What does Sleeping Beauty and hepatitis B have in common?
A silly question, perhaps, but bear with us. Both involve babies born under a curse: in many places where hepatitis B is most commonly spread from mother to child, babies with infected mothers are very likely born with the disease, and one in four will eventually die of liver complications. But this ticking timebomb often goes undetected. Just as the princess sleeps for a hundred years, the virus can lurk for decades with no symptoms until it causes cirrhosis (severe liver scarring) or liver cancer – then it may be too late. Every 30 seconds, hepatitis B claims a life globally.
Yet, unlike the wicked fairy’s unstoppable curse, death by viral hepatitis – liver inflammation caused by virus attacks – is entirely preventable. Hepatitis B can be prevented with safe and inexpensive vaccines, and its complications can be treated (such as reducing the risk of developing cancer). Hepatitis C, another common type of viral hepatitis, does not have vaccines, but can now be cured in three months with new drugs.
So is hepatitis a thing of the past? Sadly, no. Hepatitis B and C still affect more than 350 million people worldwide, posing higher cancer risks than smoking a cigarette pack a day and killing over 1.1 million per year. In fact, it is the only transmissible disease still with a rising death rate, claiming as many lives a year as HIV, tuberculosis, or malaria.
Why then, you may ak, do we hear so little about this deadly epidemic? Why have governments and funders invested so little money compared to diseases like HIV or malaria?
Hepatitis is an epidemic of the poor: the absolute majority of chronic hepatitis B (96%) and hepatitis C (72%) cases are in low- and middle-income countries, and disproportionately in marginalised groups. It is a silent epidemic: the vast majority of those infected do not know they carry the virus and unwittingly pass it on; governments may be unaware of the impact; and there may be stigma given the transmission routes of hepatitis B (sexual) and hepatitis C (by unsafe drug injections). And so, in a world grappling with pressing crisis like wars, pandemics, and economic upheavals, it becomes what it is: a neglected epidemic.
But it doesn’t have to be so. With investment and political will, viral hepatitis can be eliminated by 2030. Indeed, this may be one of the few Sustainable Development Goals (SDG3.3) that are achievable.
This is where our strategic partner the Hepatitis Fund comes in. It is the world’s first philanthropic platform dedicated exclusively to eliminating viral hepatitis. Based in Geneva, it was initiated through collaborations led by the U.S. Centers for Disease Control and Prevention, World Health Organization (WHO), and us. It examines the global hepatitis landscape, invests strategically in high-impact programmes, builds partnerships, and provides technical support. In doing so, it hopes to provide the spark that stakeholders on the ground need to set transformative efforts in motion.
Asia-Pacific is no stranger to viral hepatitis: of the burden of hepatitis-related diseases globally, 63% is in the region, with 150 million and 20 million people respectively living with chronic hepatitis B and C. This means one in nine people in Vietnam, Mongolia and the Philippines. Few are tested and diagnosed: in the WHO Western Pacific Region (WRP), which includes countries like China and Mongolia, over 80% of infected people do not know they have the virus.
The tools to prevent, test, and treat hepatitis are available, yet out of reach for many Asian countries due to lack of funding and poor healthcare infrastructure. With this in mind, the Hepatitis Fund invests in catalytic programmes that demonstrate how introducing or strengthening certain interventions can help overcome these barriers, thereby reshaping local ecosystems. Here are examples in Asia from the first round of grants, many of which went beyond expected outcomes:
- Accelerating diagnosis in Vietnam: a partnership between the nonprofit PATH and Vietnam’s Ministry of Health, which integrates hepatitis testing, diagnosis and treatment into primary care, providing health authorities with evidence for financing and scaling up such decentralised services.
- Decentralized care in Pakistan: run by the Association for Social Development Pakistan, this developed integrated test-treat-prevent hepatitis C care in rural Punjab, generating evidence that can inform health authorities in scaling up services.
- Eliminating Mother-To-Child Transmission of Hepatitis B in Vietnam: a partnership between PATH and provincial health authorities, with support from the City of Geneva, this scalable pilot is expected to build local capacity for screening and treating hepatitis B in pregnant women, and generating promising results to inform scaling-up by the government.
The Hepatitis Fund, thanks to generous donors, will open a new call for proposals in 2024. It will focus on countries with a high potential for impact, where political will is present and early action has taken place, so that catalytic investments can readily kickstart or accelerate efforts to implement national plans on hepatitis elimination. In Asia, priority is given to countries with high infection rates: Vietnam, Indonesia, Cambodia, the Philippines and Pakistan.
Investing to eliminate hepatitis will save lives – 7.3 million by 2030 if hepatitis B services were scaled up. It will also save money in health systems, given the cost of hospitalisation, liver transplants and other expensive treatments for cirrhosis and liver cancer. The benefits will far outweigh the costs: according to estimates in 2017, every dollar of increased investment in eliminating hepatitis B will earn back US$2.2 and US$1.7 respectively in the Philippines and Vietnam by 2035.
Inaction, on the other hand, is too costly. Each year sees some 180,000 new lives born with hepatitis B in the WHO WPR – compared to 1,400 by HIV. If nothing is done, viral hepatitis will kill more people annually than HIV, malaria and tuberculosis combined by 2040.
There is a real case – and a ‘thundering moral imperative’ – for investing in eliminating hepatitis. How can you join in this collective effort? Get in touch with The Hepatitis Fund to find out about programme development and co-funding opportunities. Together, we can sustain the momentum, reverse the tide, and break the spell of hepatitis.
ZeShan Foundation