Living with hepatitis: Don’t be afraid

Web story
27 July 2015

Dr Zhang*, a village doctor in Henan province in central China, knows first-hand how destructive hepatitis can be. His father died of liver cancer, most likely caused by undiagnosed hepatitis. Dr Zhang himself was born before hepatitis B vaccination was widely available and was not immunized against hepatitis B – either at birth or as a child. He went on to develop a serious hepatitis B-related illness as an adult.

Babies infected at birth, as Dr Zhang may have been, have a much greater risk of a lifetime of chronic liver infections. The World Health Organization now recommends all children be vaccinated within 24 hours of birth, followed by 1-2 more doses within the first 12 months of life.

Dr Zhang’s hepatitis went undiagnosed until well into his adult life when he became seriously sick with liver disease. Fortunately, he was able to travel to Beijing to access good medical care, including a course of the antiviral drug, entecavir. Following treatment, Dr Zhang’s liver function returned to normal and the village doctor is now in good health.

Viral hepatitis is an insidious disease – and a major public health threat globally. It is the leading cause of cirrhosis of the liver and liver cancer. In China, there are around 90 million people living with chronic hepatitis B, and almost 10 million people living with hepatitis C – making China alone home to 25% of the world’s chronic viral hepatitis cases.

In his work as a village doctor, Dr Zhang now uses his own lived experience to educate people about hepatitis.

“I tell pregnant women that they should get their babies vaccinated. I tell adults who aren’t vaccinated to get tested. And I tell people who I know have hepatitis B: don’t be afraid. Hepatitis B can be treated,” Dr Zhang says.

Dr Zhang wants others to know that they can live with chronic hepatitis B infection and still live a healthy and productive life.

Over the last 25 years, China has achieved remarkable success with its hepatitis B vaccination programme. New data show that less than 1% of under 15 year olds in China are infected with hepatitis B, a reduction of more than 90% compared to the pre-vaccination era.

“This makes the current generation of Chinese children the first to be almost completely hepatitis B-free, drastically reducing their chances of developing conditions like cirrhosis of the liver and liver cancer later in life. This is a remarkable public health accomplishment,” says Dr Bernhard Schwartländer, WHO Representative in China.

But more now needs to be done to improve treatment for hepatitis in China, so that more people like Dr Zhang can benefit from access to life-saving drugs. Of the approximately 100 million adults living with hepatitis B or C in China, tens of millions urgently need treatment, but cannot access it.

Without treatment, up to 3 in 10 chronically infected people will go on to develop life-threatening illnesses like cirrhosis and liver cancer. Liver cancer is the second most common cancer diagnosed in Chinese males, and one of the top five most common cancers in females.

While hepatitis B is treatable – as Dr Zhang’s case shows – access to treatment in China is difficult. The right drugs are available, but are very expensive because there is no public health programme that provides subsidized access – and not all health insurance schemes reimburse the cost. There are an estimated 28 million people in need of treatment for hepatitis B in China – 7 million of whom are considered high priority because they already have advanced liver disease.

Hepatitis C can be completely cured with the new, highly effective direct acting antivirals (DAAs), but these drugs are not currently available in China due to lengthy registration and approval processes. The standard treatments that are currently available in China are much less effective, more costly, require multiple injections, and result in more side effects. There are currently an estimated 2.5 million people in the country who urgently need treatment for hepatitis C because they already have advanced liver disease, and therefore a high risk of liver cancer.

WHO is working closely with the Chinese government to improve access to treatment for people living with both hepatitis B and C.

“Investing in a public health approach to hepatitis treatment – that is, making treatment available to all who need it through a public subsidy scheme, on an equitable basis – will result in many cancer cases averted, deaths avoided, and significant costs saved for both society and the Government,” said Dr Schwartländer.

“There is also an urgent need to make drugs which cure hepatitis C available and affordable in China. Drug registration and approval processes must be accelerated so people in China are not missing out on the best treatments for hepatitis that are now available in other parts of the world,” Dr Schwartländer added.

The issues facing people living with hepatitis in China are mirrored in countries across WHO’s Western Pacific Region. While successful infant hepatitis B vaccination campaigns have led to substantially lower rates of early childhood hepatitis B transmission in many countries, millions of people continue to live with chronic hepatitis B and C without access to effective medicines to prevent the severe complications of chronic infection. Indeed, in the Western Pacific Region there are more deaths from viral hepatitis than from HIV, TB and malaria combined. Yet investment in services and access to treatment remains desperately inadequate, condemning millions to the risk of liver cancer or cirrhosis.

WHO is driving change to bring to light the human tragedy of these once ‘silent epidemics’ – through coordinated efforts to improve understanding of disease patterns, prevent transmission, and to tackle the many barriers to effective treatment, including the high price of medicines. The Western Pacific Regional Action Plan for Viral Hepatitis lays out a systematic approach to combat hepatitis infection, and prevent avoidable deaths. It also provides a template for countries to tailor their public health response to the needs of local communities.

Through strengthening national and regional action on hepatitis, hepatitis infections can be prevented, and like Dr Zhang, more pe ople will be able to access effective medicines for treatment of hepatitis.

*Not his real name.