First Regional Consultation on Viral Hepatitis in Europe shows progress and reaffirms countries’ commitment to elimination
WHO/Damir Begovic
The First Regional Consultation on Viral Hepatitis in the WHO European Region is a landmark on the road to eliminating the disease by 2030. Viral hepatitis is a public health threat affecting tens of millions of people in the Region. One hundred and twenty participants from 45 Member States convened in Tbilisi, Georgia, on 11–13 February 2019 to discuss all aspects of the response and exchange tools and experiences to address common challenges. The wide participation of regional partners, leading experts, members of civil society organizations, patients’ associations and representatives in the first event of its kind reflects countries’ commitment to scale up their response to this dreadful disease.
“Despite ongoing efforts to stop this silent killer, viral hepatitis mortality has not yet decreased. Lessons learned in these first years of collective response to viral hepatitis show us that elimination cannot be achieved without serving the vulnerable and addressing social determinants with effective policies and universal health coverage. This was demonstrated by many countries that have implemented national plans”, said Dr Nedret Emiroglu, Director of Programme Management at the WHO Regional Office for Europe, in her opening speech.
Lessons learned and progress made
Of the 5 types of viral hepatitis, hepatitis B and C are major health challenges and root causes of liver disease and cancer. Most of the 30 million people affected in the WHO European Region are unaware of their infection and continue to carry the virus. They are therefore at high risk of developing severe chronic liver disease and can unknowingly transmit the virus to other people.
In 2016, countries of the WHO European Region adopted the Action plan for the health sector response to viral hepatitis, aiming to eliminate viral hepatitis as a public health threat by 2030. Since then, countries have been developing national plans to tackle the disease more consistently and effectively, with WHO’s guidance and technical assistance.
Georgia, hosting the meeting, welcomed participants and shared its success story through the words of its Prime Minister, Mr Mamuka Bakhtadze, and its Minister of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs, Dr David Sergeenko. With support from WHO and partners, Georgia has pioneered the response to hepatitis C and has become an example for other countries. In only a few years, its national hepatitis C elimination programme has managed to successfully treat more than one third of those living with hepatitis C by implementing large-scale testing – including for groups at risk – and providing universal access to treatment.
Countries and researchers shared progress and findings in different areas. Iceland’s comprehensive national response managed to substantially decrease hepatitis C prevalence in vulnerable populations (-82% among people who inject drugs and -76% among prisoners). Researchers from Scotland showed how scaling up treatment of hepatitis C has lowered cases of severe liver disease and related mortality. Italy, one of the first countries that introduced universal vaccination against hepatitis B back in 1991, confirmed the dramatic decrease in both prevalence and number of new cases of hepatitis B virus infection following the enforcement of this highly effective preventive measure.
Next steps
An increasing number of countries are adopting the WHO recommendation to treat all patients with chronic hepatitis C and ensuring universal access to effective treatment, but making diagnostics and medicines affordable is still a challenge in some countries. The Consultation provided an opportunity for exchanging good practices in reducing the costs of medicines to treat hepatitis and in ensuring people-centred service delivery models, including for the most vulnerable. WHO plans to release a compendium of good practices to make them widely available across the Region.
Testing with linkage to treatment and care for those who are positive is crucial but still inadequate across the Region, due to complex and expensive diagnostics. As new simplified treatments become increasingly available, WHO is assisting countries to adopt simplified testing approaches that should facilitate the linkage to care and reduce the costs associated with chronic hepatitis. WHO also supported the expansion of the European Laboratory Initiative to cover viral hepatitis, to promote integrated approaches to testing and diagnosis of hepatitis, HIV and tuberculosis.
Many countries lack solid and reliable data that can provide a base of evidence for developing a tailored national response and address those most in need. WHO, the European Centre for Disease Prevention and Control (ECDC) and other regional partners have developed a framework for national data collection and monitoring tools that were further illustrated at the Consultation. The discussion provided input to WHO and ECDC to improve their support in building country capacity for collecting and reporting data on viral hepatitis burden and response.
“This first region-wide Consultation created an excellent platform for national and international stakeholders to take stock of achievements and perspectives in the implementation of the Action plan. The outcomes of the Consultation will inform the next session of the WHO Regional Committee for Europe, scheduled for September 2019”, commented Dr Masoud Dara, Coordinator of Communicable Diseases and Manager of Joint Tuberculosis, HIV/AIDS and Hepatitis programme at the WHO Regional Office for Europe. “We continue to support countries in developing sustainable approaches that leave no one behind towards elimination of viral hepatitis”, he concluded.
