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World Hepatitis Day: Eliminating The Disease By 2030, How Feasible?



With the recent introduction of Direct Acting Antivirals (DAAs) for treating Hepatitis C Virus (HCV), hope was raise d and many countries including Nigeria set target to eliminate the disease by 2030. Yet, the challenge facing many individuals and countries today lies with their ability to access these treatments due to their relatively high prices. ODIRI UCHENUNU-IBEH writes

Hepatitis is a chronic infection which is often referred to as silent killer due to the fact that it does not show symptoms for a long period, sometimes years or decades.

The President, Guild of Medical Directors, Prof. Olufemi Dokun-Babalola, said Hepatitis is simply put an infection of the liver, usually caused by various subtypes of viruses.

Dokun-Babalola said these viruses are labeled A, B, C, D, and E and they can be transmitted by food and water intake (hepatitis A) or by contaminated blood through blood transfusions, shared needles, shared barbing tools, shared hair care implements, and rarely through sexual intercourse.

He said Hepatitis can cause serious damage to the liver, leading to cirrhosis and liver cancer called hepatoma, which is usually fatal.

According to him, “Worldwide, the prevalence of hepatoma is about four per cent, but by comparison, the prevalence is much higher in Nigeria at about 10 per cent. Indeed it is estimated that 23 million Nigerians are infected with the disease. However, only one per cent or less of those who are affected know that they have the disease.

“This is why it is important that as many people as possible should be tested for the disease and avail themselves of treatment. Antiviral medications are particularly available for the treatment of Hepatitis C. Nevertheless, prevention is better than cure.”

Prevention is indeed better than cure. For instance, Globalization and Health recently conducted a research in seven cou ntries in Africa (Egypt, Ethiopia, Nigeria, Democratic Republic of Congo (DRC), Cameroon, Rwanda and South Africa) to assess their financial capacity to provide DAAs for the treatment of HCV under present voluntary licensing and tiered-pricing arrangements.

The research shows that the cost of 12-weeks of generic DAA varies from $684 per patient treated in Egypt to $750 per patient treated in other countries.

According to the research the number of people with HCV infection ranges from 110,000 in DRC to more than 8 million in Egypt and Nigeria. The prevalence of HCV is 14.5 per cent in Egypt, 8.4 per cent in Nigeria, and 11.6 per cent in Cameroon.

The research revealed that, “Universal treatment of HCV would be a major expenditure for these countries: in Egypt, the total cost of 12-weeks use of DAA to treat its HCV burden ranges from $5.7 billion (from local generic manufacturers) to $9.9 billion (from originator) and in Nigeria, it costs $6 billion (from primarily Indian generic sources) and $9.7 billion (from the originator firm).

No doubt, the present aspirations, for increasing access to DAAs towards the elimination of HCV, are facing challenges that would require increases in expenditure that are either too burdensome to governments or completely catastrophic for lower income individuals and families.

Elimination of HCV as a major public health concern, according to stakeholders in the Nigerian health sector, requires political commitment, financial will, global solidarity and civil society activism to expand access to DAAs in Nigeria.

The Minister of Health, Prof. Isaac Adewole said the federal government is more than ever committed towards the elimination of viral hepatitis in Nigeria by 2021.

To achieve the goal of the government, the minister said there was need for all stakeholders to take proactive steps of knowing their status by getting tested and finally seeking for treatment to reduce needless deaths from this preventable and treatable infection.

He said the viral hepatitis was the seventh leading cause of death globally, adding that the disease was a silent killer and responsible for about 1.44 million deaths annually.

He further said that without appropriate diagnosis and treatment, around one- third of those chronically infected with viral hepatitis would die as a result of serious liver disease, including cirrhosis, liver cell cancer and liver failure.

He pointed out that with appropriate treatment of hepatitis B and C, it would prevent the development of major life- threatening complication of chronic liver disease of cirrhosis and liver cancer, adding that with the emergence of new antiviral drugs over 95 per cent of the people with hepatitis can be completely cured of the virus within three to six months.

He however commended the Nigeria Ambassador for Hepatitis Control, General Yakubu Gowan (rtd), the royal Ambassador, the Oni of Ife, WHO, Roche Pharmaceuticals Ltd, Clinton Health Access Initiative (CHAI) and other partners for supporting the fight against the scourge of  viral hepatitis in Nigeria and urged others to join the fight against the disease.

Director of research, clinical sciences division, Nigerian Institute of Medical Research (NIMR), Nkiruka Odunukwe, said hepatitis is a public health issue in Nigeria and there is need to eliminate it before it becomes an epidemic.

How can Nigeria eliminate the disease by 2030, Odunukwe said, “NIMR is already well prepared to make sure that come 2030, hepatitis is eliminated and we can do this by increasing awareness, political willingness and supports from private sectors.”

She noted the need for the public to be informed about the virus that can lead to cancer of the liver, cirrhosis and death if not diagnosed on time.

She said, “This is the time to inform ourselves about the infectious disease, take positive action to know our status by getting tested and then seek medical attention if found positive to reduce unnecessary death from preventable and treatable infection.”

As to what NIMR is doing in its contribution to the global goal, Odunukwe said: “Just as it has been our practice in the past four years, today, NIMR will mark the world hepatitis day by creating awareness, providing free screening on hepatitis B and C to Nigerians and providing medical information on how to tackle the issue when one is positive.

“In addition, we have a well-equipped laboratory for diagnosis and a specialized clinic to take care of those with hepatitis B infection. We have also expanded our scope of service to do routine vaccination for hepatitis B for persons found to be uninfected.”