The silent killer

01 February 2018
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There is a disease that has been dubbed “the silent killer” – hepatitis C. It is a virus that can be asymptomatic for decades, but when symptoms appear, evolve into cirrhosis and liver cancer. Hepatitis C kills almost 400,000 people each year globally;[1] yet there are medicines being developed and brought to market that are effective and curative. Discussions around the availability of these new life-saving treatments have put a spotlight on the disease, along with calls for international and country-level action to ensure its elimination.

The World Health Organization has set a 2030 target to eliminate this disease, as outlined in its Global Health Sector Strategy on Viral Hepatitis, and the United Nations has prioritized the global elimination of viral hepatitis within the Sustainable Development Goals, adopted by all 193 member states. Despite this growing international focus, only three million patients, out of the 71 million people affected globally, have received treatment over the past two years.[2] Competing priorities and budget constraints have made some governments complacent towards addressing hepatitis C, resulting in inadequate services along every step of the care continuum. Simultaneously, while there has been mounting pressure to lower the cost of treatment, multiple system-level barriers – including a dearth of specialists, lack of awareness, and stigma – contribute to the lack of access to appropriate care for patients in need.

This week, The European Association for the Study of the Liver is bringing together scientists, clinicians, regulatory agencies and the pharmaceutical industry to develop a mutual understanding around the burden of hepatitis C, strategies to enhance prevention, testing, linkage to care and treatment, and how these groups can better work towards the WHO’s goal  of eliminating hepatitis C as a major public health threat by 2030.

Momentum is building, and the international community must capture and fan this spark into a flame

We can draw lessons from other public health crises, such as the HIV/AIDS epidemic, which has garnered unparalleled international attention, billions of dollars in funding, and extraordinary medical advancements by the scientific community to start reversing the tide of a disease that once wiped out virtually a generation of productive adults. If such vigor and urgency is applied to hepatitis C, elimination not only becomes an eventuality, it becomes a certainty. For example, the Red Ribbon Campaign and unrelenting advocacy by high-profile actors and institutions brought an outpouring of support to end AIDS. Similarly, the recently-launched NOhep campaign is working to bring together the hepatitis community under a unifying banner.

Earlier in 2017, the World Hepatitis Summit put these issues at the center of the global health agenda, where countries made new commitments to raise awareness, develop national plans, and direct sustainable financing sources towards combatting viral hepatitis. For example, Egypt and Malta pledged to eliminate viral hepatitis ahead of the 2030 target set by the WHO. The diversity of countries in attendance – from Mongolia to the Gambia – was a testament to the global nature of the disease.

“If we had 300 million people demanding action, we would get it.” — Charles Gore, outgoing President of the World Hepatitis Alliance

The Global Health Sector Strategy on Viral Hepatitis is a concrete path forward – an international roadmap that can lead to the global elimination of this. The Strategy outlines steps to improve awareness, increase testing for those at risk, and ensure infected individuals have access to effective treatment. Its adoption and universal implementation solidifies the global political commitment to viral hepatitis elimination by 2030. What’s needed now is the dedication and cross-sector collaboration to implement this strategic plan among governments, healthcare providers, industry, civil society, and patients. Together, we can rid the world of this ‘silent killer’ within a decade.



Major gaps in viral hepatitis care. Source: Global Health Sector Strategy on Viral Hepatitis 2016-2021, World Health Organization, copyright 2016.

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