WHO: Hepatitis Death Toll Rising, Vaccination Works But Access To Tests And Medicines Still Issue

Hepatitis-related mortality is on the rise, despite the existence of an efficient vaccine for hepatitis B and a cure for hepatitis C, according to the World Health Organization hepatitis report 2017 published today. One of the issues is that a majority of people are unaware of their condition due to limited access to affordable hepatitis testing. The price of the hepatitis C medicines has decreased in low-income countries, but still remains a barrier in upper-middle income and high-income countries, the WHO said.

The WHO Global Hepatitis Report 2017 released today gives 2015 global and regional estimates on viral hepatitis B and C, which are responsible for 96 percent of all hepatitis mortality, a toll that reached 1.34 million deaths in 2015.

In May 2016, the World Health Assembly endorsed the Global Health Sector Strategy (GHSS) on viral hepatitis 2016–2021, which calls for the elimination of viral hepatitis as a public health threat by 2030.

During a virtual press briefing on 19 April, Gottfried Hirnschall, director, Department of HIV, Global Hepatitis Programme at the WHO, said one of the key messages of the report is that viral hepatitis is a major health problem. Data from 2015 shows that some 257 million people are living with chronic hepatitis B and 71 million with chronic hepatitis C. Both conditions, in many cases, if left untreated, will turn into long-term and life-threatening consequences, in particular cirrhosis and liver cancer, he explained.

The mortality rate of hepatitis B and C is comparable to that of tuberculosis, he said, outrunning that of malaria and HIV. While the mortality rate for those other diseases is decreasing, the trend for hepatitis is upwards, he said, with an increasing death toll.

According a WHO factsheet, hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic diseases. The virus is transmitted through contact with the blood or other body fluids of an infected person. Infants born to untreated hepatitis B mothers can acquire infection from the mother, mostly during birth.

Another WHO dedicated factsheet says that hepatitis C is a liver disease caused by the hepatitis C virus, which can cause both acute and chronic hepatitis infection. The hepatitis C virus is a bloodborne virus and the most common modes of infection are through unsafe injection practices, inadequate sterilisation of medical equipment, and the transfusion of unscreened blood and blood products.

Vaccine, Treatment, Cure Available, Testing Far Behind

For hepatitis B there is a highly effective vaccine, and lifelong treatment, Hinschall said, and for hepatitis C there is a cure. High attention was brought to prices at the time of the launch of the innovative hepatitis C treatment, and prices have now gone down considerably in developing countries, he said, as low as US$200 in some countries for the 3-month cure.

Ana Maria Henao Restrepo, team leader, WHO Department of Immunisation, Vaccines and Biologicals, also speaking at the briefing, underlined the impact of vaccination campaigns.

She said the global impact of vaccine campaigns in many countries is starting to show. The number of children infected with hepatitis B has been “reduced dramatically,” and the number of those children who become chronic carriers of hepatitis B, and thus at risk of cirrhosis and liver cancer, is declining substantially, she said. Between 2011 and 2015, vaccination campaigns have prevented 22 million infants from becoming chronic carriers, she added.

According to Yvan Hutin, technical officer at WHO and lead author of the report, speaking at the briefing, at the end of 2015, only 9 percent of hepatitis B infected people were aware of their infection, and about 20 percent of hepatitis C infected people were aware of their condition.

Of those who knew they were infected, only 8 percent of hepatitis B infected people got treatment, and only 7 percent for hepatitis C infected people.

This is “quite far from the 2030 target,” which is 90 percent people being aware of their infection, and of those aware, 80 percent getting treatment, he said.

Access Issues Remain for Tests, Hepatitis C Medicines

According to the report, access to affordable hepatitis testing is limited, particularly in low and middle-income countries, which account for the largest proportion of persons living with hepatitis B and C.

The report also notes that there is currently limited funding available at the international level to support national hepatitis elimination plans, leaving countries to finance most of their response through domestic sources.

WHO-recommended treatment for hepatitis B infection is available as generics in most low and middle-income countries, says the report, however noting that prices for hepatitis C treatment varies from US$200 to US$45,000.

“Without lower prices, countries are unlikely to be able to increase investment to minimize the burden of hepatitis C,” it says. “Sofosbuvir, daclatasvir and the sofosbuvir/ledipasvir combination, which are part of the preferred regimens in the WHO guidelines, are included in the 19th WHO model list of essential medicines and in the WHO prequalification programme. However, as of March 2017, only one prequalified generic formulation was available,” the report details.

The picture is different for hepatitis B medicines, which are “available and inexpensive in most high-prevalence countries.”

Rationing

Answering a question about the high prices of hepatitis C medicines in developed countries, and the rationing of medicines, Hirnschall said many countries have different policies and treatment guidelines. Some countries reserve the treatment of hepatitis C to those who have advanced infection.

“At WHO we see a benefit [of treatment] for everybody regardless of the state of the infection, or the disease progression, even though in our guidelines we do recommend, in case there are not enough resources available, that the ones with the greatest disease progression would have the greatest benefit from treatment.”

The WHO does not have data regarding how much rationing occurs, he said, “but we know that in several countries patients are on waiting list,” and are not able to access the medicines even in high-income countries.

“At the WHO, we do everything we can to work with countries to bring down the prices, to work through certain mechanisms, including intellectual property-related mechanisms, … and advocate for public sector programmes that would make treatments available to everybody who needs it, including those who do not normally have good access to health care,” he said.

Hirnschall also said that prices have come down through generic competition or through voluntary licensing agreements, but mainly in low and lower-middle-income countries.

He said the WHO is working with pharmaceutical companies, and held an event with the industry last week, to “really work towards price transparency” so that countries have a better idea of what prices could be.

“But it is certainly so that in higher and upper middle- income countries prices are still a barrier,” he said.

 

Image Credits: WHO