There has been an increase in deaths from hepatitis B and C, the infectious viral liver diseases that kill as many people each year as tuberculosis – yet few people know that they are infected and get the treatment they need.

This is according to the World Health Organization (WHO) 2024 Global Hepatitis Report – the first to document epidemiology, service and product access – which was released on Tuesday at the start of the World Hepatitis Summit in Portugal.

New data from 187 countries show that the estimated number of deaths rose from 1.1 million in 2019 to 1.3 million in 2022.  Hepatitis B and C cause around 3,500 deaths every day.  

Around 83% the deaths were caused by hepatitis B, most commonly spread by mother-to-child transmission,  and 17% by hepatitis C, usually spread through contact with infected blood. While sexual transmission is also a route for hepatitis B transmission, this typically results in acute infections, which are, in fact, less life-threatening than the chronic infections that may be acquired in infancy and may lead to early mortality.

“Sexual transmission of hepatitis B usually results in an acute infection which is not life threatening.  This report is about chronic infections which often lead to early mortality from liver disease and cancer,” explained Cary James, CEO of the World Hepatitis Alliance.

“This is an important point as the misconception that chronic HBV is associated with sexual activity can be a major contributor to stigma within families, societies and health systems.”

“Hepatitis infection is a silent killer,” said Dr Meg Doherty, WHO’s Director of HIV, Hepatitis. “Awareness is very low worldwide. Most symptoms appear only once the disease has advanced, resulting in a huge volume of undiagnosed people living with hepatitis. Even when hepatitis is diagnosed, the number of people who go on to receive treatment remains low.”

According to the report, by the end of 2022 only around 13% of people living with chronic hepatitis B infection had been diagnosed and approximately 3% (seven million) had received antiviral therapy, while about 36% of those with hepatitis C, 36% had been diagnosed and 20% (12.5 million) had received curative treatment.

Almost two-thirds of global cases are concentrated in 10 countries –  Bangladesh, China, Ethiopia, India, Indonesia, Nigeria, Pakistan, the Philippines, the Russian Federation and Viet Nam.

Meanwhile, the WHO African region accounts for 63% of new hepatitis B infections, and yet only 18% of newborns receive the hepatitis B birth-dose vaccination. 

“Achieving universal access to prevention, diagnosis and treatment in these 10 countries by 2025, alongside intensified efforts in the African region, will be essential to get our response back on track,” stressed Doherty.

On the other end of the spectrum, Egypt has made huge strides to eliminate hepatitis C in particular.

“There are five main strains of hepatitis virus referred to as types A, B, C, D, and E. And in particular types B and C lead to chronic disease and together are the most common causes of liver cirrhosis, liver cancer and viral hepatitis related deaths,” she explained. 

Updated WHO estimates indicate that 254 million people live with hepatitis B and 50 million with hepatitis C in 2022.  Half the burden of chronic hepatitis B and C infections is among people 30–54 years old, with 12% among children under 18 years of age. Men account for 58% of all cases.

Treatment costs

Pricing disparities persist both across and within WHO regions, with many countries paying above global benchmarks, even for off-patent drugs or when included in voluntary licensing agreements.

“Despite the availability of affordable generic hepatitis medicines, many countries fail to procure them at these low prices,” said report author Dr Francoise Renaud. “Pricing disparities persist both across and within the WHO regions with many countries paying above global benchmarks, even for off patent medicines or when there are voluntary licencing agreements, which allow countries to produce or import generic formulations.”

For example, although tenofovir for treatment of hepatitis B is off patent and available at a global benchmark price of $2.4 per month, only seven of the 26 reporting countries paid prices at or below the benchmark. The lowest reported monthly treatment prices reported by countries ranged from $1.22 for 30 tablets in China and India to $34.20 in Russia.

Similarly, a 12-week course of pangenotypic sofosbuvir/daclatasvir to treat hepatitis C is available at a global benchmark price of $60, yet only four of 24 reporting countries paid prices at or below the benchmark.

The lowest reported price for a 12-week course of this treatment was from Pakistan at about $33 for a generic course of treatment, while the highest reported price was from China, at about $ 10,000.

About 75% of the reporting WHO focus countries rely primarily on government funding or out-of-pocket expenditure for
viral hepatitis diagnostics

Only 60% of reporting countries offer viral hepatitis testing and treatment services free of charge, either entirely or partially, in the public sector. Financial protection is low in the African region, where only about one third of reporting countries provide these services free of charge.

–Correction (15 April, 2024). The original version of the story stated that hepatitis B infections are most commonly spread by sexual contact, when in fact the most common transmission route is mother to child transmission, according to WHO. 

Image Credits: Yoshi Shimizu/ WHO.