The World Health Organization (WHO) is calling for ambitious
new global targets for diagnosis, treatment and cure of viral hepatitis,
signalling a major increase in momentum towards elimination of viral hepatitis
Dr Gottfried Hirnschall, director of the Department of
HIV/AIDS and Hepatitis of WHO told the World Hepatitis Summit in Glasgow on
Wednesday that WHO will seek international agreement for the following targets:
- 90% reduction in new cases of chronic hepatitis B and C
- 65% reduction in hepatitis B and C deaths
- 80% of treatment eligible persons with chronic hepatitis B and
C infections treated.
Global mortality due to viral hepatitis is now outstripping
deaths from HIV, tuberculosis or malaria, Dr Hirnschall said, and whereas
deaths as a result of HIV and malaria have been declining for several years due
to improvements in prevention and treatment coverage, mortality due to
hepatitis A, B and C is still rising. Approximately 80% of all deaths from
liver cancer are a consequence of viral hepatitis.
The World Health Organization estimates that approximately
400 million people worldwide are living with hepatitis B or C, but awareness of
viral hepatitis as a major public health challenge remains limited. The World
Hepatitis Summit, taking place in Glasgow, Scotland, this week, was convened by
WHO and the World Hepatitis Alliance – the international federation of civil
society groups representing people with hepatitis. The summit is designed to
raise awareness among policy makers of the need for what the organisers
describe as comprehensive national plans encompassing prevention, diagnosis and
treatment of viral hepatitis.
Dr Hirnschall praised several lower-income and middle-income
countries for recent expansions in viral hepatitis programmes.
Georgia, one of several states in Eastern Europe with a high
prevalence of hepatitis C attributable to injecting drug use, has embarked on
an ambitious programme designed to eliminate hepatitis C, in partnership with
the US Centers for Disease Control and Prevention (CDC) and Gilead Sciences,
the manufacturer of sofosbuvir (Sovaldi).
Georgia’s programme is intended, in part, to demonstrate that elimination – the
ending of transmission resulting in the disappearance of disease over several
decades – is a feasible proposition even for middle-income countries with
limited health systems. By negotiating a substantial price reduction in the cost
of treatment from Gilead Sciences, and with advice and training on programme
design and monitoring, Georgia aims to treat 5000 people with advanced liver
damage and to screen 70,000 people for hepatitis C in 2015 alone, with an
increase in volume in subsequent years, Dr David Sergeenko, Georgian Minister
of Labour, Health and Social Affairs told the summit.
Egypt, the country with the highest prevalence of hepatitis
C in the world, has treated 100,000 people in the past year as a result of
negotiated price reductions in the costs of sofosbuvir and pegylated
interferon. Two hundred thousand people registered online for evaluation for
free treatment within three days of the launch of a government website earlier
this year, and 1.1 million had registered by July 2015, but Egypt will only
treat those with the most advanced liver disease – 350,000 people over the next
three years. Despite the advanced disease stage of people treated so far, cure
rates are very high: approximately 85% of those with cirrhosis have been cured,
said Professor Waked of the National Liver Institute, Cairo.
Although ‘champion’ countries are leading the way in the use
of new medications which can cure hepatitis C, funding remains limited at both
national and international levels. WHO is proposing an interim target of 8
million people treated for viral hepatitis by 2020 – 5 million treated for
hepatitis B and 3 million for hepatitis C – but without reductions in drug
prices these targets are unlikely to be achieved.
But, “action will be cheaper than inaction” said Dr
Hirnschall, emphasising the accumulating costs of untreated viral hepatitis in
the forms of liver cancer and hospitalisation. A 90% reduction in new cases of
chronic hepatitis B and C by 2030, for example, would reduce the burden of new
infections from 6-10 million in 2015 to 900,000 per year by 2030. Achievement
of the diagnosis and treatment targets would result in a 65% reduction in
deaths by 2030, from 1.4 million in 2015 to 500,000 deaths in 2030.
How to mobilise the necessary funding – and how to reduce
the cost of treatment – will be the subjects of further discussion during the summit
and will be covered in future reports on infohep.org. Reducing drug costs will
be critical, but reducing the cost of delivering care through simplified
treatment packages and sharing of infrastructure and services with other
programmes such as HIV, immunisation and blood safety programmes will also be
needed to make elimination affordable.
For more information on the World Hepatitis Summit visit www.worldhepatitissummit.com