by Joel Adriano, SciDev.Net

A microscopic image of the Hepatitis B virus, taken by the Centers for Disease Control and Prevention

Countries in Asia Pacific are unlikely to meet their commitment to eliminate hepatitis by 2030 unless they declare a public health emergency, as they did with COVID-19, a disease specialist suggested.

Hepatitis—an inflammation of the liver—is the second most deadly infectious disease in the world, surpassing tuberculosis and behind only COVID-19, according to the World Health Organization (WHO). It claims 3,500 lives each day.

The WHO set a target in 2016 of cutting new infections by 90% and deaths by 65% before 2030, as well as treating 80% of people affected, in order to end the disease.

However, Saeed Hamid, professor and chair at the Department of Medicine at Aga Khan University, Pakistan, stressed during a 20 June forum on infectious diseases in Vietnam that, "at the current rate, most countries in the Asia Pacific will not meet the elimination target by 2030."

Despite progress in diagnosis and the drop in prices of testing and treatment, there is still a critical gap in coverage, said Hamid, whose research focuses on hepatitis. Far too few receive treatment and for those who do, if often comes too late, he explained.

The disease is deadly because a person could be infected for years and the symptoms only emerge once the disease is in an advanced stage—which is why testing is crucial.

"We need to declare an emergency in all of the high-burden countries," Hamid said, citing the unprecedented rapid response countries adopted with COVID-19 which demonstrated "that it can be done with political will."

There are five main types of hepatitis virus, referred to as A, B, C, D, and E. Hepatitis A and B can be prevented with safe and effective vaccines, but there are no widely available vaccines specifically for the other types.

The Asia Pacific region has the greatest hepatitis burden, with Pakistan now having the world's highest number of hepatitis C cases at 8.8 million. Here, transmission of the disease is mostly driven by health care–related exposure, such as poor sterilization of medical equipment, evidence suggests.

"In Pakistan, three people are dying every minute from hepatitis, and these are preventable," Hamid said.

John Ward, director at the Coalition for Global Hepatitis Elimination, considered this as regrettable since "we have a vaccine for hepatitis B for 40 years now. In fact, it is one of the success stories we had."

He emphasized the need not just for testing but more critically accelerated treatment and health service support for those diagnosed with the disease. He also cited the importance of education and peer support to eliminate stigma associated with the disease, which prevents people from seeking treatment.

Ward agreed that declaring a public health emergency would "capture the attention" and cause authorities to implement an immediate response.

"However, with so many health issues and non-health concerns competing for limited resources it will be a challenge" for health experts to build national commitment towards hepatitis elimination by 2030, Ward said.

At the launch of the Global Hepatitis Report 2024 in April, WHO director-general Tedros Adhanom Ghebreyesus said that every year viral hepatitis kills more than 1 million people globally and infects another 3 million, emphasizing that these numbers might be underestimated.

The WHO report highlighted ten countries responsible for two-thirds of global viral hepatitis B and C burdens: China, India, Indonesia, Nigeria, Pakistan, Ethiopia, Bangladesh, Vietnam, the Philippines and Russia.

There were 304 million people living with hepatitis in 2022. Hepatitis B and C together are the most common cause of liver cirrhosis and liver cancer, which is now the third leading cancer in Asia Pacific.

Hamid highlighted the success of Egypt in combating the disease. The country used to have the highest hepatitis C burden but saw a dramatic drop following its 100 Million Healthy Lives campaign.

Egypt tested more than 60 million people and treated more than 4 million people, resulting in a drop of new infections from 300 per 100,000 in 2014 to 9 per 100,000 in 2022. The goal for hepatitis C elimination is less than 5 per 100,000 new cases per year.

Pakistan is aiming to replicate Egypt's achievement with a massive hepatitis health campaign currently underway, Hamid said.

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