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 by 2030.
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 Imam 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 aidsmap.com. 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.