World Hepatitis Day: Time for action
July 28 is World Hepatitis Day. It is an opportunity to step up national and international efforts on hepatitis, encourage actions and engagement by individuals, partners and the public and highlight the need for a greater global response as outlined in the World Health Organisation (WHO)’s Global Hepatitis Report of 2017. I will be using materials from the websites of the WHO and World Hepatitis Alliance. Some materials were pulled from the World Hepatitis Report 2024.
Hepatitis is the term used to describe inflammation of the liver. It can be caused by various factors including viral infections, alcohol consumption and autoimmune responses.
Viral hepatitis is a serious infection that causes liver damage and liver cancer. Among the five strains of the hepatitis viruses (A, B, C, D, E), B and C are the most common.
The date of July 28 was chosen because it is the birthday of Nobel-prize winning scientist Dr Baruch Blumberg, who discovered hepatitis B virus (HBV) and developed a diagnostic test and vaccine for the virus.
Under the theme “It’s time for action”, this year’s World Hepatitis Day highlights the need for collaborative action to expand access to diagnosis and treatment in countries. Only one in four people living with hepatitis B have been diagnosed and only one in five received appropriate treatment. Similarly, only one in two people living with hepatitis C have been diagnosed and only one in six have been cured. It is vital to bring hepatitis prevention and treatment services closer to communities at the primary health care level to reach unreached populations and reduce illnesses and deaths. By acting now, we can save lives, prevent new infections, reduce liver cancer cases, decrease deaths, lower healthcare costs, and achieve hepatitis elimination goals by 2030.
Low coverage of testing and treatment is an important gap to be addressed in order to achieve the global elimination goals by 2030.
Every year, 1.3 million people lose their lives to hepatitis. And new data from the World Health Organisation shows the number of deaths is rising. Hepatitis is now the world’s deadliest virus, after COVID-19. There are over two million new cases of hepatitis every year. Over 300 million people are living with hepatitis. Hepatitis is the leading cause of liver cancer. There are only six years left to meet the global goal of eliminating hepatitis by 2030 – but we are moving backwards. Take Action. Test. Treat. Vaccinate.
Improved data from 187 countries show that the estimated number of deaths from viral hepatitis increased from 1.1 million deaths in 2019 to 1.3 million in 2022. Hepatitis B caused 83 per cent of these deaths and hepatitis C 17 per cent. The increase in estimated mortality since 2019 suggests that the number of hepatitis-related cancer cases and deaths are increasing. Access to effective interventions must be urgently expanded to save lives and prevent a future generation of new infections, cancer cases and deaths.
Overall, about 304 million people were living with viral hepatitis B and C in 2022. An estimated 254 million were living with hepatitis B and 50 million were living with hepatitis C. Half the burden of chronic hepatitis B and C infection is among people 30–54 years old; and men account for 58% of all cases. An estimated 12% of the burden is among children, in particular for hepatitis B. Hepatitis B and C affect the general population in many regions but also specific populations such as those at higher risk of or with a history of exposure through unsafe blood supplies, medical injections and other health procedures; newborns and children at risk through vertical (mother-to-child) transmission of hepatitis B, notably in settings with high hepatitis B prevalence; indigenous populations and mobile and migrant populations from countries with higher prevalence; and key populations, including people who inject drugs, people in prisons and other closed settings, sex workers and gay men and other men who have sex with men, who may be disproportionately affected in different contexts.
There is regional variation in the viral hepatitis burden and response. The WHO African Region accounts for 63% of new hepatitis B infections, and yet only 18% of newborns in the Region receive the hepatitis B birth-dose vaccination. The Western Pacific Region accounts for 47% of hepatitis B deaths, and treatment coverage remains low. Among high-income countries, the United States of America has an increasing burden of hepatitis C among people who use drugs.
The global response is off-track towards 2030 goals. If action is taken now, universal access to viral hepatitis interventions will have a major public health impact – reducing incidence by 90%, mortality by 65% and the costs of achieving global targets by 15%. The benefits of achieving global targets will be apparent by 2030, saving 2.85 million lives and averting 9.5 million new infections and 2.1 million cases of cancer. Looking towards 2050, this will save nearly 23 million lives and prevent nearly 53 million new viral hepatitis infections and 15 million cases of cancer. There is a window of action in 2024–2026 to regain the trajectory to achieve the Sustainable Development Goals.
Based on a range of results obtained from several country investment case studies, there is an estimated return on investment of US$ 2–3 for every dollar invested to prevent liver cancer deaths and increasing costs of cancer treatment and care in the future. The global coverage of viral hepatitis prevention, diagnosis and treatment is too low, and people living with viral hepatitis and their communities continue to bear the heavy burden of the epidemics.
Only 13 per cent of people living with chronic hepatitis B infection had been diagnosed and close to three had received antiviral therapy at the end of 2022. Only 36 per cent of people living with hepatitis C had been diagnosed between 2015 and 2022, and 20 per cent had received curative treatment, highlighting the opportunity for better linkages between diagnosis and provision of care. Overall, almost seven million people were receiving hepatitis B treatment at the end of 2022 and 12.5 million people have received hepatitis C curative treatment, far below the global targets for eliminating viral hepatitis by 2030.
Globally, in 2022, an estimated 45 per cent of infants received a dose of the hepatitis B vaccine within 24 hours of birth. Coverage varies by region, ranging between 18 per cent in the African Region – the WHO region with the highest prevalence of hepatitis B. We need to step up efforts to curb the burden of hepatitis B and C.
DR EDWARD O. AMPORFUL
CHIEF PHARMACIST
COCOA CLINIC
