In 2016, the World Health Organization (WHO) adopted the Global Strategy for Viral Hepatitis in the Health Sector, calling for the elimination of viral hepatitis as a major public health threat by 2030, by reducing new infections by 90% and deaths by 65%. Since it was put forward, all parties in the academic circle have been actively responding to the call and making efforts to realize this goal. This year's Asia-Pacific Society for the Study of Liver Diseases (APASL) annual meeting continues to follow up the latest research progress in the field of liver disease. Professor Tawesak Tanwandee, as the chairman of the conference, made a speech at the opening ceremony of the conference on "Can chronic hepatitis be eliminated by 2030?" He gave a keynote speech and this issue of Hepatology Digest is honored to have Professor Tawesak Tanwandee share further on the topic.
IH: Is it feasible to eliminate viral hepatitis by 2030? If not, what are the difficulties?
Dr. Tanwandee: I think, because this is just 9 years from now to reach 2030. So, maybe in some countries. For example, maybe just only one country in Asia, but it’s going to be in Korea where I think that might be achievable by then. But most of those countries where it can be achievable—for example, Australia, Spain, or Switzerland or the UK—that may be feasible. But for most countries, I don’t that could be achievable for the 2030 elimination of viral hepatitis .
There are several reasons. One is that, you know, these people are asymptomatic, and awareness is quite low. So we need to raise the awareness from the people. And then, most countries, so far, do not have specific plans for viral hepatitis elimination. Maybe just two thirds of countries are WHO member states that have some plan. But just a third of them have allocated a budget for this. So, it’s going to be a lack of money and a lack of people’s awareness of having viral hepatitis. And unfortunately, most countries that have a high prevalence of viral hepatitis—especially hepatitis B—are going to be in Asia-Pacific and Africa. Especially in Africa.
So, you know, it’s going to be quite impossible to reach that goal. Even in Asia-Pacific, for example, China has done such a good job by preventing new infections, and then treating those who have already been infected. But still, there is going to be a lot more work to be done to achieve that.
And then, regarding the financial burden: you know, last year we got Covid-19. That’s going to even delay the financials for viral hepatitis elimination. There’s going to be a lot of impact on that.
IH: Is the challenge of eliminating viral hepatitis different between the East and the West?
Dr. Tanwandee: Yes. For the Western countries, most of the viral hepatitis is going to be hepatitis C. And currently, hepatitis C, you know, is curable. So, they have a cure for hepatitis C—just two or three months of treatment and that can be cured. But, for us, for Eastern or Asia- Pacific and African countries, we have the same amount of hepatitis C in some countries—even more. But the bad thing is that we have hepatitis B. This is the big issue, because, you know, 70 to 80 percent of hepatitis B right now are in Asian-Pacific and African countries. So, this is even worse because we don’t have the budget and the treatment—people are asymptomatic until the late stage of the disease. And then, there is no cure, currently. This is even worse for us.
IH: What is the progress in the last decade in elimination of viral hepatitis?
Dr. Tanwandee: Actually, in terms of elimination, there has not been a lot of progress. I think one of the big jumps for elimination is going to be that we have—during the last ten years—curable medicine for hepatitis C. And also, we have less toxic control of treatment of hepatitis B available. So, that is going to be the big focus.
But again, one of the big progresses for both hepatitis B and C is going to be prevention of new infections. Because introduction of vaccines during the last two decades also has decreased new infections, especially for the mother-child transmissions. So, I think, at the end of 2030, even if we cannot eradicate the virus, I think in terms of prevention of new infections, that will be achievable.
As for the WHO target, for children under the age of 5, if you want to get the prevalence of hepatitis B less than 0.1%, I think that can be achievable in Asia-Pacific countries. But the only region it might not be achievable is going to be in Africa. As a whole, I think that is going to be the only target that can be achievable. So that can prevent bot hepatitis B and C as well.
IH: What measures can be taken to deal with these difficulties in the next decade?
Dr. Tanwandee: One thing that I think we need to take into account is that during the past few decades, most treatments were in the hands of specialists. So we need to think this is a healthcare problem. It’s not a special issue. So we need to try to generalize or modify the treatment in order to go out to other countries or so any doctors can have access to the treatment. And we need to provide general availabilities, especially in poor countries who treat both hepatitis B and C.
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