Governments will need to dedicate resources and funds to help eliminate viral hepatitis amid an international funding shortfall, a top disease elimination advocate has told Devex. Viral hepatitis may be the seventh leading cause of death worldwide, but it hasn’t been prioritized by the global health community up until now, said Charles Gore, president of Geneva-based World Hepatitis Alliance and executive committee member at the Coalition to Eradicate Viral Hepatitis in Asia-Pacific.
Now, however, governments are starting to step in, realizing the cost of inaction. “There is actually quite a good economic case for hepatitis … for the first time in the last few years, governments have realized [that] they need to tackle it now,” Gore said. “Previously, there's been no political will.”
Over 400 million people are currently living with chronic viral hepatitis, a disease of the liver that has been dubbed global health's “silent killer.” The condition is caused by five different viruses and can lead to liver cancer and death if left untreated. According to the Pennsylvania-based group Hepatitis B Foundation, 2 billion people (or approximately 1 out of 3) have been exposed to the hepatitis B virus, the most common type, during their lifetimes.
Despite the disease's massive impact, viral hepatitis remains on the fringes of development discussions and priorities, with WHO global hepatitis program director Dr. Gottfried Hirnschall calling the epidemic “one of the poor relations of global public health.”
Gore said this has been a miscalculation on the part of the international community in understanding the severity and urgency of the disease. While few people die from the acute form of the virus, about 80 percent of all liver cancer deaths are caused by viral hepatitis.
“Hepatitis was not included in the Millennium Development Goals [because] they only measured people who died from hepatitis and not those with liver cancer that was a direct cause of hepatitis,” he said. “So really what they were looking at are only those people who died from the acute form.”
A survivor of hepatitis C virus, a type of the disease he's currently working to eliminate globally, Gore hopes to counter some of the common misconceptions about viral hepatitis. There is a “conscious belief of people that if you have a liver disease, it can better on its own … because the liver can regenerate,” he said.
Emerging awareness
Over the past half decade, the international community has shown a stronger commitment to combatting viral hepatitis, particularly in preparation of a more comprehensive post-2015 development agenda last year. Medical professionals and advocacy groups have also worked to raise awareness about the need to tackle the disease on a global scale.
Some of these initiatives include a specific target in the Sustainable Development Goals (target 3.3 under Goal 3) specifying the need to combat hepatitis, even though it falls short of talking about ending the epidemic of hepatitis, as it does with HIV.
“The important thing is that from the point of view of the SDGs, there is a commitment to tackling hepatitis,” Gore told Devex.
The funding environment, however, remains a challenge, he said. “We do hope that [the SDGs] will result in more resourcing, but as I say, this is not a very good environment at the moment financially.”
That’s where governments may need to step in, according to the CEVHAP official. Gore said that given the current belt-tightening environment in the international development community, “we have to try to get countries to put resources into hepatitis rather than looking at some external financing mechanism … because that probably will never happen.”
WHO has been developing three five-year global health sector strategies, including one on viral hepatitis, to provide national governments and other development stakeholders a much more actionable and comprehensive path towards viral hepatitis elimination. Some of the targets include reductions in new cases of chronic hepatitis B and C by 30 percent by 2020 and 90 percent by 2030. New cases of chronic infection are targeted to be reduced from 6 million to 10 million last year to 0.9 million over the next 15 years.
One of the viable options for governments is to include hepatitis testing and treatment within the “context of universal health coverage,” Gore said. Doing so would allow other stakeholders such as the private sector to rationalize the costs as part of standard health benefit contributions to their employees.
Costs and benefits
The economic case for treating the world’s 400 million cases of viral hepatitis — and potential new ones — is strong, said Gore.
As with any chronic disease, the condition gets worse — and becomes more costly — if left untreated. Testing and treating viral hepatitis in its early stages can be far more cost-effective in the long-run than treating severe cases of liver cancer or cirrhosis later on.
A study by the University of California San Francisco found that the high cost of early treatment for hepatitis C, for example, is still more efficient in the long term. Medicine to combat hepatitis C can cost up to $100,000 for a full treatment in the U.S., according to the UCSF article. But treating the disease at early stages with current drug prices would save around $20 billion, in scale, as compared with treating it at later stages.
Governments around the globe are seeing the potential benefits — economically and socially — of tackling the global epidemic earlier. Australia, for instance, last year announced a plan to eliminate hepatitis C in the country within a generation by subsidizing new and advanced treatments for the disease last year.
Other governments, particularly from the “global south” including Egypt, Georgia, Gambia and Uganda, have also expressed interest and commitment in putting more resources to tackling the hepatitis epidemic in their populace when “effective treatment is available and affordable” — something that’s already been happening — according to a meeting report by the World Hepatitis Summit last year.
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