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Hepatitis: Asia's silent epidemic

Source: Mon, 28 Jul 2014 03:15 GMT
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A relative of a person suffering from Hepatitis-B helps him drink water at a hospital in Modasa, in India's western Gujarat state February 17, 2009. REUTERS/Amit Dave
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An online “flash mob” will take place today to remind people that viral hepatitis kills 1.4 million people globally every year.  Organised for World Hepatitis Day by the World Hepatitis Alliance, the campaign is expected to reach over 11.5 million people.  

Across the world, activities ranging from public seminars and free blood tests to concerts and documentary screenings are also underway to raise awareness about the diseases.

Behind the scenes, driving these activities are the patients, clinicians, advocates and government representatives who want the world to recognise that viral hepatitis is a major global health threat, and that a coordinated response is urgently needed.  This is particularly important in Asia Pacific – the epicentre of the epidemic – which accounts for 70 percent of the global viral hepatitis mortality.

Few people in Asia Pacific are aware that more than 1 million people die from viral hepatitis every year in the region, a death toll three times higher than HIV/AIDS and nine times higher than malaria.  Even fewer know that over three-quarters of these deaths result not from acute hepatitis infection, but from liver cancers and cirrhosis caused by chronic infection with hepatitis B or C.

Viral hepatitis is the leading cause of liver cancer. In the Global Burden of Disease Study 2010, chronic hepatitis B and C have emerged as the most significant determinants of liver cancer deaths, four times greater than alcohol. The study, led by the Institute for Health Metrics and Evaluation of the University of Washington, surveyed 291 diseases and injuries and 67 risk factors over ten years globally.

The fact that so many people die from liver cancer caused by viral hepatitis is largely a consequence of inaction. Viral hepatitis is preventable and in the case of hepatitis C, it is mostly curable. Hepatitis transmission can be prevented in the first place through, for example, vaccination or safe practices in injected drug use.  Chronic hepatitis B and C infections can also be prevented from turning into liver cancer through disease management and treatment.  However, in reality, many undiagnosed cases of chronic hepatitis B and C are simply allowed to develop into liver cancer. 

To be sure, a complicating factor is that viral hepatitis often shows no symptoms until the late stage of infection.  As such, many people are not aware that they are infected.  They are often diagnosed only when the symptoms become apparent or when the infection has already developed into liver cancer – too late for treatment or the prevention of transmission to others.  But this is only the surface of the problem.

The fundamental problem is that national governments have not been taking a coordinated approach to tackle viral hepatitis, compared to their more organised response to HIV/AIDS, tuberculosis and malaria.  No amount of hepatitis B vaccine or hepatitis B and C drugs can control the spread of viral hepatitis if there is no monitoring of at-risk communities, no information about disease prevention and management, or no training for primary healthcare professionals to diagnose and refer cases to specialists who know how to treat the diseases.

The lack of coordinated response by national governments is reflected in the findings of the World Health Organization’s (WHO) global policy survey in which 126 health ministries across the world participated. It showed that half of the Asia Pacific countries in the survey do not have a national strategy for tackling viral hepatitis, and despite the high death toll, only 31 percent of participating countries have a government unit dedicated to viral hepatitis.

Where should governments begin? A coordinated national response starts with a national action plan that lays down an integrated set of actions to prevent transmission and reduce the impact of infections on people living with viral hepatitis.

The WHO has developed a Framework for Global Action to guide governments in the development and coordination of national action plans.  The Framework brings together four key areas of work, which we at the Coalition to Eradicate Viral Hepatitis in Asia Pacific (CEVHAP) call by the mnemonic, “ASAP”:

A for Awareness raising, partnership promotion and resource mobilisation

S for Scientific evidence to drive policy and action

A for Access to immunisation and information to prevent transmission

P for Provision of screening, care and treatment

All four areas of work are needed for a coordinated approach to combating viral hepatitis within countries, regardless of location or economic and cultural differences. Many countries are implementing only parts of the WHO Framework, and have as such not been able to reduce the incidence and mortality of viral hepatitis. A comprehensive coordinated approach in response to viral hepatitis is urgently needed in most countries.

Of course, there remains the problem of funding to support the lasting implementation of action plans, especially in low and middle-income countries. But without a coordinated national action plan, international donors cannot be assured that their investment into viral hepatitis prevention and control will be effectively used. 

National governments do not have to work in a silo to develop and implement coordinated their own action plans. Drawing on lessons learnt from combating HIV/AIDS, tuberculosis and malaria, cross-sector partnerships involving multilateral organisations, NGOs and the pharmaceutical industry have proven to be effective in mobilising expertise and the resources needed to tackle viral hepatitis.

We therefore urge national governments and the international donor community to join efforts with the WHO, CEVHAP and partner institutions to combat viral hepatitis in the same way we do with HIV/AIDS, tuberculosis and malaria. This starts with developing national action plans based on the WHO Framework for Global Action – “ASAP”.

Professor Ding-Shinn Chen is chair of the Coalition to Eradicate Viral Hepatitis in Asia Pacific (CEVHAP) and former dean of the College of Medicine, National Taiwan University.

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