WHO sounds alarm on viral hepatitis infections that claim 3,500 lives each day

Photo: @WHO

According to the World Health Organisation (WHO) 2024 Global Hepatitis Report, the number of lives lost due to viral hepatitis is increasing. The disease is the second leading infectious cause of death globally — with 1.3 million deaths per year, the same as tuberculosis, a top infectious killer, WHO informed in an official release.

The report, released at the World Hepatitis Summit, highlights that despite better tools for diagnosis and treatment, and decreasing product prices, testing and treatment coverage rates have stalled. But, reaching the WHO elimination goal by 2030 should still be achievable, if swift actions are taken now.

New data from 187 countries show that the estimated number of deaths from viral hepatitis increased from 1.1 million in 2019 to 1.3 million in 2022. Of these, 83 per cent were caused by hepatitis B, and 17 per cent by hepatitis C. Every day, there are 3500 people dying globally due to hepatitis B and C infections, the release added.

“This report paints a troubling picture: despite progress globally in preventing hepatitis infections, deaths are rising because far too few people with hepatitis are being diagnosed and treated,” said WHO Director-General Tedros Adhanom Ghebreyesus, adding, “WHO is committed to supporting countries to use all the tools at their disposal – at access prices – to save lives and turn this trend around.”

Updated WHO estimates indicate that 254 million people live with hepatitis B and 50 million with hepatitis C in 2022. Half the burden of chronic hepatitis B and C infections is among people 30-54 years old, with 12 per cent among children under 18 years of age. Men account for 58 per cent of all cases, the release also said.

New incidence estimates indicate a slight decrease compared to 2019, but the overall incidence of viral hepatitis remains high. In 2022, there were 2.2 million new infections, down from 2.5 million in 2019. These include 1.2 million new hepatitis B infections and nearly 1 million new hepatitis C infections. More than 6000 people are getting newly infected with viral hepatitis each day.

The revised estimates are derived from enhanced data from national prevalence surveys. They also indicate that prevention measures such as immunisation and safe injections, along with the expansion of hepatitis C treatment, have contributed to reducing the incidence. Across all regions, only 13 per cent of people living with chronic hepatitis B infection had been diagnosed and approximately 3 per cent (7 million) had received antiviral therapy at the end of 2022. Regarding hepatitis C, 36 per cent had been diagnosed and 20 per cent (12.5 million) had received curative treatment.

These results fall well below the global targets to treat 80 per cent of people living with chronic hepatitis B and hepatitis C by 2030. However, they do indicate slight but consistent improvement in diagnosis and treatment coverage since the last reported estimates in 2019. Specifically, hepatitis B diagnosis increased from 10 per cent to 13 per cent and treatment from 2 per cent to 3 per cent, and hepatitis C diagnosis from 21 per cent to 36 per cent and treatment from 13 per cent to 20 per cent.

The burden of viral hepatitis varies regionally. The WHO African Region bears 63 per cent of new hepatitis B infections, yet despite this burden, only 18 per cent of newborns in the region receive the hepatitis B birth-dose vaccination. In the Western Pacific Region, which accounts for 47 per cent of hepatitis B deaths, treatment coverage stands at 23 per cent among people diagnosed, which is far too low to reduce mortality.

Bangladesh, China, Ethiopia, India, Indonesia, Nigeria, Pakistan, the Philippines, the Russian Federation and Viet Nam, collectively shoulder nearly two-thirds of the global burden of hepatitis B and C. Achieving universal access to prevention, diagnosis, and treatment in these ten countries by 2025, alongside intensified efforts in the African Region, is essential to get the global response back on track to meet the Sustainable Development Goals.

Despite the availability of affordable generic viral hepatitis medicines, many countries fail to procure them at these lower prices. Pricing disparities persist both across and within WHO regions, with many countries paying above global benchmarks, even for off-patent drugs or when included in voluntary licensing agreements. For example, although tenofovir for treatment of hepatitis B is off patent and available at a global benchmark price of USD2.4 per month, only 7 of the 26 reporting countries paid prices at or below the benchmark.

Similarly, a 12-week course of pangenotypic sofosbuvir/daclatasvir to treat hepatitis C is available at a global benchmark price of USD60, yet only 4 of 24 reporting countries paid prices at or below the benchmark, according to WHO. Service delivery remains centralised and vertical, and many affected populations still face out-of-pocket expenses for viral hepatitis services. Only 60 per cent of reporting countries offer viral hepatitis testing and treatment services free of charge, either entirely or partially, in the public sector. Financial protection is lower in the African Region, where only about one third of reporting countries provide these services free of charge.

The report outlines a series of actions to advance a public health approach to viral hepatitis, designed to accelerate progress towards ending the epidemic by 2030. They include: expanding access to testing and diagnostics; shifting from policies to implementation for equitable treatment; strengthening primary care prevention efforts; simplifying service delivery, optimising product regulation and supply; developing investment cases in priority countries; mobilising innovative financing; using improved data for action; and engaging affected communities and civil society and advancing research for improved diagnostics and potential cures for hepatitis B.

Funding for viral hepatitis both at a global level or within dedicated country health budgets, is not sufficient to meet the needs. This arises from a combination of factors, including limited awareness of cost-saving interventions and tools, as well as competing priorities in global health agendas. This report seeks to shed light on strategies for countries to address these inequities and access the tools at the most affordable prices available, WHO also said.