By 2030, governments around the world have resolved to eliminate viral hepatitis. On World Hepatitis Day, observed today, the question looms: are we on track?
In 2016, the World Health Organization (WHO) observed that “in 2013, viral hepatitis was a leading cause of death worldwide (1.46 million deaths, a toll higher than that from HIV, tuberculosis or malaria, and on the increase since 199o).” It went on to warn that “in the absence of additional efforts, nineteen million hepatitis-related deaths are anticipated from 2015 to 2030.”
Hepatitis, the WHO explains, “is an inflammation of the liver that can cause a range of health problems and can be fatal. There are five main strains of the hepatitis virus, referred to as types A, B, C, D and E. While they all cause liver disease, they differ in important ways including modes of transmission, severity of the illness, geographical distribution and prevention methods.” Hepatitis B and C alone affect an estimated 325 million people worldwide.
Viral hepatitis is not an insurmountable challenge. As the WHO notes, “an estimated 4.5 million premature deaths could be prevented in low- and middle-income countries by 2030 through vaccination, diagnostic tests, medicines and education campaigns.” However, the WHO states, “for most, testing and treatment remains beyond reach.”
One major obstacle in the fight against viral hepatitis is that a staggering number of people worldwide are living with viral hepatitis unawares. The so-called ‘missing millions’ are believed to tally at 290 million. Without concerted efforts to reach them, elimination by 2030 is a long shot. Hence, it is understandable why ‘find the missing millions’ is the theme of World Hepatitis Day 2020.
In India, viral hepatitis is a significant public health concern. A study published last month observes that, in India, “viral hepatitis…is recently equated as a threat comparable to the “big three” communicable diseases – HIV/AIDS, Malaria, and Tuberculosis.” As previously reported by Health Issues India, “viral hepatitis…affects almost sixty million Indians and kills 1.5 lakh people in the country annually. According to the Institute of Liver and Biliary Sciences (ILBS), hepatitis B alone affects four crore Indians whilst approximately 1.2 crore are afflicted with hepatitis C. Multiple Indian states have been classed as high-risk areas for infection with hepatitis E.”
Yet the true burden of viral hepatitis in India may not be fully appraised. One issue the aforecited paper flags is that “the routine reporting of Hepatitis to [the] Central Bureau of Health Intelligence (CBHI) is highly underreported…due to paucity of data, the exact burden of disease for the country is not established.”
Robust notification systems are vital in the fight against viral hepatitis. Without detecting the ‘missing millions’, it would be a virtual impossibility for the world to reach hepatitis elimination targets by 2030. Given India’s substantial viral hepatitis burden, it is imperative that it takes meaningful action – and the Government has, to its credit, undertaken measures such as the launch of the National Viral Hepatitis Control Programme (NVHCP) in 2018. The aims of the NVHCP are to “combat hepatitis and achieve countrywide elimination of Hepatitis C by 2030… achieve significant reduction in the infected population, morbidity and mortality associated with Hepatitis B and C viz. Cirrhosis and Hepato-cellular carcinoma (liver cancer)…reduce the risk, morbidity and mortality due to Hepatitis A and E.”
Viral hepatitis is a challenge the world, and India, can overcome. To combat the disease, in all its strains, will not be easy – but by following the WHO guidelines, by aiming to reach patients, by raising awareness and countering discrimination, and through robust implementation of the NVHCP in India, progress is possible.
