Expert Speak Health Express
Published on Jul 28, 2023

Eliminating hepatitis calls for a comprehensive strategy at the global level, with compound and multisectoral coordination among society, healthcare providers, the government, and international organisations

Addressing the threat of Hepatitis through international cooperation

The World Health Organisation (WHO) observes 28 July, the birthday of Dr Baruch Blumberg, who was instrumental in discovering the Hepatitis B virus, as World Hepatitis Day. It is seen as an opportunity where efforts from multiple levels, from individuals to government actions, can be engaged for better response. Hepatitis is a liver inflammation caused by five main strains of the hepatitis virus, referred to as types A, B, C, D, and E and non-infectious agents leading to liver problems. However, types B and C are the most common strains causing liver cirrhosis, cancer, and mortality. As per WHO, nearly 354 million people globally suffer from hepatitis B or C infection. Most of the patients lack access to testing and treatment. Proper vaccination, early diagnosis, and treatment can prevent premature deaths.

Hepatitis is a liver inflammation caused by five main strains of the hepatitis virus, referred to as types A, B, C, D, and E and non-infectious agents leading to liver problems.

To indicate the economic costs of Hepatitis, studies have shown that from 2001 to 2020, Hepatitis B vaccines alone have helped save approximately US$49 billion in illness expenses and US$81 billion in economic and societal value in 73 lower- and middle-income countries (LMICs). The disease, along with other major communicable diseases, such as HIV/AIDs, tuberculosis, and malaria, is seen as a global public health challenge. The SDG Target 3.3 explicitly mentions the need for specific actions to stop Hepatitis. Yet, Hepatitis is one of those diseases often not found as a top health priority. Further, according to a WHO study, an estimated 4.5 million hepatitis-related deaths can be prevented by employing enhanced vaccine coverage, diagnosis, and educational drives.

One of the issues is that Hepatitis, as an epidemic, is inadequately studied in several countries, leading to poor data availability at both the national and sub-national levels. This, in turn, makes it challenging to formulate robust surveillance programmes. In addition, the accessibility and affordability of vaccines, particularly in LMICs, is one of the biggest challenges. Other risks associated with producing vaccines include high costs incurred in Research and Development (R&D), time taken to develop and test vaccines, and the substantial risk of failure. While economic and procedural barriers delay vaccine production locally, the issues of political economy and geopolitical flashpoints prevent the transfer of technology or export of vaccines to states in need. All these collectively diminish the prevention and control efforts to reduce the disease burden in LMICs.

Other risks associated with producing vaccines include high costs incurred in Research and Development (R&D), time taken to develop and test vaccines, and the substantial risk of failure.

The health, economic, and social impacts caused by Hepatitis highlight the need to build robust mechanisms to develop, manufacture, and distribute safe and affordable vaccines to treat Hepatitis, especially in the LMICs. In this regard, the World Health Assembly has been working towards eliminating Hepatitis since 2016, when it adopted the Global Health Sector Strategy; accordingly, a target of a 90-percent reduction in new infections and a 65-percent reduction in hepatitis-related deaths by 2030 has been set. However, most of the states failed to achieve the 2020 target. While there have been efforts from various agencies, the states would require a collective action plan to prevent and proactively counter the complex burden of Hepatitis. International collaboration is one of the means to charter a coherent health strategy at the global level to ensure the establishment of initiatives with clear accountability and responsibility for all stakeholders involved while not compromising on quality and equity. Cooperation is one means for states to augment existing health facilities as it helps consolidate and accelerate health goals. The momentum creates a platform for policy intervention and harmonisation at the national level, and the inter-state exchange provides an opportunity for potential integrated health policy action at the regional level. These health policy issues also provide a converging point for dialogues and diplomatic relations between states.

The burden of Hepatitis cases highlighted by WHO calls for a comprehensive strategy at the global level. In addressing Hepatitis, successful international collaborations have been established to improve access to treatment. Notably, the WHO's Global Hepatitis Programme, The Coalition for Global Hepatitis Elimination (CGHE), The Clinton Health Access Initiative’s (CHAI) hepatitis initiative, The World Hepatitis Alliance (WHA), Doctors Without Borders’ (MSF) hepatitis programme, and the collaboration between Gilead Sciences and several organisations across the world do substantial work. Through these partnerships, the cost of direct-acting antiviral drugs has been reduced, making them more affordable and accessible to a broader population, thereby contributing to progress in eliminating Hepatitis.

International collaboration is one of the means to charter a coherent health strategy at the global level to ensure the establishment of initiatives with clear accountability and responsibility for all stakeholders involved while not compromising on quality and equity.

The formulation of a collective response to Hepatitis can be learnt from successful cooperation arrangements in the past. The 2003 Severe Acute Respiratory Syndrome (SARS) and the COVID-19 pandemic provide instances where cooperation was instrumental in controlling the spread. As a response to these outbreaks, mechanisms such as the Global Outbreak Alert and Response Network (GOARN) and Access to COVID-19 Tools Accelerator (ACT-A) were set up with the collaboration of governments, scientists, businesses, civil society, philanthropists, and global health organisations. Thus, these initiatives have successfully promoted certain aspects, such as access to tests and vaccines, by supporting global health systems. While such coalitions help towards improving access to diagnostics and vaccines for diseases, continued outbreaks have highlighted the need for more attention to intersectoral cooperation.

Civil society organisations hold an essential role in developing such collaboration as they are seen to be closer to the affected population, which provides an avenue for faster responses. Another role of these stakeholders is to ensure that the authorities and institutions adhere to their commitments. The central role of civil society can be found in Ukraine, where the Alliance for Public Health effectively reduced the cost of medicines for HIV and Hepatitis by advocating for generic medicine. This shows that civil societies enable collaboration through decentralisation, which is crucial for effective healthcare delivery.

The 2003 Severe Acute Respiratory Syndrome (SARS) and the COVID-19 pandemic provide instances where cooperation was instrumental in controlling the spread.

An in-depth examination of common barriers and challenges faced in international collaborations to combat Hepatitis is essential. Factors such as geopolitical tensions, lack of resource-sharing, and technology transfer and limited data-sharing agreements need consideration to shed light on the complexities of global health cooperation. Despite this, international cooperation is critical for achieving health for all. This can be done through mechanisms such as improving data-sharing, R&D, production, and distribution of vaccines and creating awareness of the risk of Hepatitis.

Eliminating the disease demands compound and multisectoral coordination amongst society, healthcare providers, the government, and international organisations. With hepatitis being recognised as a public health concern, states like India are imperative for managing Hepatitis globally. With one-fifth of the global population, India accounts for a substantial part of the Hepatitis burden. To tackle this, India has rolled out a national action plan for Hepatitis, making it the first country to do so in the region. Given its experience in combating the disease through a comprehensive programme, India can lead in augmenting international collaboration and collectively work towards eliminating Hepatitis. Taking a forward-looking perspective on potential future trends and developments in Hepatitis prevention and treatment is crucial. Discussing emerging therapies, vaccine innovations, and strategies to strengthen health systems will inspire action and preparedness for the challenges ahead. Advances in telemedicine, digital health records, and AI-powered diagnostics can demonstrate how technology can revolutionise healthcare delivery in combatting hepatitis.


Kiran Bhatt is a Research Fellow at the Centre for Health Diplomacy, Department of Global Health, Prasanna School of Public Health, Manipal Academy of Higher Education. 

Oommen C. Kurian is Senior Fellow and Head of Health Initiative at the Observer Research Foundation. 

Sanjay Pattanshetty, Head of the Department of Global Health Governance and Coordinator of Centre for Health Diplomacy, Prasanna School of Public Health, Manipal Academy of Higher Education.

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Authors

Kiran Bhatt

Kiran Bhatt

Kiran Bhatt is a Research Fellow at the Centre for Health Diplomacy, Department of Global Health Governance, Prasanna School of Public Health, Manipal Academy of ...

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Oommen C. Kurian

Oommen C. Kurian

Oommen C. Kurian is Senior Fellow and Head of Health Initiative at ORF. He studies Indias health sector reforms within the broad context of the ...

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