Viral hepatitis could become a more lethal killer than malaria, tuberculosis and HIV combined by 2040, if current trends in undetected infection and treatment continue, warned the World Health Organisation (WHO) on Friday, World Hepatitis Day. 

In observance of the day, WHO launched a call, under the title “One life, one liver”, to scale up testing and treatment for hepatitis, a group of five diseases which infect the liver, causing deadly liver damage and cancer.  Of those diseases, hepatitis B and C are the two viruses in this group which cause the most disease and death.

Over 400,000 people die of hepatitis C annually, while of the two billion people infected with hepatitis B, over 800,000 die every year.

For some time, it has seemed that the world was on track to reduce or even eliminate hepatitis, with increasing numbers of people receiving curative treatment for hepatitis C. A global target for reducing hepatitis B infections was reached by 2020, making it the only health-related Sustainable Development Goals on track, with a real possibility of elimination by 2030.

Today is #WorldHepatitisDay. Ten years ago, the first ‘direct-acting antiviral’ for #hepatitisC was registered, but a life-saving cure cost almost $100k.

How far have we come in the past decade to improve #access2meds for people living with #hepC? 👇 pic.twitter.com/4I9kreJo9H

— Drugs for Neglected Diseases initiative (@DNDi) July 28, 2023

But testing remains inadequate, with only 21% of people infected with hepatitis C diagnosed – and of those, just 13% have been treated, WHO pointed out. The picture for Hepatitis B is even worse, with only 10% of people living with chronic hepatitis B having a diagnosis, and just 2% getting treatment.

And the increase in the numbers of people receiving treatment to cure hepatitis C is slowing, while many African countries do not have access to the vaccine for hepatitis B that is administered at birth, a key intervention. “SARS-CoV-2 pandemic’s detrimental impact on the health system slowed or even suspended HCV [hepatitis C virus] elimination programs” in many countries, noted a recently published paper, adding that “HCV testing and treatment fell, which increased morbidity and mortality.

“Millions of people are living with undiagnosed and untreated hepatitis worldwide, even though we have better tools than ever to prevent, diagnose and treat it,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “WHO remains committed to supporting countries to expand the use of those tools, including increasingly cost-effective curative medication, to save lives and end hepatitis.”

Vaccination, testing and treatment: the key to saving lives

New WHO guidance for countries to tackle hepatitis effectively, include a core set of recommendations to: 

• ensure access to treatment for all pregnant women living with hepatitis B;
• provide hepatitis B vaccines for their babies at birth;
• diagnose 90% of people living with hepatitis B and/or hepatitis C;
• provide treatment to 80% of all people diagnosed with hepatitis. 

Optimal blood transfusion, safe injections and harm reduction are additional measures countries can take in the fight against hepatitis.

The time is ripe for a renewed effort to reach the goal of reducing and/or eliminating hepatitis, as treatment prices have dropped significantly, WHO aded.

When the game-changing curative fourse for heptatis C was first introduced in high-income countries, its cost was over $90,000.  Today it is just $60 for the 12-week course in low-income countries. Treatment for those living with hepatitis B costs under $30 a year.

In addition, west and central African countries, where mother-to-child transmission of hepatitis B remains high, will benefit from Gavi’s Vaccine Investment Strategy 2018, which was recently restarted, and includes those interventions.

In a separate statement, the Africa Centre for Disease Control and Prevention said: “The World Hepatitis Day on 28th July gives us an opportunity to join all stakeholders such as the World Health Organization and the World Hepatitis Alliance to raise awareness on the public health importance of this silent killer and to call on member states to invest more in the fight against Hepatitis B and C in Africa to reach viral hepatitis elimination by 2030.”