Viral Hepatitis is a serious threat to global health. Hepatitis B (HBV) and C (HCV) viruses spread from person to person through blood and other bodily fluids. Hepatitis transmission is an especially big problem in Asian and African countries. Poor infection control in hospitals and inadequate screening of the blood supply allow the virus to spread virtually unchecked. Hepatitis is also a significant health problem for developed countries, including the United States.
Once inside the body, hepatitis launches a stealthy attack on the liver. Silently and without symptoms, these viral infections inflame and scar the liver, eventually leading to severe scarring (cirrhosis) and liver cancer. The lack of outward signs, combined with a lack of knowledge about the disease among the public and doctors, and poor access to screening tests, is why only one in ten people with hepatitis know they’ve been infected (WHO).
It is possible to eliminate viral hepatitis as a public health threat. Highly effective, and cost-effective interventions are available to prevent transmission of the virus, diagnose infections before people become ill, prevent and treat HBV, and cure HCV to prevent premature deaths.
In 2016, the World Health Organization (WHO) set the ambitious goal of eliminating viral hepatitis as a public health problem by 2030. The organization’s aim is to reduce hepatitis transmission by 95 percent, and deaths by 65 percent. Achieving these goals by 2030 will prevent 7 million deaths from viral hepatitis. Dramatic improvements in treatment over the last few years have made this once impossible goal realistic. Thanks to new antiviral drugs, over 95 percent of people with hepatitis C can be cured within three months of starting treatment and the first-ever cancer preventing vaccine can prevent hepatitis B.
Several challenges still stand in the way of developing and implementing successful hepatitis elimination programs.
- Lack of strategic information: Countries need information to assess the extent of their viral hepatitis problem and determine how to prepare their existing health system to deliver hepatitis preventive, testing, and treatment services at a feasible cost.
- Newborn vaccination: A dose of hepatitis B vaccine, preferably within 24 hours of birth, followed by two doses of infant immunizations, decreases the risk of HBV transmission from mother to child by 90 percent. However, only about four in 10 newborns around the world – and fewer than one in 10 children in Sub-Saharan Africa – receive this vaccine.
- Preventing bloodborne exposures: Although infection control has greatly improved, unsafe injections and other exposures in hospitals and clinics are responsible for most new HCV infections. People who inject drugs are also at high risk for hepatitis.
- Testing: To identify people who are infected, countries need access to accurate and affordable screening tests for segments of the general population, and for people with specific hepatitis risks. Testing programs that link to treatment programs are too expensive a burden for many countries to shoulder.
- The cost of treatment: The price of sofosbuvir (Sovaldi), the first curative treatment for hepatitis C, was once $84,000 (Pharmacy Times). Manufacturers like Gilead have since released generic versions of antiviral drugs that have brought the cost of a cure down considerably. More than 100 countries can now access generic medicines for $200 or less per cure. Hepatitis drug prices are expected to drop even more in the years to come.
In the spring of 2018, John Ward, MD, a senior scientist at the U.S. Centers for Disease Control and Prevention (CDC), came to The Task Force for Global Health to develop a viral hepatitis elimination initiative called the Coalition for Global Hepatitis Elimination. Under Ward’s direction, and in collaboration with the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and other partners, the Coalition was born.
The Coalition is a collaborative approach to help countries prevent, screen for, and treat hepatitis B and C. The program will bring together a coalition of stakeholders committed to helping developing countries analyze the scope of their problem, create and implement a plan for combatting hepatitis, and then evaluate its success. In creating this program, the Coalition will leverage best practices of other Task Force programs that have expertise in building and nurturing a collaborative mechanism including the Coalition for Operational Research in Neglected Tropical Diseases (COR-NTD) and TEPHINET—a network of epidemiology training programs in 100 countries.
The aim of the Coalition for Global Hepatitis Elimination is to build a “community of practice around viral elimination.” Experts from around the globe will share the evidence-based information they’ve gathered while working on successful virus elimination programs to help at-risk countries create their own solutions. The program is centered around five main axes:
- Building a community practice
- Providing useful information
- Offering technical assistance
- Developing operational research
- Raising public awareness.
To create a truly global movement, all of the information gathered will be made available in one central repository—www.globalhep.org. Its audience will include Coalition members working on viral hepatitis prevention, care, treatment, and elimination.
To achieve its goals, the Coalition will rely on a number of financial and technical partners. Nonprofit sector partnerships include organizations such as the Clinton Health Access Initiative, which provides low-cost medications to the developing world, as well as Partners in Health, WHO, and the CDC. A number of private sector partners including industry and foundations are providing financial support to the Coalition.
The Task Force has signed up several countries to join the Coalition, including Mongolia, Georgia, Egypt, Iceland, Switzerland, the United States, Japan, Australia, and Rwanda. The hope is that all national elimination programs will eventually join the network.
Supporting Hepatitis Interventions
TEPHINET, a network of field epidemiology training programs based at The Task Force, works with countries in Europe and the Middle East to support the implementation of prevention and intervention strategies for viral hepatitis. TEPHINET manages and supports Infectious Disease Detection, Prevention, and Elimination projects, including providing Support for Hepatitis C Elimination in Georgia, developing Best Practices for Hepatitis C Virus Elimination, and Viral Hepatitis Prevention and Control in Pakistan.
The Task Force for Global Health and the Pan American Health Organization
Country delegations gather virtually this month for the 75th United Nations General
Hepatitis Can Be Eliminated, Help Us Do It!
John Ward, MD
Where We Work
Header photo caption: A teacher in Pakistan explains to his students what hepatitis is and how it affects your liver.