We are living through a “golden age” of global health with
respect to communicable diseases. As a result of scientific breakthroughs,
global solidarity and focused funding, mortality associated with leading
communicable diseases is on the decline. Indeed, since 2000, the progress in combating
the leading communicable diseases (HIV, tuberculosis and malaria) has prompted
the global community to commit to end these epidemics once and for all by 2030.
But there is one glaring exception to the good news
regarding communicable diseases. While mortality from HIV, Tuberculosis, and
Malaria is now declining, mortality caused by viral hepatitis is on the rise.
The viral hepatitis challenge is monumental, as it is the seventh leading cause
of death worldwide. Annual deaths from hepatitis (1.34 million) exceed the
number of AIDS-related deaths (1 million) and approach mortality associated with
tuberculosis (1.67 million).
The continued rise in hepatitis-related deaths is both
alarming and ironic, as hepatitis is wholly preventable and, in the case of
hepatitis C, curable. Although viral hepatitis is a major global health
challenge, the world has yet to bring to the fight against hepatitis the
seriousness, passion and focus that we have seen for other leading communicable
diseases.
However, there is now reason to believe that the global
community is ready to take viral hepatitis seriously. In 2014, the World Health
Assembly called on #WHO to develop a global strategy for viral hepatitis. Two
years later, #WHO Member States unanimously endorsed the WHO Global Health
Sector Strategy for Viral Hepatitis 2016–2021.
This global strategy aims to achieve for viral hepatitis
what the world now seeks for other leading communicable diseases—eliminating
hepatitis as a public health threat by reducing new infections by 90% and
mortality by 65% by 2030.
Challenges to
hepatitis elimination
Scientific advances and new political momentum have
generated optimism in the global response to viral hepatitis. However, reaching
the goal of ending viral hepatitis as a public health threat will demand that
persistent challenges to progress are confronted and overcome.
Weak health systems undermine hepatitis prevention efforts.
As HCV transmission primarily occurs through unsafe blood or injections, simple
infection control procedures, if mainstreamed and enforced across health
systems, have the potential to sharply lower HCV incidence.
However, important
parts of the prevention agenda for viral hepatitis require action that extends
well beyond the health sector. For example, access to safe water supplies and
sanitation are critical to the prevention of hepatitis A and E.
The lack of clear, reliable evidence on the prevalence of
hepatitis and the distribution of viral hepatitis among undeveloped countries impedes
the development and monitoring of sound national plans to fight viral
hepatitis. In contrast to the HIV response, which benefited from strong to
sustained donor support, no dedicated, catalytic funding source is readily
available for hepatitis prevention and treatment services. In part due to the
low priority accorded to viral hepatitis by leading donors, prevention and
treatment of hepatitis persist as low political priorities in many countries.
The drugs historically available to treat viral hepatitis
also slowed progress, due to their limited effectiveness and to their high
prices. The emergence of affordable, highly effective, easier-to-take
direct-acting antivirals offers the possibility of transcending the inherent
limitations of older drugs. In the case of HBV, however, treatment regimens are
complex and lifelong, posing challenges to efforts to reduce HBV-related
mortality.
Translating rhetoric
into action: key actions steps
Although international donors have played a key role in the
progress made in recent years against HIV, TB and Malaria, the truth is that
national governments have largely driven efforts that have reversed these
epidemics. Similarly, in the case of viral hepatitis, national governments must
own and lead the development of evidence-based policies and programmes to
sharply lower morbidity and mortality associated with viral hepatitis.
National governments should leverage progress towards
universal health coverage to ensure that the response to viral hepatitis is
equitable and grounded in a respect for human rights. While national
governments must lead the fight against hepatitis, they cannot conquer viral
hepatitis on their own, underscoring the urgent need to partner and collaborate
with communities, people living with viral hepatitis, and other key sectors.
Several key actions are needed. First, all infants and
newborns must be immunized at birth for HBV, with an additional two to three
doses required as follow-up, depending on national guidelines. At no more than
50 cents per child, the HBV vaccine saves a lifetime of health risks, including
cirrhosis and liver cancer. Although the three-dose regimen has moderately high
coverage (87%), only 23% of children globally are immunized at birth.
In addition, injection safety in health settings must be
ensured, including through the use of safe syringes that prevent re-use and
sharp injury. As in the case of immunization, costs associated with injection
safety are minimal, as each safe syringe costs no more than 10 cents extra
while minimizing transmission risks for HBV and HCV infection, both of which
are costly, life-threatening conditions.
Blood safety must also be assured, by requiring the
screening of every unit of blood and related products for hepatitis B and C to
block a major route of hepatitis transmission. Drinking water must be made
safe, and all people should have access to effective sanitation. Not only is
this approach one of the most effective prevention strategies for viral
hepatitis, but it is also a basic human right.
Finally,
immediate steps are needed to scale up diagnostic and treatment facilities.
Persons infected with Hepatitis B or C virus are usually unaware of their
infection. Effective treatments exist for viral hepatitis at reasonable
cost—under US$ 160 for a curative regimen for HCV and US$ 250 for a year’s
worth of treatment for HBV. Yet, despite the affordability of these life-saving
regimens, few patients in globally—3% for people with HBV infection, and 9% of
people with HCV—currently have access to testing and treatment services.
.
Failure to ensure access to effective diagnostic and
therapeutic tools contributes to substantial, preventable illness and mortality
associated with cirrhosis and liver cancer. It also wastes precious financial
resources. Direct-acting antivirals for treatment of HCV are cost-effective
within 2 years of treatment and cost-saving within 10 years of treatment.
Conclusion
We have the tools and the knowledge we need to prevent
morbidity and mortality associated with viral hepatitis—including universal
vaccination of newborns and infants, which would have the greatest impact on
new HBV infections, as well as treatments for HBV and HCV that are now
affordable. Now we must act to put these tools and knowhow into action. If we
do not, we will miss the chance to end viral hepatitis by 2030.
Thus far, political commitment has been the key missing
ingredient in the fight against viral hepatitis. With momentum from newer
scientific breakthroughs, global commitments and reductions in the prices of
key medicines, much stronger political action is needed to take the hepatitis response
to the next level.
National action plans must be fully funded and implemented,
and political leaders need to actively engage physicians’ associations,
academics, patient support groups, affected populations, non-governmental
organizations, the private sector, media and celebrities to build awareness of
the hepatitis challenge and mobilize diverse sectors around the common goal of
ending hepatitis. #WorldHepatitisDay #EliminateHepatitis #StopHepatitis
#Prevention #TakeScreenTests #TakeAction
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