The global health community has made significant strides in the fight against hepatitis, yet the journey towards its elimination remains fraught with challenges, particularly in regions such as Africa, writes Bada Pharasi, the CEO at the Innovative Pharmaceutical Association of South Africa, and Professor Wendy Spearman, the recently retired Head of the Division of Hepatology at the Faculty of Health Sciences, UCT.
Viral hepatitis is one of the most pressing global health challenges today. The silent epidemic, often overshadowed by more visible health crises, affects millions worldwide, causing significant morbidity and mortality. Worryingly, an estimated 354 million people globally are living with hepatitis B or C, yet most lack access to the necessary testing and treatment.
To address the plight, World Hepatitis Day, observed annually on July 28, serves as a pivotal opportunity to raise awareness about viral hepatitis and its devastating impact on millions of lives. The day not only highlights the urgent need for improved prevention, diagnosis and treatment strategies, but also galvanises public health efforts and policy actions worldwide.
To this end, the World Health Organization has committed to eliminating the threat of viral hepatitis as a public health threat by 2030. Ambitions are high, with the WHO intending to achieve a 90% reduction in new cases of chronic hepatitis B and C, and reduce mortality due to hepatitis B and C by 65%1.
While WHO’s intentions are admirable, many regions across the globe remain vulnerable, with limited disease awareness evident, particularly across Africa.
According to the WHO Global Hepatitis 2024 report, the WHO Africa region accounted for 63% of all new viral hepatitis infections in 2022. Only 4.2% of people living with hepatitis B have been diagnosed and only 0.2% have been treated in African region. Similarly, for people living with hepatitis C, only 13% have been diagnosed and 3% have been treated. Intervention is thus urgently needed to enhance awareness of viral hepatitis and bring healthcare prosperity to the continent.
While several interventions exist to combat the threat of viral hepatitis, the most effective and transformative approach is through comprehensive vaccination efforts.
Vaccination against hepatitis B, in particular, offers nearly 100% protection and serves as a powerful tool to prevent the transmission of the virus, especially from mother to child during birth. This is vital for regions such as Africa, where perinatal hepatitis B infection is associated with an increased risk of liver cirrhosis and liver cancer in adulthood. To date, there is no vaccine for hepatitis C.
With innovation being the bedrock of vaccine development, it is paramount to advance the frontiers of scientific knowledge and pave the way for new medicines and vaccines that can drastically alter public health outcomes.
Despite the inherent challenges of vaccine development – where, for every compound identified, one in 5 ,000 to 10 000 screened compounds make it through the research process and can take up to 10 to 15 years to come to fruition and bring a viable vaccine to market – the process fosters scientific ingenuity and resilience, ultimately leading to groundbreaking advancements that save lives and protect public health on a global scale.
The most notable example of this is evidenced in the history of hepatitis C research. In the 1970s, cases of transfusion-associated hepatitis that couldn’t be attributed to hepatitis A or hepatitis B baffled clinicians. The condition, known as non-A, non-B hepatitis, remained a mystery for nearly two decades until the hepatitis C virus was identified as the cause 5. The breakthrough solved a long-standing medical enigma and spurred the development of effective treatments and preventive measures, underscoring the transformative impact of pharmaceutical innovation on global health.
Collaborative efforts are required to ramp up vaccination efforts across Africa. This includes scaling up hepatitis B and C testing, with governments encouraged to implement co-designed testing strategies with individuals who have experienced hepatitis. Furthermore, collaboration between public, private and community-based services is critical, using innovative point-of-care screening and diagnostic tools to enhance the effectiveness of the efforts.
Additionally, ensuring access to life-saving treatments and enhancing partnerships with affected communities are crucial steps toward elimination. Integrating viral hepatitis into health systems, particularly in antenatal care, and including hepatitis B birth dose vaccination in routine immunisation programmes can prevent long term morbidity and mortality from chronic hepatitis B acquired in childhood.
Lastly, significantly increasing domestic financing for hepatitis programmes is necessary to ensure access to vaccination, testing, care and treatment across the continent.
Saturday Star
norman.cloete@inl.co.za