About 10 million people living with chronic hepatitis will die mostly avoidable deaths by 2030 unless urgent action is taken to improve access to treatment. On this year’s World Hepatitis Day (28 July), WHO commends China on the progress that has been made in the last few decades in preventing the disease through wide-scale immunization. It is now time to scale up access to effective treatment for the millions of people living with chronic hepatitis who urgently need it.
“The world has ignored hepatitis at its peril. It is time to mobilize a global response to hepatitis on the scale similar to that generated to fight other communicable diseases like HIV/AIDS and tuberculosis,” said Dr Margaret Chan, WHO Director-General, who is in Beijing this week.
The burden of hepatitis in China
An estimated 90 million people in China currently have chronic hepatitis B (HBV), with 28 million needing treatment and 7 million requiring urgent treatment due to advanced liver disease and the high risk of developing cancer. Approximately 10 million people in China live with chronic hepatitis C (HCV), for which 2.5 million people are in urgent need of treatment.
China’s hepatitis burden is the highest in the world: one-third of the world’s 240 million people living with chronic HBV are in China, while approximately 7% of the world’s 130-150 million people living with HCV are in China.
“Approximately 100 million people in China – that’s 1 in 13 people – are living with chronic HBV and HCV infection. The majority of them are unaware they are carrying the virus, making it a truly ‘silent epidemic’. Unless they are treated, up to one-third of them will develop life-threatening illnesses like liver cancer,” said Dr Bernhard Schwartländer, WHO Representative in China.
Having chronic hepatitis means having a high risk of developing cirrhosis and liver cancer, and dying a premature death. It is estimated that about 400,000 people die each year in China from hepatitis-related complications. In total, about 10 million people could die due to chronic hepatitis-related cirrhosis and liver cancer between 2015 and 2030, most of them due to hepatitis B.
Beyond the tragic loss of life and the emotional impact it has on families and communities, hepatitis also has a tremendous negative economic impact on the nation’s health care system, the overall economy; and society as a whole:
- the cost to individuals for treatment of HBV and its related diseases can exceed 40% of annual household income; and this figure increases as the disease worsens;
- billions of yuan are spent every year on sub-optimal treatment for a small portion of those living with the disease;
- the consequences for the overall economy and society through loss of productivity and income are immense.
Immunization vigilance the key to prevention
Great progress has been made in the fight against hepatitis in China in recent decades. Thanks to China’s large-scale hepatitis B immunization program, chronic HBV among young children has decreased by 97%. Tens of millions of babies have been spared from infection as a result.
“Immunization has led to the current generation of Chinese children being virtually HBV free and protected for life. This is a great public health success story. But we must remain vigilant. Use of HBV vaccine on the first day of life, followed by two more doses in infancy, is the safest way to protect children from HBV infection. HBV vaccine is very safe and highly effective. Parents must continue to vaccinate,” said Dr Schwartländer.
Access to treatment: a crucial public health priority
While preventative measures have been highly successful, treatment for those currently suffering from the disease is where things are grim. Less than 1 in 50 HBV and HCV patients in need of treatment are currently receiving it. The biggest hindrance is the prohibitive cost of hepatitis treatment and care, which is well above the disposable income level in China. In the case of HCV, the complex and lengthy process of registration of drugs in China prevents access to the most effective medicines – direct acting antivirals (DAA) which cures HCV infection and are available globally.
Fortunately, a foundation has been laid to establish large-scale access to hepatitis treatment as a result of two major policy developments in the last year:
- the drastic reduction in the cost of the drug used to treat HBV; and
- a commitment to acceleration of the registration process for new medicines, including those used for the treatment of HCV.
“The challenge now is to make sure that hepatitis B treatment is fully included in health insurance schemes, so that people living with hepatitis avoid catastrophic expenditure in order to get the treatment and care that they urgently need. Only when a person actually can get these medicines – at an affordable price – will lives be saved,” said Dr Schwartländer.
“Similarly, we need to see the commitment for accelerating registration of the new HCV drugs turned into a better reality for people living with HCV. It is still unclear how long the acceleration process will take. Everyday these medicines are not registered in China, thousands of patients suffer the consequences of HCV infection,” said Dr Schwartländer.
Breaking down stigma and discrimination
Finally, the stigma of the disease and the discrimination that many of its sufferers feel remains a major problem in China. This can range from people being unwilling to hug or shake hands with people with chronic hepatitis, to losing a job (or not being hired in the first place). Fear of infection is the main factor behind discrimination, which stems from a general lack of awareness of the disease’s transmission routes.
“There is a need for more public education to break myths and misconceptions and educate the public on hepatitis so that people living with hepatitis do not suffer more than they already do,” said Dr Schwartländer.
About the World Health Organization
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