Is Eradicating Viral Hepatitis by 2030 a Realistic Goal?

Eliminating a disease is a feat that we have seldom accomplished.

Smallpox is the shining example of how a global effort can muscle its way through roadblocks to completely eradicate a disease in humans.

Polio and Guinea worm disease, too, have made considerable leaps and bounds; polio was eradicated in the United States in 1979, and only about 30 cases of Guinea worm were reported in 2017. Current global health efforts are also underway to try and halt the spread of vector-borne diseases like malaria, but challenges persist.

Such efforts are not sprints, but marathons that require Herculean force of both hard work and financial backing to see them through.

One condition the global community has its sights on is viral hepatitis. In 2015, 1.34 million people died from the infection globally. The US Centers for Disease Control and Prevention (CDC) reported on World Hepatitis Day (July 28, 2018) that more than 250 million people are living with hepatitis B alone and, worldwide, only 1 in 10 have received a diagnosis and are aware of their infection.

The global hepatitis report authored by the World Health Organization (WHO) endorses the Global Health Sector Strategy on viral hepatitis and calls for the elimination of viral hepatitis by 2030, which would reduce new infections by 90% and mortality by 65%.

Rob Brierley, editor-in-chief of The Lancet Gastroenterology & Hepatology, addressed the feasibility of viral hepatitis eradication in a recent commentary.

He first underscores the importance of addressing the burden of viral hepatitis and notes that, while the target is ambitious, the strategy has the capacity to work.

Brierley points to a collaborative commission organized by The Lancet Gastroenterology & Hepatology, which sought to address the current problem and aid in prioritization needed for action. During its analysis, the commission identified 20 countries that experience the highest burden of viral hepatitis, specifically hepatitis B and C viruses. When combined, these countries represented 75% of the global burden and were predominantly in Asia and sub-Saharan Africa.

Perhaps one of the largest barriers to eradication, the investigators found, was diagnosis; only 10% of the 292 million people living with chronic hepatitis B viral infection were aware of their status in 2015, and only 20% of the 71 million with hepatitis C were aware of their infection status.

To meet the eradication goal, there is a critical need for new and affordable diagnostics that are also deployable in non-specialty centers. Furthermore, testing needs to be ramped up in populations at increased risk for viral hepatitis infections—people who inject drugs, men who have sex with men, and Indigenous populations.

Diagnosis only gets us halfway there, though, as treatment is a second critical step in halting the spread of viral hepatitis infections.

As Brierley notes, for hepatitis C infections, there are pan-genotypic antiviral agents that cure most patients, but a hepatitis B viral infection cure is challenging and existing antivirals only keep the disease at bay.

Financial support from donors for diagnostics and further commitment from the pharmaceutical companies to develop treatments are necessary for meeting the 2030 goal. In all of this, affordability is vital, as so many countries that are plagued by viral hepatitis infections are also resource-strained.

Thankfully, hepatitis B vaccination has been quite successful, but vertical transmission (mother-to-child) does represent a critical transmission route. It is also thought that 5% of individuals with hepatitis B are co-infected with hepatitis D virus, which requires hepatitis B for viral replication. This codependent relationship further supports the need to eradicate hepatitis B.

The goal of viral hepatitis eradication by 2030 is lofty, but as Brierly highlights, there is truly a potential for it to occur. With the right financial and pharmaceutical backing for vaccination, testing, and drug development, it is possible eradicate these viral infections.