hepinion: We must invest in viral hepatitis

30 Jul 2019 Chris Wingrove

Earlier this year JHEP released an article entitled ‘Global progress on the elimination of viral hepatitis as a major public health threat: An analysis of WHO Member State responses 2017’. Encouragingly, the article concludes that countries are making progress with respect to national hepatitis planning. However, there remains a major issue: financing.

The World Health Organization (WHO) reports that, as of April 2019, 124 countries have developed, or are in the process of developing, national plans and strategies. However many of these plans lack dedicated funding, and the 2017 data analysed in JHEP’s article shows that only 58 per cent of the 82 reported low- and middle-income countries had, at the time, included domestic funding in their national hepatitis plans.

For us to have any hope of reaching elimination, major investment in viral hepatitis programmes is required.

WHO are seeking to address this critical gap in funding with their theme for this year’s World Hepatitis Day: "invest in eliminating hepatitis". Through this theme, WHO aims to urge national and regional policymakers to increase political and financial commitments for the hepatitis response, to encourage national governments to ensure that national hepatitis testing and treatment plans include dedicated funding and investment, and to seek optimal prices for medicines and diagnostics.

While the World Hepatitis Alliance (WHA) echoes this call to policymakers to address the funding crisis, it is important to note that we, as civil society organisations, can play a pivotal role in securing adequate investment for hepatitis elimination programmes. The "global progress" article reveals that not only are countries whose governments engaged with civil society more advanced in their national planning efforts, they are also significantly more likely to have a funded plan. 52 per cent of countries whose governments have drawn on the expertise of civil society have plans with dedicated funding, compared to just 23 per cent of countries where civil society has not been engaged. The fact that countries who have involved civil society are more than twice as likely to have funded plans is a real testament to the know-how and strength of civil society, and we call on all countries faced with the challenge of how to finance their plans to ensure that civil society organisations are meaningfully involved in the response.

As well as engaging with civil society, governments need to take a strategic approach to costing and financing their viral hepatitis programmes, and one tool which can help guide them in this is the National Viral Hepatitis Programme Financing Strategy Template which WHA developed. This template explores each of the steps required as part of a comprehensive financing process and reflects the work we are doing in countries to support governments to cost, create the investment case and explore financing options for their viral hepatitis plans. Working with governments, local civil society organisations, and external stakeholders, we have completed or are working on costing national viral elimination plans in four countries across Africa, Asia, and South America.

Each scenario explored in our costing and investment work in Nigeria (conservative, moderate or aggressive scale-up of elimination activities) found projected cost savings compared to taking no action. And it’s about more than money – all scenarios also showed a dramatic reduction in infection rates and deaths from end-stage liver disease. As this particular case study demonstrates, investing in hepatitis elimination would save money in the long run, and save tens of thousands of lives each year.

In response to the challenges countries are facing in funding their elimination plans, our work goes a step beyond simply creating the investment case to look at the different options for funding that plan. Importantly, these discussions must be embedded within the context of Universal Health Coverage (UHC), though for those countries that are working towards UHC, or are not able to fund all the areas of their programme in this way, catalytic financing strategies may be required.

At WHA, we are working hard to promote the strong case for funding national viral hepatitis plans – after all, as highlighted in the JHEP article, 82 per cent of people with hepatitis B or hepatitis C currently live in countries where there is either no national plan, or no dedicated funding identified to implement a plan. Without investing in hepatitis, millions of lives will continue to be lost and countries will continue to face the huge financial burden of disease management costs. This is not good enough.



WHO’s recent costing analysis reveals that additional funding of US$6 billion per year will be needed in low- and middle-income countries between 2016 and 2030 in order to achieve hepatitis elimination targets, but only US$ 0.5 billion was invested in 2016.

This investment would increase the global health price tag by 1.5 per cent. But it will bring greater returns on better general health outcomes as well as future cost savings; funding hepatitis testing and treatment services as part of UHC efforts could cut global deaths by five per cent and increase healthy life years by ten per cent by 2030. These are achievements that cannot be ignored, and it is essential that viral hepatitis is given the same recognition as HIV/AIDS, malaria and TB in UHC planning.