The Need for a Cross-Border Hepatitis Response: A Call for Urgent Action
In the face of a rapidly silent emergency that is projected to surpass the combined death toll of malaria, tuberculosis and HIV by 2040, the need for a coordinated cross-border response to hepatitis has never been more urgent. The Asia-Pacific region (APAC) bears the brunt of the global hepatitis burden, emerging as the epicentre of a public health emergency that demands immediate and collaborative action. The statistics are staggering; APAC accounts for 63% of global deaths from liver disease, with viral hepatitis and hepatocellular carcinoma (HCC) leading the charge.
The two major hepatitis viruses—hepatitis B virus and hepatitis C virus—are oncogenic, and viral hepatitis is the leading cause of primary liver cancer, most commonly hepatocellular carcinoma. Today, 90% of those infected with viral hepatitis in the region remain undiagnosed, and even fewer people have access to necessary treatment and medication that effectively halt disease progression. The number of new cases of liver cancers is predicted to increase by 55% by 2040, pointing to a looming crisis of unmet health needs and preventable deaths on the horizon.
Infectious diseases like viral hepatitis do not respect national borders; they demand coordinated, cross-border responses to scale up intervention efforts effectively.
The Current Crisis
Globally, hepatitis B and C infections affect an estimated 304 million people, resulting in 1.3 million deaths annually from complications such as liver cirrhosis and liver cancer. It is estimated that 1.3 million people died from viral hepatitis in 2022, with 83% of those deaths attributed to hepatitis B and 17% to hepatitis C. In APAC alone, this crisis is even more pronounced—hepatitis-related deaths reach more than 820,000 annually, contributing to a significant portion of the global death toll.
The majority of this loss of life can be prevented and/or treated with currently available diagnostics and medications, including at a primary care and community level. However, major barriers persist. Many people remain unaware of their condition due to limited access to screening and a lack of understanding about its silent progression—only one in five people with hepatitis C globally are aware of their status. Even among those who are fortunate enough to be diagnosed, treatment rates are alarmingly low due to various health system and societal factors. By the end of 2022, only 13% of individuals with chronic hepatitis B worldwide had been diagnosed, and approximately 3% had received antiviral therapy. For instance, despite the availability of generic medications lowering treatment costs, many countries struggle to procure them at lower prices or lack the financial resources to cover patient co-pays.
While some APAC countries have made notable progress, many still fall short of the components required for a successful hepatitis elimination strategy. An effective approach requires: 1) a national plan with clear, time-bound targets and detailed programs and funding requirements; 2) strong political will and coordination to secure stakeholder buy-in and government support; 3) adequate and sustainable funding, with international support as needed in less developed areas; and 4) well-established and integrated health services, particularly screening programs and effective linkage to care, tailored to the needs of diverse populations to ensure early detection and treatment.
A fundamental issue for governments is translating national plans and international guidelines into effective outcomes at the sub-national and community levels. This lag can be partly attributed to limited national funding earmarked for the implementation of hepatitis programs and gaps in social health insurance coverage, resulting in insufficient screening infrastructure and reduced outreach efforts. However, operational challenges are also significant. For example, access to and affordability of necessary diagnostic tools for eliminating viral hepatitis also remains a major obstacle. Systemic barriers, including poor integration of hepatitis management into primary health care, and a lack of training of community health workers, all further complicate linkage to care, as does the lack of public awareness and community engagement. Additionally, stigma and discrimination often discourage many individuals from seeking diagnosis and treatment, thereby perpetuating the cycle of infection and disease progression. Together, these health system and societal factors hamper efforts to control and eliminate hepatitis by preventing timely diagnosis, limiting preventive actions, and diminishing the effectiveness of healthcare programs and policy initiatives. As a result, progress toward the World Health Organization (WHO)'s 2030 goals remains sluggish.
If the moral imperative to save lives is not compelling enough, consider the economic case for a cross-border response.
As the leading cause of primary liver cancers and liver cirrhosis deaths in the region, viral hepatitis poses a significant economic burden due to the high costs of treatment and loss of productivity. It affects individuals and their families through costly testing and treatment, and income loss due to illness. Moreover, it impacts communities and countries by reducing productivity, as these diseases often affect people during their prime working years.
Without expanded vaccination, diagnosis, and treatment, hepatitis B is projected to result in USD 784 billion in lost productivity globally between 2022 and 2050. Studies have shown that achieving global hepatitis C elimination would cost USD 51 billion between 2018 and 2030, with minimal ongoing costs thereafter. In contrast, the expenditure on HIV, tuberculosis, and malaria strategies over the same period is projected to total USD 343.2 billion. This financial strain is further exacerbated by sub-optimal policies, inadequate implementation, and insufficient funding in many APAC countries. As a result, the anticipated benefits of investment are lost, leading to increased long-term economic and health costs. This scenario places the WHO’s 2030 elimination target out of reach.
Why a Cross-Border Approach is Needed
A coordinated, cross-border approach is crucial to overcoming the systemic barriers to hepatitis elimination. Recent progress includes the WHO's release of new guidelines for the prevention, diagnosis, and treatment of chronic hepatitis B infection at the 2024 Asian Pacific Conference for the Study of Liver Disease (APASL) in Kyoto—guidelines that offer significant simplification and expansion of treatment eligibility, now covering at least 50% of people living with hepatitis B, up from the previous 8-15%. This development improves access to hepatitis B testing and treatment, presenting a huge opportunity to reduce both the disease burden and its progression. However, the key challenge rests in whether and how these and other national strategies are operationalized effectively.
The urgent need for a collaborative, cross-border, multi-stakeholder hepatitis response that centres people and communities is clear given the complex challenges of hepatitis elimination. Whilst regional integration creates many opportunities, including economic growth and security, it also heightens the risk of communicable diseases like viral hepatitis crossing borders. The limited national resources and political will for elimination efforts highlight the necessity for a coordinated, multi-stakeholder approach. This approach should not only maximize the impact of existing resources but also mobilize new, sustainable financing, share expertise to strengthen capacity and leverage regional advocates to drive collective change.
With a severe health crisis and economic burden at hand, the time for collaborative action is now. We have the tools and a critical window of opportunity to act, and failing to use them effectively would be a disservice to those affected. Engaging all stakeholders at the highest level is crucial. Every participant in the ecosystem—ranging from Ministries of Health, policymakers, and funders to industry leaders, healthcare providers, physicians, caregivers, and patients—has valuable contributions to make and stands to benefit from a unified effort.
Regional collaboration boosts public awareness through comprehensive campaigns that combat stigma and promote education on prevention and treatment. By pooling resources and aligning efforts, regional cooperation allows for coordinated learning and the rapid scaling of successful strategies across similar systemic challenges and belief constructs. This collective approach not only strengthens political will and elevates hepatitis elimination on national agendas but also drives increased investment in targeted programs and initiatives.
As such, we are excited to announce that the APAC Liver Disease Alliance is hosting its inaugural Hepatitis Summit, titled “Hep-free: Eliminating Asia’s Silent Public Health Threat by 2030,” on October 1, 2024, in Bangkok, Thailand. Co-hosted with Thailand’s Ministry of Public Health, this event marks a significant milestone in our shared efforts to address liver disease in the region. By bringing together policymakers, physicians, NGOs, patient advocates, and academic experts, the APAC Liver Disease Alliance aims to promote equitable access to diagnosis and treatment, enhanced linkage to care, engage and empower vulnerable populations, and drive collective action for a hepatitis-free APAC through collaboration and effective public-private partnerships.
As we approach the WHO’s 2030 target, we are confident that the APAC Liver Disease Alliance Summit will serve as a key catalyst in accelerating efforts and fostering the collaboration needed to make a hepatitis-free future a reality.
Co-authors: Jade Chakowa, Yuhui Chan, Bethany Holt, Benedetta Nirta, and Roberta Sarno
Join our Hepatitis Summit virtually by registering here.
