On Day 2 of its annual meeting, the World Health Organization (WHO) Regional Committee for the Western Pacific—the Organization's regional governing body—approved action plans and frameworks to strengthen efforts to reduce viral hepatitis and tuberculosis, and attain universal health coverage in the Region.
Action plan for viral hepatitis
"I appreciate the contributions from Member States in developing this comprehensive regional action plan for viral hepatitis," said Dr Shin Young-soo, WHO Regional Director for the Western Pacific. "With the success of hepatitis B vaccination over the past 15 years, now is the time to move to the next phase in addressing hepatitis and to provide access to timely diagnosis and treatment for the hundreds of millions living with the often-devastating consequences of chronic viral hepatitis."
The Regional Action Plan for Viral Hepatitis in the Western Pacific 2016–2020 provides Member States with tools to reduce viral hepatitis and related liver disease. The action plan was developed through a series of Member State and expert consultations in high-burden countries and at the regional level. Viral hepatitis is the seventh leading cause of death globally, claiming 1.45 million lives in 2013. The Western Pacific Region has only a quarter of the world's population but bears 40% of global deaths from viral hepatitis, with more than 1500 lives lost each day.
The consequences of chronic hepatitis B and C infection—cirrhosis (end-stage liver fibrosis) and liver cancer—account for 94% of deaths associated with hepatitis. Approximately 78% of liver cancer cases are a result of chronic viral hepatitis B or C.
The Region has had significant success in fighting viral hepatitis B. By 2012, the Region as a whole—as well as 30 of the 37 countries and areas—were estimated to have met the 2012 milestone of less than 2% chronic hepatitis B prevalence among 5-year-old children. Building on these gains, the Regional Committee in 2013 set a target date of 2017 to reduce chronic hepatitis B infection rates to less than 1% among 5-year-old children—a goal that will ultimately save millions of lives. Twelve countries have already reached the 2017 target.
These gains have been limited to hepatitis B immunization among children, not the large burden of adult chronic viral hepatitis in the Region. New, highly effective antiviral treatment is available for chronic hepatitis B and C. This treatment can reverse chronic hepatitis-related liver disease and reduce the risk of cancer. However, these medicines remain expensive and out-of-reach for most in need. The very high prices for hepatitis C medicines, in particular, are a barrier to access across the Region and a pressing issue taken up by Member States.
Framework for tuberculosis (TB)
"We've come a long way. But the death toll from TB is still unacceptably high and we face evolving challenges such as drug-resistant TB and TB among vulnerable groups," said Dr Mark Jacobs, WHO Director of Communicable Diseases.The Regional Framework for Action on Implementation of the End TB Strategy in the Western Pacific 2016–2020 aims to adapt the Global strategy and targets for tuberculosis prevention, care and control after 2015 to the particular circumstances of countries and areas in the Western Pacific Region.
Implementation of the strategy requires quality, people-centred TB services for all patients and families, addressing the looming burden of drug-resistant TB, social and financial risk protection, effective regulatory policies to support TB control efforts, and new tools and capacity for rapid adoption of new technologies.
Much work remains to be done to further reduce the burden of TB. Despite big reductions in deaths, TB continues to be a top killer, responsible for more than 100 000 deaths annually in the Region. In 2013, 1.6 million people fell ill with TB, severely affecting their lives and livelihoods.
The disease affects low-income and disadvantaged groups disproportionately. As such, innovative and multisectoral responses are needed to address the problem effectively. Studies show 50% of families with a TB patient lose more than half of their annual income. Stigma and discrimination make matters worse.
Progress in reducing the burden of TB in the Region has been remarkable.
The rapid adoption and Region-wide expansion of the directly observed treatment, short course, or DOTS, was further developed in 2006 into an expanded End TB Strategy. DOTS and the End TB Strategy have resulted in significant health benefits in the Region. Since 1990, concerted efforts resulted in TB prevalence reduction by more than 53% and TB deaths reduced by more than 73%. Since 2000, an estimated 9 million lives have been saved. With incidence continuously declining, the Western Pacific Region has already achieved the TB-related targets of the Millennium Development Goals.
"We hope this regional framework facilitates the national roll out of The End TB Strategy, and is a driving force for a collective regional response to this deadly disease. WHO will continue to support Member States until our Region is free of tuberculosis," said Dr Kasai.
Attainment of universal health coverage
"I thank Member States for their continued commitment to advance universal health coverage [UHC] in the Region," said Dr Shin. "Health systems in the Region face diverse challenges. The response requires political commitment, sufficient resources and strengthened partnerships," said Dr Shin.
He added that "Much work remains to be done. I trust that the action framework will be an effective guide for countries to develop high-performing health systems that stress quality, efficiency, equity, accountability and resilience. As always, WHO stands ready to collaborate with Member States to accelerate progress towards UHC."
An essential element of the Sustainable Development Goals, UHC calls for all people to have access to quality health services without facing undue financial burden.
A 2014 progress report on UHC for the Regional Committee for the Western Pacific highlighted the importance of including UHC in national health policies and strategies. However, challenges remain due to changing epidemiological and demographic profiles, the need for sustainable financing, urbanization and migration, climate change and emerging diseases.
The Western Pacific is one of the most diverse WHO regions in terms of economic development and social, political and cultural contexts. Increasing social expectations have helped create a call for access to quality health services and financial protection from the undue costs of health services. Member States have strengthened health system governance, improved financial protection and access to quality health services. In sum, they are using resources more efficiently.
To help address the challenges of sustainable financing, urbanization and migration, climate change and emerging diseases, Universal Health Coverage: Moving Towards Better Health, outlines 15 action domains for countries to consider in working towards achieving UHC. The document takes a whole-of-system, multisectoral approach, recognizing different country pathways and the importance of monitoring progress towards UHC to inform policy. The document was developed following country, regional and technical expert consultations.