* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
Unless large gaps in healthcare systems and policies are addressed, the goal of eradicating this deadly disease will be impossible to achieve
Eliminating viral hepatitis by 2030 is firmly on the global health agenda. But unless the large gaps in healthcare systems and policies are addressed, the goal of eradicating this deadly but entirely preventable disease will be impossible to achieve.
Globally, 1.34 million people die of viral hepatitis every year, a death toll as high as that of HIV/AIDS related diseases. With over 70% of these deaths occurring in Asia Pacific, this region is right at the frontline.
According to the World Health Organization’s (WHO) Global Hepatitis Report, only 9% of people living with hepatitis B and 20% of people living with hepatitis C have been tested and are aware of their status. The big challenge is identifying who is at risk of developing liver disease, and ensuring that they can access effective medical care.
While the WHO is guiding efforts across Asia, commitment from national governments is key. Most countries in Asia Pacific consider the fight against hepatitis to be a key public health issue, so the challenge now is to ensure that public health programmes are implemented effectively.
Results from CEVHAP’s Asia Pacific Hepatitis Policy 2016 Survey show that only 40% of the 15 countries surveyed have made treatment accessible in all parts of the country with many still required to pay for care. Today we face the perverse situation where an antiretroviral drug is available for free to people living with HIV, but people living with chronic hepatitis B have to pay for it.
We believe that three key conditions are required to ensure the effective implementation of hepatitis strategies:
Funding
Looking ahead, international donors will continue to tighten their belts, yet the goal of eliminating hepatitis by 2030 requires resourcing. As many countries in the region increase in wealth, their capacity to access development funding is decreasing. However, resourcing will be critical to provide funding for education and awareness campaigns and to assist governments in funding the infrastructure needed for treatment.
Civil society participation
Countries need to build infrastructure and public awareness in the way they did to deal with other large-scale public health threats, such as HIV/AIDS and tuberculosis. As we saw with those two examples, implementing action plans needs collaborative partnerships led by governments that include civil society organisations, people with or at risk of viral hepatitis and clinicians, researchers and healthcare NGOs.
Civil society organisations are well positioned to support the process by reporting on the situation on the ground. They have a vital role to play to ensure that people living with viral hepatitis can contribute to the development of public health policies targeted at the disease.
Primary care
CEVHAP’s Asia Pacific Hepatitis Policy 2016 Survey shows that nationwide access to services from diagnosis to treatment is not available. Only three countries reported that people with hepatitis B or hepatitis C get appropriate information, counselling and care. People living with chronic hepatitis require access to diversified forms of clinical management, including basic care and support at the primary care level. Upskilling primary care workers and making diagnostic services as well as management of patients with the most effective antivirals part of their responsibility will improve accessibility and lead to greater early detection.
The need for a holistic public health approach to tackle viral hepatitis is particularly important in Asia Pacific and upskilling primary care providers will be crucial. This, along with civil society partnerships and funding, are critical to the elimination of viral hepatitis. A collaborative effort, including shared expertise and best practices, will help make this goal a reality.
Jack Wallace is an executive member of the Coalition to Eradicate Viral Hepatitis in Asia Pacific.
