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A dozen good ideas to battle hepatitis Editorial
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The Lancet May 17, 2008; 371:1637
The number of people living with chronic viral hepatitis is startlingly high: nearly half a billion people around the world, or one in 12 of the global population, are infected with hepatitis B or C. Even worse, most of them are not even aware they are infected. These two diseases combined kill up to 1¥5 million people yearly. But hepatitis is not high on the global health-care agenda. In view of the scale of infection and the indifference, ignorance, and stigma surrounding the disease, a multi-pronged plan of action is needed.
Because viral hepatitis is largely preventable and treatable, the toll it takes on the health and lives of people is needless. Hepatitis A and B are both preventable through vaccination. There is no vaccine for hepatitis C, but it can be cured with anti-viral drugs in more than 50% of patients. Hepatitis D is found in some patients with hepatitis B, more commonly in injecting drug users, and causes more severe disease than does hepatitis B alone. Hepatitis E, which is transmitted by contaminated water, is prevalent more in developing countries than in the developed world. Both hepatitis B and C can be found as a co-infection in people with HIV/AIDS, and co-infected patients are likely to develop cirrhosis or hepatic decompensation and liver cancer. All types of hepatitis can create extraordinary financial burdens, with related health-care costs in the USA alone estimated as more than US$2¥5 billion in 2003 by the Centers for Disease Control and Prevention.
Getting the word out about these numbers is the first step toward combating the disease. Until now, hepatitis has not had its own awareness day, unlike many other serious diseases. But this will change on May 19, when the first World Hepatitis Day will be observed. The occasion will be more than yet another rubber-stamped, pro forma, politically motivated Disease of the Day. It represents the culmination of a global effort, the result of an initiative that has been entirely led by patients. A new non-governmental organisation, the Geneva-based World Hepatitis Alliance, has been formed, with a governing board of patients from seven world regions.
The aims of the alliance are divided into two arenas, public and policy. For patients, the question "Am I Number 12?" forms the heart of the effort to increase awareness. Thus, awareness and education, among the public, those at risk, health-care providers, and governments, are the starting points. Patient groups in participating countries are developing materials appropriate for local needs. The most ambitious part of the campaign is aimed at governments, which will be asked to commit to 12 goals, six universal and six tailored to the needs of the individual country, by 2012. Some of these goals that go beyond increased public awareness are: the appointment of a hepatitis tsar to lead a national strategy; measurable targets to increase screening and reduce incidence, prevalence, and mortality; commitment to a national vaccination scheme; surveillance and publication of statistics on the national burden of disease; provision of free, confidential testing; and commitments to work with patient groups to develop and implement a hepatitis policy.
One important project will be a Hepatitis Atlas, which will be the first global resource for country-specific and cumulative statistics on the disease. Perhaps as important as the data the Atlas will show are the data it will not show: gaps in knowledge will provide opportunities for further action. In future years, the Atlas will reveal patterns of barriers to prevention, treatment, and improved outcomes, and it will showcase best practices in individual countries and regions.
A global hepatitis campaign is an ambitious and long overdue undertaking. It will require sustained commitments from WHO and individual governments over a long period. What may well guarantee its success, however, is that it is a bottom-up enterprise, with patients setting the agenda. As decades of progress in some diseases-HIV/AIDS and breast cancer being two of the most prominent examples-have shown, grassroots action can prod governments and other lumbering bureaucracies into effective action. Those actions can clearly improve outcomes and translate eventually into lives saved. The World Hepatitis Alliance has ambitions by the dozen, on behalf of the one in 12 already infected. We applaud the arrival of the first World Hepatitis Day and look forward to the year when hepatitis can be eliminated from the global disease calendar.
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