Today is World Hepatitis Day. Although it kills around 1.4 million people every year, particularly affecting the developing world, viral hepatitis is very much a neglected disease. Daily Development speaks to Charles Gore, President of the World Hepatitis Alliance, to learn about the response to the disease and to find out what is being done to raise its profile. 

DD: Viral hepatitis kills around 1.4 million people every year, but the impact is especially hard on developing countries. Why is this?

CG: For hepatitis B, we have been much less successful in preventing mother-to-child transmission. This is partly due to the infrastructure challenges that hinder delivery of a birth dose of hepatitis B vaccine within the first 24 hours, coupled with GAVI’s funding only of hepatitis B vaccine in a pentavalent combination that cannot be given as a birth dose. For hepatitis C, where the main transmission route in developing countries is nosocomial, the investment needed to ensure safe blood, safe and rational use of syringes and proper sterilization of hospital and dental equipment has not always been available. With higher prevalence rates, developing countries have then been faced with extremely limited access to diagnostics and treatment. This is not only about cost, but also about awareness and prioritization. The prominence given to HIV, tuberculosis and malaria in developing countries, particularly through the Millennium Development Goals (MDGs), has meant that viral hepatitis has been consistently neglected.

DD: What are the particular challenges associated with responding to the disease in developing countries?

CG: There are many challenges. It was clear from what was said by the delegations from developing countries at this year’s World Health Assembly that many of them feel they lack the technical expertise to develop a comprehensive response to viral hepatitis. The World Health Organization (WHO) is aware of this and is putting together a technical manual and a team of experts to help countries develop national strategies. To support that, the World Hepatitis Alliance, together with WHO and the Scottish Government, are organizing a high-level summit next year for country hepatitis programme managers.

Clearly resources are also an issue, both human and financial. Viral hepatitis is a complex subject and there is an acute shortage of sufficiently trained health-care workers, especially hepatologists, in developing countries. However, WHO has just produced guidelines for the testing, care and treatment of hepatitis C specifically for developing countries, and is in the process of doing the same for hepatitis B. These guidelines seek to standardize and simplify the approach in the same way as the HIV guidelines to help developing countries scale up their response. The cost of viral hepatitis diagnostics and treatments has been high, but generic versions of key hepatitis B drugs are now available and the signs are that low prices for, and/or generic versions of, some of the new hepatitis C drugs will become available to developing countries very soon. Nonetheless, resources will remain a major issue simply because of the numbers involved and the total absence of any global funding mechanism. The inexplicable absence of viral hepatitis from the Millennium Development Goals has had a profound impact on the ability of developing countries to address it. This applies also to nongovernmental organizations (NGOs) and civil society organizations working in those countries, which are not getting the funding or support they need. Just last month UNITAID gave a grant to Médecins Sans Frontières to start hepatitis C treatment in a handful of developing countries, but, very welcome as it is, it is just a drop in the vast ocean of need.

There is also a philosophical shift in global health, which is inevitably felt in developing countries, away from vertical, disease-specific programmes, which are perceived to weaken health systems, and also away from communicable diseases towards noncommunicable diseases. We have not perhaps made the case sufficiently strongly that addressing the prevention in particular of viral hepatitis through safe food, water and sanitation, safe blood, safe injections and harm reduction measures will prevent many other infections and harms and strengthen the whole system. We also need to see viral hepatitis prevention, diagnosis and treatment as an essential part of cancer prevention, with liver cancer now the second cause of cancer mortality, 80% of it due to viral hepatitis.

We also find that NGOs and civil society organizations seeking to tackle viral hepatitis in developing countries aren’t getting the funding or support they need, and that’s because viral hepatitis has consistently been left off the agenda of the big funding organizations. The Global Fund to Fight AIDS, Tuberculosis and Malaria, the Bill & Melinda Gates Foundation, the MDGs, none mention viral hepatitis despite it killing more than HIV, tuberculosis or malaria. That wilful ignorance of the disease by those top international agencies has had a huge impact on the organizations trying to do grass-roots work in developing countries.

Some challenges we see across the world, but are particularly acute in developing countries. High levels of stigma means people are wary of getting tested; it is often hard to encourage people to come forward. In some developing countries, this is exacerbated by a lack of protection for people who may lose their jobs upon finding out they have hepatitis. Addressing this stigma and discrimination would have a huge effect on the treatment response.

DD: Hepatitis has a much lower profile than many other health issues that particularly affect the developing world, such as HIV, tuberculosis and malaria. What can be done to raise its profile?  

CG: We need a collaborative response. Governments need to commit to the asks from the new viral hepatitis resolution, passed at the World Health Assembly in May, including formulating national strategies, implementing surveillance and strengthening prevention. Once governments show they are prioritizing viral hepatitis we need international agencies to do the same, to start writing about viral hepatitis, implementing programmes and working to make viral hepatitis as well-known as an international health issue as HIV, tuberculosis and malaria. Finally, we need more civil society organizations that can speak out about viral hepatitis. These organizations play a vital role in raising awareness and lobbying for increased action, and, at the moment, they simply aren’t numerous enough. 

DD: Today, 28 July, is World Hepatitis Day. What can our readers do to make a difference?

CG: Go to the World Hepatitis Day website (www.worldhepatitisday.org) to find out all the events happening across the world. You can watch a video that features the sensational Las Vegas superstar Richard Cheese accompanied by Lejo’s innovative hand puppetry. If you use social media, make sure you sign up to the Thunderclap, which is one of the easiest ways to share the message on World Hepatitis Day. Finally, we’ll be in Glasgow on 27 and 28 July during the Commonwealth Games with one of the world’s largest LED screens. On the screen will be a tweet wall consisting of negative word bricks. You can help turn a negative brick into a positive message by sending a tweet using the hashtag #thinkhepatitis. If you can’t be in Glasgow with us you can still get involved and see the impact of your tweet by visiting www.worldhepatitisday.org, where the tweet wall is being streamed.