amfAR, The Foundation for AIDS Research

How the WHO Is Taking the Lead in Combating Global Hepatitis

WHO Drs. Ying-Ru Lo (third from the right) and Nick Walsh (fifth from the right) visit a community-based viral hepatitis treatment facility in Ulaanbaatar, Mongolia. 
WHO Drs. Naratuya Jadambaa (second from right), Ying-Ru Lo (third from the right), and Nick Walsh (fifth from the right) visit a community-based viral hepatitis treatment facility in Ulaanbaatar, Mongolia.

Globally, approximately 150 million people are infected with the hepatitis C virus (HCV)—including 15% of all people living with HIV—and approximately 240 million with hepatitis B virus (HBV). Together, these infections result in approximately one million deaths each year. However, due to the high cost of treatment and a lack of physician experience in treating and screening for hepatitis, treatment access is extremely low in most low- and middle-income countries. In addition, until recently, there was little response from international organizations to address this massive public health need.

"For many years, the hepatitis epidemic was a silent epidemic, ignored by communities and governments alike," says Dr. Nick Walsh, viral hepatitis medical officer for the World Health Organization’s Western Pacific Region. "Finally, the world has woken up to realize that half a billion people are living with chronic hepatitis."

The WHO released the world’s first international treatment guidelines for HCV in April 2014, and it expects to release similar guidelines for HBV in March of this year. "We realized several years ago that while guidelines for HBV and HCV were available in high-income countries, there were no guidelines available to clinicians in low- and middle-income countries. The new guidelines seek to fill that gap," says Dr. Walsh.

A nurse practicing how to counsel patients on HCV screening and treatment during a TREAT Asia training workshop.

In May 2014, the World Health Assembly passed a hepatitis resolution (WHA 67.6) that reaffirmed member states’ commitment to comprehensive action on hepatitis and called upon the WHO to offer increased guidance and support to improve access to quality hepatitis screening and care. The WHO is now developing more detailed guidelines to improve hepatitis treatment and surveillance in resource-limited settings and a Global Hepatitis Strategy to unify global efforts. Both are slated for release later this year.

The Asia-Pacific bears the highest burden of the world’s hepatitis infections, but, as in many regions, very few governments have established screening and treatment plans. The WHO Western Pacific and Southeast Asian regional offices are working together and with civil society, physicians, and national governments to translate the WHO’s international strategies and guidelines into actionable, regionally appropriate plans that national governments can adopt and implement. The Western Pacific Office will bring its Regional Hepatitis Action Plan before the WHO Regional Committee, made up of national ministers of health and their delegations, for endorsement in the last quarter of 2015.

"The Regional Hepatitis Action Plan for the Western Pacific will be an important advocacy tool to convince the highest levels of governments to commit to a public health response for the prevention and control of hepatitis in low- and middle-income countries," says Dr. Ying-Ru Lo, coordinator of the HIV, Hepatitis, and Sexually Transmitted Infections Unit of the WHO Western Pacific Region.

It will include detailed plans for everything from raising awareness to implementing plans for screening, treatment, and care, and overcoming challenges, including treatments that are priced too high for many national healthcare plans to cover them. Collaboration between all sectors—including pharmaceutical companies, civil society, governments, media, and physicians—is essential to successfully combating hepatitis, and one of the plan’s key guidelines is establishing national hepatitis task forces with representatives from all relevant stakeholder groups.

The Western Pacific Office is also collaborating with international and regional partners, including the U.S. and South Korean Centers for Disease Control, on its response. It is consulting with the United Nations Office on Drugs and Crime (UNODC) to better target populations at highest risk of infection, including prison inmates and people who inject drugs.

TREAT Asia has been working with the WHO on the guidelines and the regional response, and in January 2014 it launched a new clinical study investigating how to better diagnose and treat HCV in resource-limited settings, with the aim of developing a treatment and education pilot model that can be replicated across the Asia-Pacific.

"We are looking to partners like TREAT Asia to continue to demonstrate that it is possible to provide high-quality hepatitis C care in the Asian low- and middle-income setting," says Dr. Walsh. "These initiatives are extremely valuable in convincing policymakers not only that action is needed, but that it is actually possible despite the challenges."