7 steps to hepatitis elimination
Sustained action is needed now if we are to capitalise on the opportunity to eliminate viral hepatitis by 2030.
Viral hepatitis kills more people than either HIV or malaria, but has historically received less global attention despite its devastating impact on communities around the world. But the tide is slowly changing – here are 7 steps to viral hepatitis elimination.
1. Global action, national plans
In 2016, the World Health Assembly (the decision-making body of the World Health Organization) adopted the Global Health Sector Strategy on Viral Hepatitis, an action plan to achieve Sustainable Development Goal 3 – which calls for specific action to combat viral hepatitis. The WHO has been working with countries on an elimination plan that focuses specifically on hepatitis B and hepatitis C, which together account for around 96% of all hepatitis deaths. Left unchecked, chronic hepatitis can lead to liver cirrhosis, liver cancer, and premature death. But too few people are accessing the services they need, and too few countries are devising and rolling out national plans.
Getting people testing for hepatitis remains one of the biggest obstacles in the push to end viral hepatitis by 2030. Just 9% of people infected with hepatitis B (HBV) and 20% of people infected with hepatitis C (HCV) were aware of their status in 2015, suggesting targets of diagnosing 50% of all people infected with viral hepatitis by 2020, and 90% by 2030, are off-course.
Health systems are struggling to reach those not testing, despite the incentives of there being a cure for HCV, and treatment and a vaccine for HBV. In the next few years, 107 million of the 257 million people infected with HBV will need to become aware of their status, and 15 million of the 71 million people infected with HCV if targets are to be reached. Treatment coverage is also far too low. In 2015, only 8% of those diagnosed with HBV and 7.4% of those diagnosed with HCV were receiving treatment.
4. Hepatitis B immunisation
For HBV, the priority remains getting infants immunised from HBV and preventing mother-to-child transmission. Immunisation programmes which aim for three-dose coverage of the HBV vaccine are faring well at 84% (2030 target: 90%), but with geographical variation – America and Asia Pacific regions performing better than Europe and Africa.
5. Preventing mother-to-child transmission
Many countries are still failing to get HBV treatment to infants and mothers as part of preventing mother-to-child transmission. In 2015, just 39% (2030 target: 90%) of infants were vaccinated within 24 hours of birth. For HCV – there is currently no safe and effective treatment to prevent mother-to-child transmission, and no effective treatment approved for use in under 12s. An estimated 2.1 million children (those under the age of 15) are thought to be living with chronic hepatitis, so further research into appropriate drugs are urgently needed.
6. Blood safety
Other prevention targets for both HBV and HCV are around blood safety, aiming for 100% coverage of blood screening and elimination of unsafe injecting practices (0%). There is evidence of progress here, with 97% and 5% coverage respectively.
7. Harm reduction
But getting clean needles to drug users is another story. Each person who injected drugs in 2010 (latest available data) received, on average, just 27 syringe and needle sets. Global targets call for 300 sets per person per year. While harm reduction often lacks the political will to deal with these issues – it is also suffers from a lack of data, resulting in a hidden epidemic.
In a recent commentary, WHO staff Yvan J-F Hutin, Marc Bulterys, and Gottfried Hirnschall state, “The 2015 service coverage indicators are a clear call for immediate and sustained action so that these life-saving services can be integrated in the universal health coverage package in order to achieve elimination by 2030.”
This story was developed by Avert and the World Health Organization (WHO) Department of HIV/AIDS and Global Hepatitis Programme.