Lancet Gastroenterology and Hepatology gathered a group of experts, including ISGlobal researcher Jeffrey V Lazarus, to assess the global viral hepatitis situation and identify priorities for action to accelerate progress toward elimination. The Commission’s analysis has just been published, together with a series of related comments.
A Public Health Problem
Viral hepatitis is a major public health threat resulting in around 4,000 deaths per day, with 96% of these deaths due to hepatitis B virus (HBV) and hepatitis C virus (HCV). The fact that highly effective preventive measures and treatments are now available means that global elimination is possible, and World Health Organization (WHO) member states have set ambitious targets for 2030: reduce mortality by 65% and new infections by 90%. The LancetGastroHep Commission on viral hepatitis, led by Graham Cooke of Imperial College London, analyses progress, barriers and examples of success around the world.
Obstacles and Progress
The authors point out that interrupting transmission of viral hepatitis will require shifting from a focus on individual patients to a public health approach. This involves adopting simple standardized interventions that can be delivered on a large scale and will strengthen health systems as a whole. It is also important to shift toward more decentralized models of care, with diagnostics and treatment delivered by less specialized staff, in order to reach those in need. In fact, one of the greatest challenges to achieving elimination targets is HBV and HCV testing: in 2015, around 290 million infected individuals remained undiagnosed. Making affordable, high-quality diagnostics more available in non-hospital settings should thus be a key element of the new paradigm.
Despite the existence of a highly effective HBV vaccine, a rising percentage of new early-life infections indicates that there is not sufficient uptake of birth vaccination or antiviral treatment for infected mothers. Injecting drug use remains central to the viral hepatitis epidemic, yet opioid substitution therapy and needle and syringe programmes are not widely available in many settings, including many high-income settings. Regarding HCV, treatment costs and treatment reimbursement restrictions continue to slowly progress.
“Despite the remaining barriers, some countries are making real progress toward elimination,” concludes Lazarus. “With increased and coordinated efforts, the 2030 targets can be achieved.” Following on the heels of this Commission, the EASL-Lancet European Liver Commission, in which Lazarus leads one of the five working groups, has started addressing liver disease more broadly and will publish its results in 2020.
Cooke GS, Andrieux-Meyer I, Applegate TL, et al. Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission. Lancet Gastroenterol Hepatol. 2019. 4:135-184. doi: 10.1016/S2468-1253(18)30270-X