In April 2024 WHO shared that the 2024 Global Hepatitis Report, released at the World Hepatitis Summit, reveals an increase in the number of lives lost to viral hepatitis. The disease is reportedly the “second leading infectious cause of death globally”, claiming 1.3 million lives a year. This is the same as tuberculosis, described as a “top infectious killer”. The report highlights that, although we are equipped with diagnostic and treatment tools, coverage rates for testing and treatment have “stalled”. However, WHO suggests that the elimination goal for 2030 should “still be achievable” if “swift actions” are taken.
Data highlights
Data from 187 countries reveal that the estimated number of deaths from viral hepatitis increased from 1.1 million in 2019 to 1.3 million in 2022. Hepatitis B was the cause of 83% of these deaths, and hepatitis C caused 17%. The increase in estimated mortality over the past few years indicates that the number of hepatitis-related cancer cases and deaths are increasing.
“Access to effective interventions must be urgently expanded to save lives and prevent a future generation of new infections, cancer cases, and deaths.”
The estimated number of new infections declined from 2.5 million in 2019 to 2.2 million in 2022. Of these new infections, 1.2 million were hepatitis B and nearly 1 million hepatitis C. Improved data imply that hepatitis B and C prevention, including immunisation and safe injections, as well as the initial effect of expanded hepatitis C cure, have influenced the incidence reduction.
The report states that “half the burden” of chronic hepatitis B and C infection is among people between the ages of 30 and 54 years, and men account for 58% of all cases. Roughly 12% of the burden is borne by children, particularly for hepatitis B. Populations at greatest risk are those with a history of or risk of exposure through unsafe blood supplies, medical injections, and other health procedures. Newborns and children at risk through vertical transmission of hepatitis B are also at higher risk. The report also identifies “key populations”, including people who inject drugs and people in “closed settings”.
There is “regional variation in the viral hepatitis burden and response. For example, the WHO African Region accounts for 63% of new hepatitis B infections, but only 18% of newborns in the Regions receive the hepatitis B birth-dose vaccination. Another example is the Western Pacific Region, which accounts for 47% of hepatitis B deaths but has “low” treatment coverage.
“Innovative approaches are needed to expand prevention and treatment for hepatitis B and C in varying regional and country context.”
2030 targets
The report emphasises that the global response is “off-track” for 2030 goals.
“If action is taken now, universal access to viral hepatitis interventions will have a major public health impact.”
This could drive a reduction in incidence by 90%, mortality by 65%, and the costs of achieving global targets by 15%. The report also states that the benefits of achieving global targets will be apparent by 2030, saving 2.85 million lives and averting 9.5 million new infections and 2.1 million cases of cancer.
Access to vaccines
The report highlights the lack of equitable access to vaccines. For example, the coverage of the hepatitis B birth dose “remains low”, particularly in the African Region, which has the “highest prevalence of hepatitis B”. Coverage varies between 18 in the African Region and 80% in the Western Pacific Region. A total of 115 countries worldwide have introduced a universal hepatitis B birth dose. However, access to the birth dose vaccination is “often hampered” by a “lack of policy within the national immunisation programme” or a “lack of access to newborn infants within the first 24 hours of life”.
An additional barrier is identified in “out-of-pocket expenditure” for hepatitis B vaccines. Finally, efforts to develop an effective vaccine against for HCV should be an “important component of the viral hepatitis research agenda”.
10 Key Actions
The report proposes 10 key actions to “advance a public health approach”:
- Testing: expand access to high-quality, affordable viral hepatitis testing and diagnostics services.
- Treatment: shift from policies to implementation for equitable access to viral hepatitis treatment and care.
- Prevention: strengthen investment in primary prevention of viral hepatitis to bridge the coverage gap in pregnancy, especially in Africa.
- Service delivery: simplify and decentralise the delivery of viral hepatitis services through a public health approach.
- Product regulation, procurement, and supply: optimise product registration, procurement, and supply, improve market transparency and support local production.
- Investment cases: develop investment cases in priority countries for a rapid shift to a public health approach.
- Financing: increase financing from all sources.
- Data for action: use improved country data and strengthen country data systems and accountability for viral hepatitis.
- Community engagement: engage the affect populations and civil society in the viral hepatitis response for advocacy and service delivery.
- Innovation: advance the research agenda for viral hepatitis to improve diagnostics and work towards a hepatitis B cure.
WHO’s commitment
Dr Tedros Adhanom Gebreyesus, WHO Director-General, commented on the report in a statement from WHO, suggesting that it “paints a troubling picture”.
“Despite progress globally in preventing hepatitis infections, deaths are rising because far too few people with hepatitis are being diagnosed and treated. WHO is committed to supporting countries to use all the tools at their disposal – at access prices – to save lives and turn this trend around.”
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