Firm action is needed to eliminate viral hepatitis in Viet Nam

World Hepatitis Day 2017

28 July 2017 – Hanoi – On World Hepatitis Day, WHO calls for action to ensure that everyone in Viet Nam has access to safe, affordable, good-quality prevention and treatment options for viral hepatitis. Viet Nam is one of the 11 countries which carry almost 50% of the global burden of chronic hepatitis, so addressing this major public health issue is vital.

New World Health Organization data from 28 countries - representing approximately 70% of the global hepatitis burden - indicate that efforts to eliminate hepatitis are gaining momentum. Published to coincide with World Hepatitis Day, the data reveal that nearly all 28 countries have established high-level national hepatitis elimination committees (with plans and targets in place) and more than half have allocated dedicated funding for hepatitis responses.

“It is encouraging to see countries turning commitment into action to tackle hepatitis.” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Identifying interventions that have a high impact is a key step towards eliminating this devastating disease. Many countries have succeeded in scaling-up the hepatitis B vaccination. Now we need to push harder to increase access to diagnosis and treatment.”

Global action towards eliminating viral hepatitis

World Hepatitis Day 2017 is being commemorated under the theme "Eliminate Hepatitis" to mobilize intensified action towards the health targets in the 2030 Sustainable Development Goals. In 2016, the World Health Assembly endorsed WHO’s first global health sectors strategy on viral hepatitis to help countries scale up their responses.

The new WHO data show that more than 86% of countries reviewed have set national hepatitis elimination targets and more than 70% have begun to develop national hepatitis plans to enable access to effective prevention, diagnosis, treatment and care services. Furthermore, nearly half of the countries surveyed are aiming for elimination through providing universal access to hepatitis treatment. But WHO is concerned that progress needs to speed up.

“The national response towards hepatitis elimination is gaining momentum. However, at best one in ten people who are living with hepatitis know they are infected and can access treatment. This is unacceptable,” said Dr Gottfried Hirnschall, WHO's Director of the HIV Department and Global Hepatitis Programme.

“For hepatitis elimination to become a reality, countries need to accelerate their efforts and increase investments in life-saving care. There is simply no reason why many millions of people still have not been tested for hepatitis and cannot access the treatment for which they are in dire need.”

Viral hepatitis affected 325 million people worldwide in 2015, with 257 million people living with hepatitis B and 71 million people living with hepatitis C - the two main killers of the five types of hepatitis. Viral hepatitis caused 1.34 million deaths in 2015 – a figure close to the number of TB deaths and exceeding deaths linked to HIV.

Improving access to life-saving hepatitis treatment in Viet Nam

Viet Nam bears a high burden of viral hepatitis, with hepatitis B and C as the major contributors for liver cirrhosis, liver cancer and liver-related deaths. Recent estimation and projection by the Ministry of Health, Center for Disease Analysis and WHO reported that one out of 11 people in Viet Nam live with a chronic infection of hepatitis B or C. Moreover, it is projected the complication and liver-related deaths due to viral hepatitis will continue to rise, unless the interventions are intensified.

Fortunately, efficacious medicines are also available for hepatitis B treatment. Currently available medicines do not cure the HBV infection, but treatment can slow the progression of cirrhosis, reduce incidence of liver cancer and improve long term survival. In Viet Nam, the oral antiviral medicines to treat hepatitis B are increasingly available at hospitals, and are already reimbursable by health insurance.

Moreover, we have seen revolution in hepatitis C treatment in recent years. With the new medicines, called Direct Acting Antivirals (DAAs), over 95% of people with HCV infection can achieve cure, usually within 3 months. In Viet Nam, access to these new medicines is still limited. Currently, only a few DAAs are registered in the country, and the treatment is still very expensive for many patients.

“As these new treatment options for hepatitis C offer a cure for over 95% of patients following a three to six months treatment, they are a true break-through”, says Dr Lokky Wai, WHO Representative to Viet Nam. The new oral antiviral medicines are not only more efficacious, but also have fewer side effects, and are more convenient for patients, as they can be taken orally. Previous hepatitis C treatments were costly, had more side effects and required regular injections. “With the availability of these new treatment options for hepatitis C, it is now crucial for the government to make them more affordable and better accessible for everyone – especially the most vulnerable parts of the population”, affirms Dr. Wai.

WHO has been working with the Ministry of Health to explore solutions for improved access to the new hepatitis C medicines, and important efforts and progress are being made. More DAAs are being considered for registration in the near future. Also, DAAs are now being considered for inclusion in the list of medicines that are reimbursable by the health insurance. There is ongoing discussion to set targets for hepatitis treatment scale-up, and to monitor the progress. Efforts are also being made to raise awareness among health care workers and the public on viral hepatitis and the treatment.

In Viet Nam, one out of 11 people is living with chronic hepatitis B and C. However, many of them are not yet diagnosed or not accessing treatment. Hepatitis B is treatable, and hepatitis C is curable, as long as people receive diagnosis and initiate treatment in a timely manner. Everyone needs to have correct understanding of viral hepatitis, and its prevention, diagnosis and treatment.

Continued investment in preventing new infections critical

Viet Nam has made considerable progress in preventing viral hepatitis infections. Important achievements have been made in expanding hepatitis B vaccination among infants. Viet Nam is on track to achieve the regional target to reduce hepatitis B prevalence below one percent among children at the age of five. However, continued efforts are needed to improve the uptake of the birth dose of hepatitis B vaccine, which should be given in the first 24 hours after birth.

In Viet Nam high hepatitis C prevalence has been reported among people who inject drugs, and people receiving haemodialysis or blood transfusion for multiple times. Building upon the progress made, continued investments and efforts are needed to strengthen programmes for people who inject drugs, and promote infection prevention and control and safe medical practices.

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