More than a decade ago, scientists achieved a historic breakthrough: they found The first cure for hepatitis COne of two related liver diseases that, combined, take More than a million lives every year
In 2016Just three years later the antiviral drug Sovaldi received FDA approval, World Health Organization (WHO) set Audacious goals Eliminate the two most common versions of viral hepatitis, B and C. The criteria were, by 2030, to reduce new infections by 90 percent and deaths by 65 percent. The previous year that target was set at 1.3 million people has died From hepatitis B and C.
Much of that optimism behind that goal has now evaporated. After a brief decline in the global death toll from hepatitis increased Again — from 1.1 million in 2019 to 1.3 million in 2022, according to the WHO. New infections fell slightly over the same period, from 3 million to 2.2 million, but not enough to turn the tide of deaths. About 6,000 people are still diagnosed with hepatitis B or C every day, and more than 3,500 people die from the infection every day.
This story first appeared in the Future Perfect Newsletter.
Sign up here to explore the big, complex problems facing the world and the most effective ways to solve them Sent twice a week.
Chari Cohen, now its president Hepatitis B Foundationwhich advocates investment in research and treatment for the disease, began his career researching the disease at the turn of the century. “Twenty-five years later, I thought we’d be in a better place,” he told me recently.
The main obstacle to stamping out these diseases is particularly in Africa and South Asia Where the burden is greatestIncludes low-resource health systems and chronic stigma against patients infected with hepatitis. And while hepatitis C has been solved by science, a clinical solution to deadly hepatitis B remains elusive. Forecasts for other long-term public health challenges are improving with new treatments, but will fall far short of its 2030 target to slow global hepatitis.
“We’re nowhere near the ability to do that. Unfortunately, we’re falling far short of that target,” Andrea Cox, who studies hepatitis at Johns Hopkins University, told me. “If current trends continue, by 2040 the number of people who die from hepatitis B and C will exceed the number of people who die from HIV worldwide. [tuberculosis]and combined malaria.”
Hepatitis B and C have proven difficult to stamp out
Hepatitis It is a viral infection of the liver, causing chronic inflammation that can lead to cirrhosis, liver cancer, and death over time.
D B and C variants spread through contact with bodily fluids; There are also versions that result from alcohol use and autoimmune disorders. In developing countries, people often contract hepatitis at a young age through exposure to infected blood and develop more serious complications years later. In rich and poor countries alike, hepatitis can be spread by sharing intravenous drug needles and through sexual contact.
Hepatitis B integrates in the host’s DNA, which makes it more difficult for the body’s immune system to find and eliminate it. With hepatitis C, a new generation of remedies has debuted Sovaldi In 2013 it was able to activate the human immune system to completely eradicate the virus when used in combination with other existing drugs. Hepatitis B has so far proved resistant to similar approaches. Some animals develop hepatitis infection naturally Research is slowCohen said.
Today, hepatitis B is a more damaging disease: it is responsible for most hepatitis deaths (87 percent) and more than half of new infections worldwide. In recent years, treatment As has tenofovir proven capable Allowing people to live longer after diagnosis and An effective infant vaccine Available to prevent infection in the first place.
The availability of both antiviral drugs and vaccines means we have the tools to significantly reduce the damage caused by hepatitis. How could we be losing ground instead?
Why the world’s goal to eliminate hepatitis is slipping
Beyond biology, the fight against hepatitis faces two distinct challenges.
First, the disease is particularly prevalent in developing countries where local health systems may not be equipped to provide the prevention, surveillance, and treatment necessary to bring these diseases under control. In Africa, vaccine uptake is particularly low; In Asia, antivirals are not as readily available as experts would like.
Hepatitis is notoriously difficult to diagnose, as it may have few symptoms until damage to liver function becomes more severe. By the end of 2022, an estimated 13 percent of people living with chronic hepatitis B worldwide will have been diagnosed, and as a result, only 3 percent will have received available antivirals. For hepatitis C, an estimated 36 percent of cases were diagnosed between 2015 and 2022, and only 20 percent of people received a combination drug that cures the disease.
More than 60 percent of new hepatitis B infections occur in Africa, and yet only 18 percent of newborns on the continent receive the vaccine that effectively eliminates the risk of infection. Fewer than half of children worldwide will receive the hepatitis B vaccine in 2022, according to WHO estimates. Improving these figures will require more aggressive public health campaigns, including better education and an increased capacity to dose out the field.
Developing countries are already facing a variety of health problems, of which hepatitis is only one. While they’ve focused on bringing malaria or empox or dengue under control, that leaves limited resources for another disease — and one that’s highly stigmatized.
According to the WHO, some of the countries most affected by hepatitis struggle to acquire medical equipment to combat the disease. Although hepatitis B drugs should be available for just a few dollars per dose and hepatitis C cures can cost $60 or more, most of the 25 countries that bear the greatest burden of hepatitis are failing to procure those drugs at those low prices, reducing their overall supply.
Prejudice against people with hepatitis, both personal and institutional, results from its association with drug use and sex. In some of the worst-hit countries, people may face formal sanctions DiscriminationThey lose their jobs or are denied immigration visas or school admissions.
This stigma reduces the willingness of physicians and government officials to be more proactive about trying to control the disease. It also reduces the willingness of patients to get tested if they are worried about symptoms. If we don’t know who has hepatitis B or C, we can’t use these effective drugs.
“In many parts of the world, if a family is known to have hepatitis B, they really avoid it,” Cohen said. “If I’m in a country I don’t want to get tested and I know if I test positive I’ll lose my job.”
There are some signs of the stigma breaking down with more people talking about their experiences with hepatitis, especially in developed countries like the United States. But long-standing prejudices are hard to break. And unless the hepatitis community can organize a political movement that government officials can no longer ignore, the dream of hepatitis eradication may slip away.
“I somehow felt that after 25 years, I don’t have to constantly argue about priorities. I thought it would be a no-brainer,” Cohen said. “But the communities that are most affected by hepatitis B are disenfranchised communities, communities that typically don’t have a political voice. They don’t have political power. And when you don’t demand action, you Don’t get it.”
