World Hepatitis Day and the Eradication Campaign in Pakistan

By:

Shiza Nasir

Each year 28 July marks the day endorsed by WHO as World Hepatitis Day. WHO along with international health authorities takes this opportunity to raise awareness about the viral disease, propose strategies and action plans to tackle its prevalence and mortality rate around the world [1]. Viral hepatitis happened to be the 8th leading cause of death worldwide [2]. It can be categorized into 5 types; A, B, C, D, & E; hepatitis B and C have the highest prevalence and contribution to death figures [3]. The viral infection is associated with liver inflammation and symptoms which might not even appear until a few years of infection; in the worst case, the chronic infection leads to liver cirrhosis and cancer [4].

The most common risk factors associated with the disease incidence are unscreened blood transfusions and the sharing of therapeutic syringes. Other risk factors are associated with the use of non-sterile medical equipment, sharing of razors at roadside barbers, sexual contact, and injecting drug use have also been observed [5]. Transmission of viral hepatitis is mainly attributed to regular medical malpractices and community actions, particularly involving the unaware group. As the disease is asymptomatic in its early stages, most people are not diagnosed until the disease has progressed to the chronic stage and most patients pass the disease unknowingly. In the case of diagnosed ones, most patients do not go for the treatment assuming it expensive and unaffordable [6].

According to the WHO statistics, approximately a population of 325 million is infected with viral hepatitis globally with 49 million in South-East Asia. In the region, Pakistan and Egypt contribute about 80% of the disease burden [7]. Pakistan has 15 million people who are either infected with hepatitis B or hepatitis C which makes it the country with the second-highest prevalence after Egypt [8]. According to the WHO study in 2016, hepatitis and related complications caused the death of 23,720 people in Pakistan that year [9].

The statistics revealed the global burden of the disease which caused 1.34 million deaths in 2015 [7]. The alarming figures eventually lead WHO to devise a Global Health Sector Strategy (GHSS) to eliminate viral hepatitis as a global health threat by 2030. It became part of the agenda for health-related sustainable development goals (SDG-3) for 2030 by the UN. Based upon prevalence in the regions, WHO proposed a regional action plan for 2016-2021 which included control programs and effective recommendations to achieve the GHSS goal. The strategy includes coordinated actions involving hepatitis B immunization, safe blood transfusions, reduced harm while using injecting drugs, accessibility to affordable screening and treatment facilities [9].

In 2016, WHO released a report on the access to hepatitis C treatment in Pakistan which reported the treatment of 161,000 patients that year but most patients got treated through the private sector [7]. Considering the present policy for the diagnosis and treatment of viral hepatitis in Pakistan, the goal of eliminating the disease seems unachievable [10]. The country must scale up its treatment up to 880,000 treated patients per year, for this, about 9.0% of its yearly allocated health budget is required to sufficiently scaling up screening and treatment. The standard sterilization practices for medical tools and prevention interventions must also be acted upon to attain the goals of GHSS and subsequently, eliminating the disease by 2030 [11].

In October 2017, the government of Pakistan launched the National Hepatitis Strategic Framework (2017-2021) to control the disease under the light of recommendations by WHO [12]. The government has enabled provincial authorities by providing resources for birth vaccination of hepatitis B. EPI (Expanded Programme on Immunization) workers, who are also responsible for BCG and polio vaccine procure and store the hepatitis B vaccines which are administered to newborn children [7]. Before the arrival of DAAs (direct-acting antivirals) in 2016 in Pakistan, pegylated interferon-based therapy was referred for hepatitis C treatment which is invasive and costly [9]. The cost of DAAs-based therapy is greatly reduced in Pakistan in comparison to the regions like the USA, where patients have access to DAA generics at a cost of <US$100 per regimen per person—one of the lowest costs globally. SOVALDI, the newly registered oral drug in Pakistan is priced for 99% to that in the USA [12].

There is a need for awareness campaigns regarding viral hepatitis, its transmission, and treatment options available, particularly emphasizing the steps taken by the government to make treatment accessible to financially disadvantaged people at reduced costs. This could make patients from lower-income families inclined towards getting the treatment who otherwise suppose the treatment unaffordable and inaccessible [13]. This year, World Hepatitis Day is themed “Hepatitis-free future”, with an emphasis on preventing hepatitis B among mothers and newborns [1]. Each year around this time, WHO releases a report on the progress of the hepatitis eradication action plan in different regions and propose further key interventions for the target year. By 2017, 84 countries have reported their national strategic plan to control hepatitis [7]. Moreover, 22 countries are taking steps for the elimination of hepatitis but Pakistan’s efforts towards the elimination campaign appear ineffective and even insufficient [10]. Among the coronavirus pandemic, the disease continues to take hundreds of lives and demands more attention.

Ms. Shiza Nasir (shiza.nasir198@gmail.com) has recently completed a Bachelor of Science in Biotechnology from IBBt-UVAS.

References

1.      World Health Organization (WHO). Available from: https://www.who.int/campaigns/world-hepatitis-day/2020

2.      Jeffrey D Stanaway et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Lancet 2016; 388: 1081–8.

3.      Hepatitis B virus burden in developing countries. Zampino R, Boemio A, Sagnelli C, et al. World J Gastroenterol. 2015;14:11941–11953.

4.      Hepatitis B. [Oct;2019]; http://www.who.int/mediacentre/factsheets/fs204/en/2019

5.      Waheed et al. (2009) Waheed Y, Shafi T, Safi SZ, Qadri I. Hepatitis C virus in Pakistan: a systematic review of prevalence, genotypes, and risk factors. World Journal of Gastroenterology. 2009;15(45):5647–5653.

6.      National Hepatitis Strategic Framework for Pakistan (2017-2021). Available from: http://phrc.org.pk/Extra/NHSF.pdf

7.      Global hepatitis report 2017. Geneva: World Health Organization; April 2016 (http://apps.who.int/iris/bitstream/10665/255016/1/9789241565455-eng.pdf?ua=1).

8.      Gower E Estes C Blach S Razavi-Shearer K Razavi H. Global epidemiology and genotype distribution of the hepatitis C virus infection. J Hepatol. 2014; 61: S45-S57.

9.      World Health Organization (2016) World Health Organization 2016. [29 May 2016]. Global health sector strategies on viral hepatitis 2016–2021. Available from: http://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_32-en.pdf?ua=1

10.  Polaris Observatory. Center for Disease Analysis. Available from: http://cdafound.org/polaris/.

11.  Lim AG, Qureshi H, Mahmood H, Hamid S, Davies CF, Trickery A, Glass N, Saeed Q, Fraser H, Walker JG, Mukandavire C, Hickman M, Martin NK, May MT, Averhoff F, Vickerman P. Curbing the hepatitis C virus epidemic in Pakistan: the impact of scaling up treatment and prevention for achieving elimination. Int J Epidemiology.

12.  Pakistan Health Research Council (PHRC). Available from: https://phrc.org.pk/hepatitis.html

13.  World Health Organization (WHO). Available from:  https://www.who.int/hepatitis/news-events/pakistan-hepatitis-elimination-plan/en/

 

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