The Lancet Global Health, Early Online Publication, 22 July 2013
doi:10.1016/S2214-109X(13)70038-X Cite or Link Using DOI
Copyright © 2013 2013 Lazarus et al. Open Access article distributed under the terms of CC BY World Hepatitis Alliance Published by Elsevier Ltd. All rights reserved.
Viral hepatitis has not received the level of attention that it warrants. However, the global picture began to change in May, 2010, when the World Health Assembly adopted its first resolution on viral hepatitis.1
Recent data clearly show the magnitude of the challenge. Hepatitis A and E together caused more than 34 million cases of illness in 2005.2 According to Global Burden of Disease3 estimates, 1·3 million deaths occurred in 2010 from diseases related to hepatitis B and C. To put this finding into context, malaria and HIV caused about 1·2 million and 1·5 million deaths in 2010, respectively.3 Much of the suffering caused by hepatitis is unnecessary. Safe and effective vaccines for hepatitis A and B are available. Hepatitis C is curable, and hepatitis B treatable. Improvements in sanitation, hygiene, and blood and injection safety can reduce the spread of viral hepatitis and many other diseases.
In 2012 WHO, in collaboration with the World Hepatitis Alliance, did the first worldwide survey to investigate how governments are addressing viral hepatitis.4 The findings will be released on July 28, 2013—World Hepatitis Day.1 126 of WHO's 194 member states submitted answers to the survey—a response rate of 64·9%. Slightly more than a third of the countries reported the existence of a national hepatitis strategy or plan. Less than half of respondents reported holding events for World Hepatitis Day 2012, and less than a third had funded any other type of hepatitis public awareness campaign in recent months. The survey also asked questions about surveillance, disease prevention measures, and policies and practices for screening, care, and treatment.4
The findings provide a crucial baseline against which progress can be measured in coming years. We hope that the report will also stimulate dialogue with respect to the roles of all stakeholders in forging a cohesive and effective response to viral hepatitis. For example, civil society organisations can help to strengthen and call attention to governmental responses to hepatitis, in line with their involvement in many other pressing health issues. The relatively high response rate for the survey is an affirmation of the global community's concern about viral hepatitis.
However, low response rates from the WHO African Region and Western Pacific Region suggest that some of those member states do not see viral hepatitis as a priority disease. Further, the fact that so few survey respondents reported having a national strategy or plan for viral hepatitis is alarming. Such documents provide foundations for strong national leadership to address the complex array of issues to improve prevention, treatment, and care.
Another component of an effective public health response is to raise awareness of hepatitis among the general public, policy makers, and health-care workers. Governments should commemorate World Hepatitis Day and promote other awareness-raising activities. The World Hepatitis Alliance has adopted the three wise monkeys motif (figure) for World Hepatitis Day to call attention to the widespread public ignorance surrounding viral hepatitis, which will not end unless policy makers show better leadership on this issue. The World Hepatitis Day slogan is: “This is hepatitis…Know it. Confront it.” We invite readers to ask themselves why, given its burden, viral hepatitis is absent from major global health initiatives.
Figure Full-size image (76K) World Hepatitis Alliance
The three wise monkeys call attention to how people block out the reality of viral hepatitis
TN, HH, and SW are staff members of WHO. The authors alone are responsible for the views expressed in this publication, and they do not necessarily represent the decisions or policies of WHO. We declare that we have no conflicts of interest.
1 WHO. Sixty-third World Health Assembly. WHA63.18 Viral hepatitis. Geneva: World Health Organization, 2010.
2 WHO. Prevention and control of viral hepatitis infection: framework for global action. Geneva: World Health Organization, 2012.
3 Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2095-2128. Summary | Full Text | PDF(1201KB) | CrossRef | PubMed
4 WHO. Global report on the prevention and control of viral hepatitis in WHO member states. http://apps.who.int/iris/bitstream/10665/85397/1/9789241564632_eng.pdf. (available July 22, 2013).
a Copenhagen HIV Programme, Copenhagen University, Copenhagen, DK-2100, Denmark
b World Hepatitis Alliance, London, UK
c World Health Organization, Geneva, Switzerland