The story of one million lives lost

Friday, 26 July 2013 08:15 GMT

In a file photo from 2009, a nurse checks the pulse of a person suffering from Hepatitis B at a hospital in Modasa, in India's western Gujarat state. REUTERS/Amit Dave

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Viral hepatitis kills 1.4 million each year - on par with HIV/AIDS; 70 percent of cases are in Asia Pacific, yet most learn they are infected in later stages of the disease, which can be too late

On Sunday advocates, patients, clinicians and a growing number of government representatives will come together in support of World Hepatitis Day, an annual event endorsed by the World Health Organization (WHO) that aims to raise awareness of viral hepatitis among at-risk groups.

The need for raising awareness of viral hepatitis is immense. Indeed, although the transmission of viruses that cause hepatitis is preventable, we now know that the number of people dying globally every year from these viruses has increased from approximately 986,000 in 1990 to more than 1.4 million people today. This is a similar number of people that die each year as a result of HIV/AIDS.

The situation is graver in the Asia Pacific region, where the data shows that 70 percent of all worldwide deaths related to viral hepatitis occur. That means that in Asia, one million people die needlessly every year and on average one person dies every 30 seconds. These figures - from the Global Burden of Disease Study (GBDS) by the University of Washington’s Institute for Health Metrics and Evaluation - were presented for the first time in Asia in June 2013, at the Liver Week conference of the Asian Pacific Association for the Study of the Liver (APASL).

An important part of a worldwide movement to halt this death toll, World Hepatitis Day aims to raise awareness of how hepatitis is transmitted and to prevent the many millions of new infections that occur each year. The event addresses the abysmally low awareness levels that surround these diseases, which mean that in the case of South East Asia around 65 percent of people living with chronic hepatitis B, and 75 percent with hepatitis C, are unaware they are infected.

The significant number of undiagnosed people explains why - despite the existence of an effective vaccine for hepatitis B and treatments for chronic hepatitis C that could save millions of lives - the number of people dying from viral hepatitis continues to rise. Fundamentally, a large proportion of people are diagnosed late - once they start to have symptoms and become ill. It is only then, when their infection has led to liver cirrhosis or liver cancer, that they discover the infection they have carried, usually for many years. Unfortunately, by the later stages of the disease, treatment options are more limited.

Viral hepatitis represents one of the world’s greatest threats to health, and yet these diseases remain low on the global and Asia health priority list, falling way behind other diseases such as HIV, tuberculosis (TB) and malaria. These new figures reveal the increasing threat posed by viral hepatitis to the Asia Pacific region and are symptomatic of the poor understanding and lack of political commitment that has typically surrounded these diseases in many countries.

In defence of government policymakers, however, there has been a distinct lack of categorical evidence needed to guide policy development and justify the required investments. We now have the evidence we need to prove that viral hepatitis is an urgent public health priority in Asia. On World Hepatitis Day, the Coalition to Eradicate Viral Hepatitis in Asia Pacific (CEVHAP) is urging governments to embrace the blueprint contained in the WHO’s new Global Framework for Action.

The WHO’s framework was first launched on World Hepatitis Day 2012 and, recognising that each country will face a different set of challenges, provides a guide for governments to develop their own nationally-coordinated action plans to tackle viral hepatitis. The WHO framework represents a comprehensive strategic policy approach, and over the last year, many of our members have held encouraging discussions with ministries of health across the region, a number of which have expressed interest in strengthening their country’s response to viral hepatitis.

The success in implementing the framework within countries requires, however, the realisation that many countries, particularly in the Asia Pacific region, are resource-constrained and that funding issues present a significant barrier to their ability to implement lasting measures to reduce the burden of disease. The recent formation of WHO’s Global Hepatitis Network provides governments with access to the expertise needed to translate this framework into national action plans and public policy, but its work will require funding, and many governments will need support to build capacity and mobilise resources.

In the past, we have seen what can be achieved when governments, the medical community, donor organisations and civil society come together in a collective response to spur change and secure funding through the global response provided by UNAIDS, the Stop TB Partnership and Rollback Malaria Partnership. Viral hepatitis lacks a major international funding structure to resource the change that is needed to implement the framework within individual countries. On World Hepatitis Day, our members will ask governments to embrace the WHO’s new global framework and CEVHAP will offer our support, but we need international commitment.

In Asia Pacific, World Hepatitis Day is a story of one million lives lost every year, but it simply does not need to be that way. We can save lives if all people who are touched by viral hepatitis work together, but our human resources alone are not enough. Development agencies, governments and donor bodies must also come to the table and designate viral hepatitis as a funding priority if we are to reverse the escalating impact of these silent but destructive diseases.

Ding-Shinn Chen is the chairman of the Coalition to Eradicate Viral Hepatitis in Asia Pacific (CEVHAP).