World Hepatitis Day is an opportunity to bring the world together under a single theme—to raise awareness for the global burden of viral hepatitis and to influence real change. In 2021 the theme is “Hepatitis Can’t Wait.”
With a person dying every 30 seconds from a hepatitis-related illness—even in the current COVID-19 crisis—we cannot wait to act on viral hepatitis. According to the WHO, here is a list of essential reasons why Hepatitis can’t wait:
- People who are unknowingly living with viral hepatitis can’t wait for testing.
- People living with hepatitis can’t wait for life saving treatments.
- Expectant mothers can’t wait for hepatitis screening and treatment.
- Newborn babies can’t wait for birth dose vaccination.
- People affected by hepatitis can’t wait to end stigma and discrimination.
- Community organizations can’t wait for greater investment.
- Decision makers can’t wait and must act now to make hepatitis elimination a reality through political will and funding.
According to WorldHepatitisDay.org, “In spite of the ongoing COVID-19 pandemic, the global hepatitis community united with policymakers, medical professionals and the general public to reach hundreds of millions of people with life-saving information about viral hepatitis…
Thousands pointed at the time to let the world know they can’t wait for hepatitis elimination and the #WorldHepatitisDay hashtag reached half a BILLION people with life-saving messages about viral hepatitis!”
The Lancet reports, “Every 30 seconds, someone dies from viral hepatitis. With the disruptions caused by COVID-19, this health crisis has become even more urgent. We can no longer wait to act on hepatitis. People are dying because they did not receive simple interventions. People who are unaware that they are living with viral hepatitis cannot wait for testing and treatment. Pregnant mothers cannot wait for screening and prophylactic treatment. Newborn babies cannot wait for the hepatitis B birth-dose vaccination.
The COVID-19 pandemic has affected hepatitis prevention, testing, treatment, and vaccination services globally. Even before COVID-19, very few countries were on track to reach the 2030 elimination goals set by WHO. The pandemic has put elimination efforts further behind. Interruptions in the provision of services, coupled with delays in implementing major programmes, such as the anticipated support from Gavi, the Vaccine Alliance, for the hepatitis B birth-dose vaccine, will have dire consequences…
The World Hepatitis Alliance (WHA), a global network of more than 300 community-based organisations across 100 countries, conducted a survey at the onset of the COVID-19 pandemic (March–April, 2020) about the effect of the pandemic on hepatitis services and on the people and communities that need them. We conducted a follow-up survey a year later to understand how front-line hepatitis services continue to be affected. The survey also sought to assess the effect of COVID-19 on organisation’s planning and finances and the respondent’s country’s progress on hepatitis elimination. The online nine-question questionnaire (appendix pp 1–2) was distributed by email to WHA members between Jan 3 and March 23, 2021. There were 63 respondents from 33 countries representing all WHO global regions (appendix p 3).
Most (55 [90%] of 61 analysable responses) respondents reported that COVID-19 had a negative impact on the hepatitis services available in their country. This finding reflects other global surveys, including one by WHO on the continuity of essential health services in May to July, 2020, with a follow-up survey in 2021. Respondents to the WHO survey were government officials representing more than 100 countries. Of all the communicable diseases measured (including HIV, malaria, and tuberculosis), hepatitis had the highest ranking of disruption. Notably, the proportion of respondents who answered “do not know” for the impact of COVD-19 on the hepatitis response was much higher than for HIV. Thus, the gaps we are seeing might only be a small part of a larger problem.
COVID-19 has potentially jeopardised national elimination planning for viral hepatitis due to diverted resources and attention. 43 (77%) of 56 analysable respondents to our survey reported that their country’s progress towards hepatitis elimination has been affected. With governments facing the economic fallout of the COVID-19 pandemic, there is a real risk that funding will be reduced or lost for the foreseeable future. If this is the case, then many of the hard-fought advocacy wins that saw increases in domestic budget allocations would need to start again.
Fear of COVID-19 has been a substantial barrier to hepatitis testing and treatment throughout the crisis. 22 (73%) of 30 respondents reported that people did not have access to their medication because they avoided health-care facilities due to COVID-19. In the 2020 survey, this fear was reported by 50% of respondents.
Fear also affects testing, with 24 (86%) of 28 respondents reporting that the reason for people not accessing testing was avoidance of going to testing facilities due to COVID-19. In our 2020 survey, 65% of respondents cited this fear of attending testing facilities. Throughout the pandemic, civil society organisations have played a key role in overcoming this barrier and evolved their services to provide opportunities to test for hepatitis in settings where the community feels safe and confident during the COVID-19 crisis.
Decentralised, simplified services delivered at the community level are needed more than ever for viral hepatitis. We must innovate and find ways to provide life-giving care to people in locations they trust in a person-centred approach, which might require different approaches. Differentiated care models have been successful for HIV and represent a growing trend in hepatitis C care.
Our survey revealed signs that some services had returned over the pandemic, albeit not to previous levels. 27 (48%) of 56 responses reported community education and awareness raising had stopped but had now resumed at a reduced level. 28 (50%) of 56 responses reported hepatitis B vaccination had stopped but had resumed at a reduced capacity.
Childhood vaccines have been substantially disrupted in many areas, jeopardising children’s protection and leading to the tragic rise in hepatitis B infections in children born during the pandemic. Modelling conducted at Imperial College London showed that in a worst-case scenario, with a 60% reduction in administration of birth dose and a 20% reduction of childhood hepatitis B immunisation at age 1 year, there would be an additional 5·3 million chronic hepatitis B infections in children born between 2020 and 2030, and 1 million additional hepatitis B-related deaths among those children later on in life…”
And Sermo physicians agree. According to a recent poll of 200+ global Sermo physicians, 73% said the pandemic has interrupted the testing, diagnosing, and treatment of hepatitis. And 91% believe that despite the progress that has been made, policy makers still need to increase steps needed for preventing, diagnosing and treating hepatitis.
When asked which types of hepatitis, the physicians come across most frequently, the results were fairly even:
- 35% said hepatitis C
- 33% said hepatitis B
- 29% said hepatitis A
Regarding the stigma of hepatitis, 74% said the stigma makes it harder for people to live with the disease; while 39% said the stigma of hepatitis can make it harder as a doctor to test and diagnose the illness.
Here is more of what Sermo physicians have to say on this topic:
It is important to create public health policies in this regard and increase vaccination campaigns, not only HBV but HAV, which is more prevalent by the route of transmission– General Practice, Venezuela
Hepatitis C could be eradicated today!Gastroenterology, Germany
People needs to participate and discuss the diagnosis and management.Rheumatology, Brazil
Prevention and vaccines to reduce its lethalityGeneral Practice, Columbia
Hepatitis is a public health disease, which requires preventive management by governments.General Practice, Venezuela
The health system in my country is very precarious, opportunities for prevention, detection and treatment of hepatitis have been lost.Pediatrics, Venezuela