Where should money go to manage global health's 'silent epidemic'?

Dr. Mohamed Dawalbeit, the lone doctor at the El Sereif hospital in North Darfur, attends to about 300 patients every day with serious health problems like hepatitis. All over the world, mobilizing resources is sorely needed for the prevention, care and treatment of this silent epidemic. Photo by: UNAMID / Albert González Farran / CC BY-NC-ND

The negotiations for the next set of development goals have yielded hope for advocates fighting hepatitis. The disease made it under goal 3 in the draft outcome document that is expected to be adopted in September at the U.N. General Assembly, which means it now has a better chance of mobilizing resources.

But just how much will it really take to bring the disease under control, and eventually eliminate it?

Unlike other diseases like HIV and AIDS and tuberculosis — which would need an estimated $22 billion to $24 billion, and $8 billion, respectively, according to statistics released by relevant stakeholders — hepatitis does not yet have a ballpark estimate attached to it. But with the introduction of a World Health Organization draft action plan for the prevention, care and treatment of viral hepatitis, stakeholders have started working on estimates on what would be required to address this silent epidemic, which kills at least 1 million people every year.

The Coalition for the Eradication of Viral Hepatitis in Asia-Pacific, a not-for-profit organization that advocates for public policy reform to reduce hepatitis burden in the region, is one of them. Just last week, the coalition started working out the cost of addressing hepatitis in the state of Victoria in Australia, a province of 6 million people. Their initial estimate: 2.1 million Australian dollars ($1.53 million).

That estimate is based, however, on the assumption that the drug to treat patients infected with hepatitis is free, and that doctors’ time are paid for by the government, according to Dr. Stephen Locarnini, co-founder of CEVHAP.

It is expected to go higher — or lower — depending on a state or country’s health structure, although Locarnini said there’s now a lot of pressure on governments in the Asia-Pacific region, which is most heavily burdened by the disease, to make the drugs free.

But assuming that the money is there — or it becomes available, as the disease has never really received a significant amount of attention and resources as others — the other critical question is: Where do you put that money?

Based on their discussions, Locarnini breaks it down into three key areas: people, awareness and coverage.

Invest in people training

There aren’t a lot of specialists in managing hepatitis, so it is critical, according to the doctor, that primary care physicians are engaged to manage viral hepatitis. In Australia, general practitioners and community-based doctors are “allowed” and “encouraged by the government” to treat patients infected with hepatitis B and C.

But for countries where this is not yet the case, Locarnini suggested to create a clinical workforce development training program, under which primary care physicians will be trained in delivering viral hepatitis care.

He said this should be a key part of any budget for managing viral hepatitis.

“This is how HIV was managed,” the physician said. “Unless this step is taken, then it would be very expensive to do it any other way, and very limiting, because there’s just not enough doctors” to deal with viral hepatitis cases.

Engaging nurses in the response is also critical. In a number of countries in Asia and the Pacific, like China for instance, nurses are a key part of the delivery of care — although this is not the case in others such as Japan, according to Locarnini.

Promote those action plans, and invest in surveillance

Having a national strategy or action plan in place would also be critical. And CEVHAP welcomes the strong push it is now getting from WHO on this front.

But having that plan won’t help push hepatitis out of the window if only a few people are made aware of it. So donors and governments should also allocate a portion of their budget in producing, distributing and promoting these national strategies or action plans to both affected communities and the medical and clinical workforce.

It’s also critical that they apportion part of their budgets to surveillance and program evaluation work, ensuring that the services are working and reaching intended purposes.

Proper analysis

The estimate they’ve come up with in Victoria is “very high,” according to Locarnini, so spending outside Victoria — and Australia even — might end up to be cheaper.

But the physician notes this is just an initial estimate, and to really arrive at a bottom-line figure would require country-by-country assessments. CEVHAP has done some preliminary work in this area, but that’s not been fully costed yet, Locarnini said.

The nonprofit aims to work on this more in coming months, however, and will engage partners in the process.

“With WHO support, we’re hoping now that doors will start to open,” he said. “But if this time next year … you rung me up on an update, if that WHO activity has not resulted in investments by government and philanthropy into liver disease, then another 1 million people would have died.”

To read additional content on global health, go to Focus On: Global Health in partnership with Johnson & Johnson.

About the author

  • Ravelo jennylei

    Jenny Lei Ravelo

    Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.