On July 28, the globe will celebrate World Hepatitis Day. To mark the event, the World Health Organization’s Global Hepatitis Program launched findings earlier this week from a new viral hepatitis policy survey, setting a new benchmark against which we can measure future progress in tackling a disease that causes one million deaths in Asia-Pacific every year.
The report was published just one month after new figures came to light from the Institute for Health Metrics and Evaluation, University of Washington’s Global Burden of Disease Study, showing that globally, viral hepatitis causes the same number of deaths as HIV and AIDS — approximately 1.4 million every year.
The figures for Asia-Pacific are even more startling: 70 percent of all deaths related to viral hepatitis occur in the region. The number of deaths that result from viral hepatitis in Asia-Pacific is approximately three times as many as HIV/AIDS and nine times as many as malaria. Simply put, viral hepatitis is a regional health threat of significant proportions.
Given the enormity of the disease burden and the annual mortality in Asia-Pacific, it is encouraging that the response rate to the WHO survey from member states across South East Asia was 100 percent, compared to an overall response level of 64.9 percent globally. The response rate in the Western Pacific was 55.6 percent. There seems to be growing recognition among countries in the region that much more needs to be done to comprehensively tackle viral hepatitis and there is an emerging opportunity to further work with governments to assess ways of strengthening existing policies and to use the findings from this report to support the development of comprehensive national strategies — an essential first step in tackling viral hepatitis.
Before looking at the findings of the report in more detail, it is worth noting that a blueprint for these strategies was published by the WHO on World Hepatitis Day 2012 under its Framework for Global Action. The framework has four distinct axes, each aimed at strengthening a different aspect of public health and these areas informed the design of the policy survey: Raising awareness, promoting partnerships and mobilizing resources; evidence-based policy and data for action; prevention of transmission, and; screening, care and treatment.
It is heartening to see that the WHO report shows at least 14 countries across Southeast Asia and the Western Pacific have a national policy plan in place. However, when looking at the WHO findings within the context of the axes, significant policy gaps remain.
Part of the reason why these gaps exist is that governments have often lacked the evidence needed to justify the investment in interventional strategies, something that is borne out by the fact that while WHO’s research shows 80 percent of responding countries in the Western Pacific report having routine surveillance in place for viral hepatitis, only 55 percent of countries in Southeast Asia report this to be the case. Surveillance informs evidence-based policy decisions and enables governments to measure and track the success of interventional strategies. Without surveillance, countries will struggle to tackle these infections in a meaningful way.
Another trend that we see coming out of this report is the fact that even relatively cheap and cost-effective measures seem to be lacking from the effort to tackle these diseases in many countries. For example, just five countries (45 percent) in South East Asia report that free-testing for chronic hepatitis B and C is available. When looking at the Western Pacific region, we see that only four countries (27 percent) report offering free testing for hepatitis C, while seven (47 percent) offers this for hepatitis B.
Similar challenges exist when looking at treatment, with publicly-funded treatment being reported to be available in just six countries in South East Asia (55 percent), while in the Western Pacific publicly-funded treatment for hepatitis B is available in eight countries (53 percent) and seven countries for hepatitis C (47 percent).
The development of effective, coordinated action plans built around the blueprint set down in the WHO Global Framework for Action can help increase access to diagnosis, medical care and, where appropriate, treatment, but it will require a collaborative effort involving governments, clinicians, the communities affected by these diseases, the private sector and, of course, the international development community.
The findings from this report are illuminating but also highlight the lack of funding and resources, in particular within lower and middle income countries, which have yet to be fully addressed by the international community. Funding issues present a significant barrier to the ability of governments to implement lasting measures to reduce the burden of disease. I urge the international donor community to step forward and join the efforts of WHO and organizations such as Coalition for the Eradication of Viral Hepatitis in Asia Pacific in combating viral hepatitis.
WHO director-general Margaret Chan said in her foreword to the report that the 2010 WHO resolution on viral hepatitis heralded “a new era of awareness about the magnitude of disease caused by viral hepatitis and the need for urgent action on several fronts.” I believe that the actions needed to begin the monumental task of eradicating viral hepatitis rests in the implementation of effective public policy initiatives and a greater regional and international commitment from all stakeholders.
Click on the image to view in large size. Infographic by: CEVHAP
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