Elimination of viral hepatitis by 2030 is now the goal, advocates say

Keith Alcorn
12 April 2016

Hepatitis advocates are to launch a push for a global campaign to eliminate viral hepatitis by 2030. The move is part of a drive to raise political commitment for tackling viral hepatitis.

The NOhep campaign, established by World Hepatitis Alliance, will be a global platform designed to bring together activists, patient groups, medical professionals and policy makers, and to build public awareness of viral hepatitis as a global health problem.

Elimination means reducing the annual number of infections from 6-10 million a year to less than 1 million per year by 2030, so eliminating viral hepatitis as a major public health threat.

The call for elimination marks a big step forward in thinking about viral hepatitis. Just a few years ago, the World Health Organization had no staff working on viral hepatitis; today the organisation has a Global Hepatitis Programme and a draft Global Health Sector Strategy on Viral Hepatitis which sets the goal of eliminating viral hepatitis by 2030. Furthermore, the 2030 Agenda for Sustainable Development will call on UN member states to 'combat' hepatitis C – not as final as 'ending' hepatitis, but “the simple fact that we are there is very important, since we weren’t mentioned in the Millenium Development Goals,” said Raquel Peck, chief executive officer of the World Hepatitis Alliance, in a recent webinar.

“There is so much catching up to do that if we don’t have ambitious goals, we won’t have the drive to move things fast,” said Raquel Peck.

“The big advantage that we have is effective interventions – we know what to do. We just have to do it at scale,” said Stefan Wiktor, head of the hepatitis programme at the World Health Organization. Implementing needle and syringe programmes, providing opioid substitution therapy, immunising infants and implementing universal precautions in health care settings – all at sufficient scale – have the potential to reduce transmission of viral hepatitis by 90% by 2030.

Advocates for viral hepatitis issues are also part of a growing international push for universal health coverage, through improvements to health systems and expanded coverage of essential interventions.

“It’s really important to understand that the era of disease-specific programmes is over. We’d love to see a huge investment in hepatitis but we really don’t see it happening,” said Stefan Wiktor.

“Our argument is that by tackling hepatitis you will be automatically strengthening health systems, because it crosses over so many areas – blood safety, immunisation programmes, injection safety and maternal-child health,” said Raquel Peck.

The NOhep campaign aims to convert hepatitis C from a stigmatised, low-priority health issue into a social justice issue by focussing on the goal of elimination and on the personal achievements of people living with viral hepatitis.

The NOhep campaign will be launched on World Hepatitis Day, as an interactive web platform which can be used to connect people, lobby governments and international organisations and mobilise supporters. Organisations and individuals will be able to sign up as supporters and download campaign materials from 29 April at the World Hepatitis Day website.

Elimination will also require very substantial reductions in drug prices to make treatment affordable. The HepCoalition is campaigning for price reductions, wider access to generic drugs under the terms of voluntary licensing agreements and the use of TRIPS+ provisions in international trade agreements to allow compulsory licensing of drugs to treat viral hepatitis where drugs remain unaffordable.

Building political commitment to end viral hepatitis will require pressure at many different levels. As well as international policy documents and resolutions – which governments sign up to, making them accountable to advocates at national level – national governments also need to be encouraged to act by data which shows the impact of viral hepatitis at national level and the economic and social benefits of eliminating the problem.

A meeting taking place this week ahead of the International Liver Congress in Barcelona, organised by a group of partners including World Hepatitis Alliance, European Liver Patients Association, Infohep.org, the World Federation of Science Journalists and Deusto Business School, Spain, will look at some of the tools that can be used to build awareness of viral hepatitis and influence governments and payers.

These include a macro-economic analysis tool developed in Germany, a database of action plans, tools and case studies designed to support implementation of viral hepatitis programmes, and the use of survey data to influence governments and raise public awareness.

One example of the use of survey data as an influencing tool is HCV Quest, a 73-country survey of people with viral hepatitis published last week by the World Hepatitis Alliance.

The survey found that nearly seven out of ten people hadn’t heard of hepatitis C at the time they were diagnosed, despite a 2010 World Health Assembly resolution in which member states agreed to raise public awareness of hepatitis C. Awareness at the time of diagnosis was as low as 13% in Brazil.

A high proportion of people with health problems probably caused by hepatitis C were not offered a test for the virus when they visited a doctor with these symptoms. Rates of testing by general practitioners were below 30% in Europeans and North Americans surveyed.

Awareness of the existence of patient organisations and the support available to people with hepatitis C was very limited, adding to the sense of stigma and social isolation resulting from a diagnosis of hepatitis C.

The survey findings have been broken down into reports covering 22 countries and will be used by patient groups to advocate with government, health care professionals and media for greater awareness of hepatitis C and the challenges of living with the infection.

A joint workshop on Thursday 14 April, run by World Hepatitis Alliance and the European Association for Study of the Liver, will look at regional targets for elimination and the role of medical and professional societies and patient organisations in achieving the targets.

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