in the Region have: demonstrated political will; increased access to hepatitis prevention, testing and treatment; and made progress towards eliminating viral hepatitis. Below are links to stories that illustrate their efforts.