World Health Organization Calls for Ambitious Global Targets for Viral Hepatitis Control


The World Health Organization (WHO) is calling for ambitious new global targets for diagnosis, treatment, and cure of hepatitis B and C, signaling a major increase in momentum towards elimination of viral hepatitis by 2030, participants heard at the World Hepatitis Summit last week in Glasgow.

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Gottfried Hirnschall, director of the WHO Department of HIV/AIDS and Hepatitis, told summit attendees that WHO will seek international agreement for the following targets:

Global mortality due to viral hepatitis is now outstripping deaths from HIV, tuberculosis, or malaria, Hirnschall said. 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.

WHO 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 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 policymakers of the need for what the organizers describe as comprehensive national plans encompassing prevention, diagnosis, and treatment of viral hepatitis.

Hirnschall praised several lower-income and middle-income countries for recent expansions in their viral hepatitis programs.

Georgia, one of several states in Eastern Europe with a high prevalence of hepatitis C attributable to injection drug use, has embarked on an ambitious program designed to eliminate hepatitis C, in partnership with the U.S. Centers for Disease Control and Prevention (CDC) and Gilead Sciences, the manufacturer of sofosbuvir (Sovaldi) and sofosbuvir/ledipasvir (Harvoni).

Georgia’s program is intended, in part, to demonstrate that elimination -- the ending of HCV 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, and with advice and training on program design and monitoring, Georgia aims to treat 5000 people with advanced liver damage and to screen 70,000 people for HCV in 2015 alone, with an increase in subsequent years, David Sergeenko, Georgian Minister of Labor, 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. 200,000 people registered online for evaluation for free treatment within 3 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 3 years. Despite the advanced disease stage of people treated so far, cure rates have been very high: approximately 85% of those with cirrhosis have been cured, said Imam Waked ofthe National Liver Institute in 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 Hirnschall, emphasizing the accumulating costs of untreated viral hepatitis in the forms of liver cancer and hospitalization. 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 in 2030.

How to mobilize the necessary funding -- and how to reduce the cost of treatment -- was the subjects of further discussion during the summit and will be covered in future reports. 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 efforts such as HIV, immunization, and blood safety programs will also be needed to make viral hepatitis elimination affordable.



World Hepatitis Summit. Glasgow, September 2-4, 2015.