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In July 2013, I wrote on this site about the story of one million lives lost. It was a story that reflected the escalating impact of viral hepatitis in Asia Pacific; infections that we now know are associated with over one million deaths every year in the region.
The figures were a sobering reminder of the devastating impact these viruses have on the lives of people living in Asia Pacific, revealing for the first time that viral hepatitis causes three times as many deaths as HIV/AIDS and nine times as many deaths as malaria across the region.
In my last post, I wrote about the fact that we now have all the evidence we need to prove that viral hepatitis is an urgent public health priority in Asia. That was true six months ago and it is certainly true today, as we study the gravity of the situation across individual countries, following the release of country mortality data (deaths from acute infection, as well as from cirrhosis and liver cancer related to chronic viral hepatitis infection) from the Global Burden of Disease Study (GBDS).
This new data, which the Coalition to Eradicate Viral Hepatitis in Asia Pacific (CEVHAP) has populated into an interactive graphic to help raise awareness of the impact of viral hepatitis, shows that six of the ten countries with the highest levels of mortality are in the Asia Pacific region, including the four countries with the highest viral hepatitis death rates (China, India, Japan and Indonesia).
An analysis of the data also reminds us that one of the major barriers to combating viral hepatitis is the fact that the highest disease burden is often found in Asia Pacific countries that can least afford the resources needed to tackle these diseases. India, Indonesia, Pakistan and Bangladesh are four such countries that appear in the list of the ten countries with the highest annual mortality globally.
Unfortunately, despite the significant death toll, a recent World Health Organization (WHO) policy survey of ministries of health worldwide found that only half of the countries surveyed in Asia Pacific reported having a national strategy for the prevention and control of viral hepatitis, indicating that much more needs to be done if we are to begin the monumental task of eradicating these diseases.
Closer analysis of this data is as illuminating as the new mortality data, showing that despite the last decade witnessing significant breakthroughs in the development of effective medicines for chronic hepatitis B and C, only half of the countries in Asia Pacific make publicly funded treatment available. Even fewer governments in Asia Pacific report making free hepatitis B and hepatitis C testing available (46% and 35%, respectively), a situation that goes some way to explaining why so many patients are diagnosed late and often at a stage when their infection has progressed to the point where they have severe and, in many cases, untreatable liver disease.
With such high disease burden and with viral hepatitis policy largely in its infancy in most countries, there is much room for improvement, but where should public health experts start?
The WHO’s Global Framework for Action, a policy blueprint aimed at preventing, treating and saving the lives of people infected with hepatitis through targeted regional and country-specific strategies, is an excellent starting point, but its effectiveness is tied to the political will to tackle these infections, which varies enormously from country to country.
This variability is evident in the fact that just 8 of the 26 Asia Pacific governments that responded to the WHO policy survey reported having a government unit/department responsible solely for viral hepatitis.
With such limited resources being allocated to viral hepatitis within governments, cross-sector partnerships become increasingly important; having the capacity to fill critical knowledge, expertise and even funding gaps, where they exist.
I am heartened to see that a new WHO resolution on viral hepatitis is due to be debated at this year’s World Health Assembly, only the second time in the history of the organization that a resolution addressing the full impact of these diseases has been addressed by the agency. Reports suggest that at least 14 countries are currently sponsoring this resolution, which is an improvement on the first resolution passed in 2010, which had just four initial member state sponsors.
If passed, the resolution’s success will also rest on the ability of the international community to form cross-sector partnerships that mobilize both the expertise and the funds needed to tackle viral hepatitis. The WHO Global Hepatitis Network, of which CEVHAP is a founding member, is an important foundation step, but it does not address the need for an international funding mechanism to support efforts to combat viral hepatitis in low-income countries.
For these reasons, CEVHAP has this week convened a policy forum at the annual meeting of the Asian Pacific Association for the Study of the Liver, as we look to establish a regional blueprint for the establishment of a cross-sector partnership response to these diseases.
The global response has built momentum, but to date, action in Asia Pacific has largely been slow and uncoordinated, with very few cross-sector partnerships to support national or regional efforts to combat viral hepatitis. Each country in Asia Pacific can derive great benefits from a more coordinated national response that involves cross-sector partnerships working together to implement the WHO’s Framework for Global Action. CEVHAP and other organizations stand ready to help, because together, we can save lives.
Together with my colleagues, I look forward to providing further progress updates regarding government and cross-sector action to combat viral hepatitis in the Asia Pacific region, as the outcomes of the World Health Assembly debate and our own policy forum chart new paths and add greater weight to the global fight.
Professor Ding-Shinn Chen is Chair of the Coalition to Eradicate Viral Hepatitis in Asia Pacific (CEVHAP) and Immediate Past Dean of the College of Medicine, National Taiwan University