On World Hepatitis Day 2016, World Health Organisation (WHO) is urging countries to take rapid action to improve knowledge about the disease, and to increase access to testing and treatment services. Today, only 1 in 20 people with viral hepatitis know they have it. And just 1 in 100 with the disease is being treated.
“The world has ignored hepatitis at its peril,” said Dr Margaret Chan, WHO Director-General. “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. Around the world 400 million people are infected with hepatitis B and C, more than 10 times the number of people living with HIV. An estimated 1.45 million people died of the disease in 2013 – up from less than a million in 1990.
In May 2016, at the World Health Assembly, 194 governments adopted the first-ever Global Health Sector Strategy on viral hepatitis and agreed to the first-ever global targets. The strategy includes a target to treat 8 million people for hepatitis B or C by 2020. The longer term aim is to reduce new viral hepatitis infections by 90% and to reduce the number of deaths due to viral hepatitis by 65% by 2030 from 2016 figures.
The strategy is ambitious, but the tools to achieve the targets are already in hand. An effective vaccine and treatment for hepatitis B exists. There is no vaccine for hepatitis C but there has been dramatic progress on treatment for the disease in the past few years. The introduction of oral medicines, called direct-acting antivirals, has made it possible to potentially cure more than 90% of patients within 2–3 months. But in many countries, current policies, regulations and medicine prices put the cure out of most people’s reach.
“We need to act now to stop people from dying needlessly from hepatitis,” said Dr Gottfried Hirnschall, WHO’s Director of the HIV/AIDS Department and Global Hepatitis Programme. “This requires a rapid acceleration of access to services and medicines for all people in need.”
Some countries, however, are finding ways to get services to the people who need them. These efforts are made easier by the declining price of hepatitis C medicines. Prices are now dropping, particularly in countries that have access to generic drugs. In 2015, a preliminary analysis estimated that 300 000 people living in low- and middle-income countries had received hepatitis C treatment based on the new direct-acting antivirals.
In Egypt – a lower–middle-income country with one of the world’s highest prevalence rates of hepatitis C – 200 000 people were treated during the past 12 months, and the price of hepatitis C treatment for each person dropped from US$ 900 in 2014 to less than US$ 200 in 2016. Other countries have stepped up efforts against hepatitis C. Brazil and Pakistan are already expanding treatment coverage rapidly, and Georgia has announced a plan to eliminate the disease.
Hepatitis B and C infections are transmitted through contaminated blood as well as through contaminated needles and syringes in healthcare setting and among people who inject drugs. The viruses can also be transmitted through unsafe sex and from an infected mother to her newborn child.
As of 2014, 184 countries vaccinate infants against hepatitis B as part of their vaccination schedules and 82% of children in these states received the hepatitis B vaccine. This is a major increase compared with 31 countries in 1992, the year that the World Health Assembly passed a resolution to recommend global vaccination against hepatitis B.
In addition, implementing blood safety strategies, including quality-assured screening of all donated blood and blood components used for transfusion, can help prevent transmission of hepatitis B and C. Safe injection practices, eliminating unnecessary and unsafe injections, can be effective strategies to protect against transmission. Harm reduction services for people who inject drugs are critical to reduce hepatitis in this population. Safer sex practices, including minimizing the number of partners and using barrier protective measures (condoms), also protect against transmission.