‘Think again’ on World Hepatitis Day

This was done because of the increasing recognition of the global burden of viral hepatitis, a group of infectious diseases causing acute and chronic liver disease and characterised as hepatitis A, B, C, D, and E. Millions of people are infected and affected worldwide and almost 1.4 million people die every year. Deaths due to viral hepatitis now exceed those of HIV/Aids but unfortunately viral hepatitis remains largely ignored by policy makers. South Africa was one of the sponsors of a comprehensive resolution on viral hepatitis at the recent World Health Assembly in Geneva.  This is a positive step but more is needed.

Hepatitis A and E are responsible for acute infectious hepatitis and those of extreme age or immune-compromised are at risk of acute liver failure.  Hepatitis A is vaccine preventable but no real public policy exists in South Africa to guide who may benefit from using it in preventing morbidity and less so, mortality.

Sub-Saharan Africa is endemic for hepatitis B with about 2.5 million South Africans chronically infected with the virus. It remains the leading cause of liver cancer in our country and on the continent, often disproportionately affecting young people. It is entirely vaccine preventable and while good progress has been made in South Africa by incorporating hepatitis B vaccine into the Expanded Programme of Immunisation (EPI) in 1995, we do not yet use a birth dose vaccine. This has been recommended by several groups including the WHO and CDC but only 23% of African countries currently use a birth dose vaccine.

There is evidence to suggest that HIV may have attenuated some of the gains with the vaccine programme, particularly the risk of mother-to-child transmission of hepatitis B.  The SA Medical Association (SAMA) believes a birth dose would be a strategy to reduce this risk. Drugs to treat hepatitis B also pose somewhat of a challenge.  While some are available and accessible in South Africa, others remain patented and very costly. A vexing scenario in Africa is the availability of Lamivudine and Tenofovir, drugs active against hepatitis B that are funded for but only limited to those who are HIV infected and not those who are hepatitis B mono-infected.

A new era of therapy for hepatitis C has dawned where almost everyone in the very near future will be cured with relatively short courses of oral therapy, irrespective of their HIV status. On the continent, without affordable access to these new therapies, the new developments will be meaningless to the majority. SAMA believes South Africa should play a pivotal role in leading the way for Africa to access these drugs just as it did for HIV/Aids. Similarly governments should prioritise these issues as well.

A critical issue is the general lack of access privately funded patients in South Africa have to treatment for chronic viral hepatitis.  Neither hepatitis B nor C is a so-called “Prescribed Minimum Benefit”.  Most schemes do not automatically fund any therapies and those that do, do so through scheme exceptions or other mechanisms and then often levy significant co-payments.   In a country and continent burdened with viral hepatitis, this is contradictory.

On World Hepatitis Day SAMA called on its members to ‘think again’ about what is a silent killer.  “We need to play a role in destigmatising those with chronic infection and ensure that as medical practitioners, our own hepatitis B vaccination is up to date. We call on the Department of Health to introduce a birth dose vaccine into our EPI and together to show leadership in ensuring access to affordable therapy for not only South Africans but for the African continent as a whole,” read a statement.

For more information visit www.worldhepatitisalliance.org