The Task Force for Global Health has launched an ambitious program to eliminate hepatitis B and C, two infectious diseases that affect more than 300 million people and kill an estimated 1.3 million people annually – a higher death toll than HIV, malaria or tuberculosis.
The initiative, anchored in The Task Force’s collaborative approach, will create a platform for stakeholders in the viral hepatitis space to share knowledge, access technical assistance, and coordinate operational research to accelerate elimination of hepatitis B and C.
“There is nothing that exists right now that provides these services to help countries eliminate viral hepatitis,” says John Ward, MD, who heads the program and is seconded to The Task Force from the Centers for Disease Control and Prevention (CDC).
The Program for Viral Hepatitis Elimination (PROVE) will work with CDC, World Health Organization (WHO), and a diverse group of private and public global health partners. The startup is seeded by a $460,000 grant from the biopharmaceutical company, Gilead Sciences Inc.
Ward says recent advances in the prevention and treatment of hepatitis B and C make elimination feasible and the initiative timely. Two years ago, the WHO responding to the growing incidence of the diseases, endorsed the goal of eliminating hepatitis B and C as public health threats by 2030.
With PROVE, Ward plans to leverage The Task Force’s expertise in building partnerships to solve large-scale public health problems. “Right now, countries are expected to develop elimination programs but the knowledge to guide these activities is fragmented and in some cases, unavailable. Plus there’s little capacity to help countries start a program or improve ones that are underway.”
The coalition-based approach draws inspiration from other Task Force programs including the Coalition for Operational Research in Neglected Tropical Diseases (COR-NTD), which provides a mechanism for those working on NTD elimination to come together to optimize operational research.
Another model is The Task Force’s TEPHINET program, which serves as the hub for a network of field epidemiologists globally, among other activities. Ward says the field epidemiology training program lays a solid foundation for strengthening national health systems.
“The Task Force has a lot of in-house expertise we can pull from to help countries eliminate viral hepatitis,” says Ward. “If a country wants to implement hepatitis surveillance, we can tap into TEPHINET’s field epidemiologist programs in more than 100 countries. We are also learning from NTD programs here on how to bring partners together to achieve consensus on a research agenda.”
The program will connect those engaged in viral hepatitis elimination and help facilitate problem solving through new tools such as a centralized knowledge repository. “We want to capture the work of those in the field so that all programs can benefit from evidence-based information that is readily accessible,” says Ward.
Ward points out that with partnerships and technical support, elimination of hepatitis B and C is feasible. The elimination goal for hepatitis B – which currently affects more than 250 million people – can be achieved if all newborns are vaccinated against the disease. “We look forward to assisting countries integrate vaccine for the disease into the maternal-child health programs,” says Ward.
More than 95 percent of hepatitis C cases globally can now be cured with a treatment regimen that many countries can afford with medicines averaging as little as a few hundred dollars. As lower-cost medications become more readily accessible, health systems will need to be bolstered to increase uptake. Ward thinks working with other national infectious disease programs – such as HIV and TB – to co-locate testing and treatment services for hepatitis C could expand access and defray costs.
One area of technical assistance that Ward hopes to focus on is helping countries with strategic information analysis. “This is a real gap. There is a need for data to benchmark the burden of disease at the start of an elimination program, monitor implementation of interventions, and track progress toward elimination goals. This information will help countries and the WHO evaluate progress towards elimination.”
While a few countries have already expressed their desire to join PROVE, Ward says the goal is for all national elimination programs to join the network. Ward is setting up a scientific advisory committee to guide long-term commitment of technical assistance to national programs. The advisory group will help the program set priorities based on the country’s burden of disease and its health system capabilities.
Globally, hepatitis B or C is responsible for two out of every three deaths from liver cancer – among the top three deadliest cancers. Non-communicable diseases (NCDs) such as cancer are an area of global health The Task Force is exploring entering. Ward says the connection between hepatitis and liver cancer could provide the gateway for The Task Force’s foray into NCDs.
Hepatitis B and C are viral infections that cause severe inflammation of the liver. Globally, it’s estimated that 90 percent of people with hepatitis B and 80 percent with hepatitis C remain undiagnosed, causing some to unknowingly transmit the infection to others.