Is hepatitis elimination feasible by 2030?

Keith Alcorn
Published:
06 August 2020

Major gaps in hepatitis elimination efforts throughout the world threaten achievement of the World Health Organization (WHO) targets for achieving substantial reductions in new infections and deaths due to viral hepatitis by 2030, experts write in Nature Reviews Gastroenterology & Hepatology, in a Viewpoint article published to coincide with World Hepatitis Day.

In 2016, World Health Organization member states agreed to work towards elimination of hepatitis B and C by 2030. Specifically, they set targets of reducing deaths from hepatitis B and C by 65%, by diagnosing 90% of infections and treating 65% of eligible people, as well as preventing 90% of infections.

But even high-income countries may fail to achieve elimination targets, due to lack of national plans and slow progress in diagnosing and treating viral hepatitis. An analysis published earlier this year estimated that only nine high-income countries, including the United Kingdom, Australia, France, Italy and Spain, were on target to meet the 2030 elimination targets.

Experts in viral hepatitis identified gaps and challenges in hepatitis eliminations, as well as priorities for intensification of elimination efforts.

Elimination requires investment, experts agreed. Viral hepatitis could be eliminated in 67 lower- and middle-income countries by 2030 with an investment of $58.7 billion. An investment of $6 billion a year would avert 4.5 million premature deaths by 2030 if generic drugs can be used. Investments to combat COVID-19 may eventually benefit hepatitis control if they lead to improved surveillance and strengthening of healthcare systems.

Efforts are hindered by a lack of national elimination strategies to mobilise resources and co-ordinate activity. A 2017 survey by WHO found that only 84 out of 135 countries had developed a national plan and just 49 had dedicated funding to hepatitis elimination.

Other gaps identified by hepatitis experts include:

  • Very low rates of diagnosis (only 9% of hepatitis B infections are estimated to have been diagnosed worldwide)
  • Lack of implementation of key interventions recommended by WHO, especially hepatitis B birth dose vaccination
  • Lack of access to diagnostic testing or affordable treatment
  • Lack of donor-supported funding mechanisms to support elimination efforts in lower- and middle-income countries.

Where should money and efforts be invested to achieve elimination goals?

  • Leverage synergies with HIV programmes and develop point-of care testing for viral hepatitis that can be integrated into HIV community screening.
  • Use models of community treatment delivery already implemented in HIV to decentralise viral hepatitis treatment.
  • Prioritise development of harm reduction programmes to prevent hepatitis C transmission among people who inject drugs. Harm reduction programmes can provide a gateway to hepatitis screening and treatment for people who may not be engaged with medical services.
  • Raise public awareness of viral hepatitis through mass screening programmes.
  • Improve monitoring and evaluation so that all countries and health systems can report performance in diagnosis, treatment initiation and sustained virologic response.
  • Develop models of care that support microelimination in defined populations rather than using a 'one-size fits all' approach to scaling up diagnosis and treatment. Intensified screening of people who inject drugs is critical for achieving elimination in many settings where the vast majority of new infections occur in this population.
  • Maintain financial support for hepatitis B birth-dose vaccination in lower- and middle-income countries, especially sub-Saharan Africa.
  • Accelerate research efforts to develop a curative treatment for hepatitis B that can be delivered affordably in lower- and middle-income countries, which account for most of the global burden of hepatitis B infection.
  • Accelerate research efforts to develop a preventive vaccine for hepatitis C.

Reference

Cox A et al. Progress towards elimination goals for viral hepatitis. Nature Reviews Gastroenterology and Hepatology, 23 July 2020. (Free full text available).