World Hepatitis Day: Accelerated Action Needed to Combat Liver Cancer in South-East Asia
World Hepatitis Day, observed annually on July 28th, serves as a crucial reminder of the global health burden posed by hepatitis, a group of infectious diseases that includes hepatitis A, B, C, D, and E. This day highlights the urgent need for comprehensive strategies to address these silent epidemics, particularly in regions like South-East Asia, where liver cancer rates are alarmingly high. The World Health Organization (WHO) is calling for countries in this region to provide universal access to prevention, vaccination, diagnosis, and treatment of viral hepatitis B and C. These diseases are preventable and treatable, yet they continue to cause an increasing number of serious illnesses and deaths from liver cancer, cirrhosis, and liver failure.
In the South-East Asia region, liver cancer is the fourth biggest cause of cancer deaths and the second most common cause of cancer deaths among men. A staggering 75% of liver cirrhosis cases are due to hepatitis B and C infections. In 2022 alone, the region accounted for 70.5 million people living with viral hepatitis B and C. Despite the availability of effective vaccines for hepatitis B and highly effective antiviral drugs for both hepatitis B and C, the coverage of testing and treatment remains dismally low. Only 2.8% of people diagnosed with hepatitis B receive treatment, while just 3.5% of those diagnosed with hepatitis C are treated. This gap in healthcare services underscores the need for accelerated action to prevent a looming public health crisis.
The theme for this year’s World Hepatitis Day is “It’s time for action,” a call to arms for faster efforts to provide equitable services for viral hepatitis. Early testing and treatment can cure hepatitis C and prevent hepatitis B from causing liver cirrhosis and cancer. However, many people with hepatitis remain undiagnosed, and even when diagnosed, they often do not receive the necessary treatment. This lack of access to healthcare services is particularly pronounced in rural and underserved areas, where healthcare infrastructure is inadequate, and there is a shortage of trained medical professionals. Strengthening primary healthcare centers and ensuring a steady supply of essential medicines can make a significant difference in these communities.
Globally, hepatitis B and C combined cause approximately 3,500 deaths per day, with 6,000 new infections each day. An estimated 254 million people are living with hepatitis B, and 50 million with hepatitis C worldwide. Despite these staggering numbers, viral hepatitis remains a largely neglected area of public health. In 2022, viral hepatitis was the second leading cause of death among communicable diseases, after COVID-19. The urgency of addressing this issue cannot be overstated, as liver cancer rates in the South-East Asia region are predicted to double by 2050, potentially resulting in over 200,000 deaths annually. This dire projection highlights the need for immediate and sustained action to combat viral hepatitis and its devastating consequences.
WHO’s Regional Director for South-East Asia, Ms. Saima Wazed, has been vocal in urging for faster and more equitable efforts to combat viral hepatitis. She emphasizes the importance of integrating hepatitis testing and treatment into primary healthcare services and making them accessible as part of universal health coverage. This approach ensures that people can receive care in their communities, rather than having to travel to larger hospitals or referral centers. There is also a strong economic incentive for countries to invest in the viral hepatitis response, with an estimated return of $2-3 for every dollar invested. This investment not only saves lives but also protects the health of future generations.
The challenges in combating hepatitis are not limited to South-East Asia. Regions like Kashmir face unique healthcare challenges, including a lack of awareness, limited infrastructure, and socio-political instability, which exacerbate the spread and impact of hepatitis. Studies have shown a higher than average rate of hepatitis B and C infections in Kashmir compared to other parts of India. Targeted efforts are needed to raise awareness, improve diagnosis, and enhance treatment accessibility in such regions. Public health campaigns tailored to the local context, utilizing mass media, social media, and community outreach programs, can effectively spread information about preventive measures such as vaccination for hepatitis B and safe practices to avoid hepatitis C transmission.
Improving healthcare infrastructure is crucial in addressing hepatitis in regions with limited resources. The healthcare system in Kashmir, for example, faces challenges such as inadequate facilities and a shortage of trained medical professionals. Strengthening primary healthcare centers and ensuring a steady supply of essential medicines can make a significant difference. Training healthcare workers to effectively diagnose and manage hepatitis is also crucial. Mobile health clinics and telemedicine services can play a pivotal role in reaching remote areas and providing access to care. Collaborative efforts involving government bodies, international health organizations, and local community groups are necessary to combat hepatitis on a global scale and in specific regions like Kashmir.
Hepatitis B and C are often referred to as silent epidemics due to their asymptomatic nature and ability to cause severe liver damage without noticeable symptoms. Millions of people in India and worldwide are affected by these viruses, making them significant health concerns. Efforts are being made to increase vaccination for hepatitis B, raise awareness, and improve access to screening and treatment. However, more needs to be done to address the high burden of chronic hepatitis B and C infections. For instance, India has a high burden of chronic hepatitis B, with approximately 3-4% of the population being infected. This can be attributed to low vaccination rates in certain regions and vertical transmission from mother to child.
The introduction of the hepatitis B vaccine in the national immunization program has been a positive step, but more efforts are needed to improve adult vaccination coverage and increase awareness about prevention. Hepatitis C, on the other hand, is primarily spread through blood-to-blood contact, often through sharing contaminated needles. Unlike hepatitis B, there is no vaccine for hepatitis C, making prevention efforts more challenging. It can also be acute or chronic, but it is the chronic form that poses the greatest health risk. Chronic hepatitis C can lead to liver cirrhosis, liver failure, and liver cancer over time. In India, the prevalence of hepatitis C varies, with an estimated 1-2% of the population being affected.
One significant issue with hepatitis C is its asymptomatic nature, which can lead to late diagnosis and treatment. This is why hepatitis B and C are called silent epidemics, as many people do not show symptoms until the disease has progressed. Public health strategies should focus on increasing awareness, promoting regular screening, and ensuring early diagnosis and treatment. Screening and early diagnosis are especially important for high-risk populations, such as those who inject drugs or have received blood transfusions. Treatment for hepatitis C has significantly improved with the advent of direct-acting antiviral therapies, but access to these treatments remains a challenge in many parts of India and other low-resource settings.
Despite the availability of effective interventions, the fight against viral hepatitis requires a concerted effort from all stakeholders. Governments, international health organizations, and local community groups must work together to implement comprehensive strategies that address the various challenges associated with hepatitis. This includes raising awareness, improving healthcare infrastructure, training healthcare workers, and ensuring access to essential medicines and treatments. Additionally, public health campaigns must be culturally relevant and tailored to the local context to effectively reach and educate communities about hepatitis prevention and treatment.
The elimination of viral hepatitis by 2030 is a feasible goal, but it requires a public health approach and significant investments in universal health coverage. Countries must prioritize hepatitis as a public health issue and allocate the necessary resources to combat it. This includes expanding testing and treatment services beyond larger hospitals and referral centers to reach people in their communities. By doing so, we can ensure that everyone, regardless of their location or socioeconomic status, has access to the care they need. The return on investment for countries that invest in the viral hepatitis response is substantial, not only in terms of economic benefits but also in saving lives and protecting the health of future generations.
In conclusion, World Hepatitis Day serves as a critical reminder of the urgent need to address the global health burden posed by hepatitis. The increasing number of serious illnesses and deaths from liver cancer, cirrhosis, and liver failure in regions like South-East Asia underscores the importance of accelerated action. By providing universal access to prevention, vaccination, diagnosis, and treatment, we can combat these silent epidemics and prevent a looming public health crisis. The theme “It’s time for action” calls on all stakeholders to work together to eliminate viral hepatitis by 2030. It is our collective responsibility to take action now to save lives and protect the health of future generations.