According to the latest report from the World Health Organization (WHO), hepatitis stands out as the leading communicable disease worldwide. Its death toll is alarmingly high, with approximately 1.3 million people succumbing to hepatitis in 2022 alone. Following closely behind is tuberculosis.

Enhanced data from 187 countries reveal a concerning trend: the estimated number of deaths from viral hepatitis rose from 1.1 million in 2019 to 1.3 million in 2022. Among these fatalities, hepatitis B accounted for 83%, while hepatitis C contributed to 17% of the total deaths.

According to the report, approximately 304 million people were living with hepatitis B and C in 2022. The majority of cases were attributed to hepatitis B, totaling around 254 million, followed by hepatitis C, which accounted for approximately 50 million cases.

Hepatitis is a silent epidemic that has been gaining its grip all over the world. Over the years, the infectious virus has garnered more attention.

Hepatitis B and C are among its various strains that pose serious health threats, affecting millions globally.

The World Health Organization (WHO) plays a pivotal role in monitoring and addressing the spread of hepatitis worldwide. In its latest report released in 2024, WHO provides a comprehensive overview of the current status of hepatitis, shedding light on the progress made and the challenges that lie ahead.

India is counted among the top 10 countries having two-thirds of hepatitis B and C patients, the WHO report mentions. The fact highlights the intensity of the issue in the country. Also, it commands immediate and urgent solutions to prevent diseases that arise from HBV and HCV infections.

Highest hepatitis b and c worldwide WHO

WHO Report – Hepatitis Crisis in India

The report published in April 2024 highlights the rising number of deaths due to Hepatitis infections. Globally, Hepatitis infections are considered the second-largest infection.

Unfortunately, India ranks second among the ten countries that have the highest Hepatitis burden. The countries affected the most with HBV and HCV diseases and deaths are –

China
India
Indonesia
Nigeria
Pakistan
Ethiopia
Bangladesh
Vietnam
The Philippines
The Russian Federation

In 2022, China, India, and Indonesia collectively have 50% of the total HBV infection burden worldwide!

Moreover, India with China, Indonesia, Pakistan, and the Russian Federation are burdened with 50% of HCV infectious diseases globally.

What are the Key Points of the WHO Report?

Number of people estimated to live in India with Hepatitis infections –
- 2.9 crore people – Hepatitis B infection
- 0.55 crore – Hepatitis C infection
The Hepatitis infection deaths were 1.1 million in 2019. By 2022, the rate increased to 1.3 million. Among these fatality rates, Hepatitis B resulted in 83% of deaths, while Hepatitis C caused 17% of deaths.
In 2022, India had more than 50,000 new Hepatitis B cases and 1.4 lakh new Hepatitis C cases!
1.23 lakh people died in India in 2022 due to these viral hepatitis infections.

Diagnosis and Treatment in India

In India, only 2.4% of Hepatitis B cases and 28% of Hepatitis C cases are diagnosed.

Despite the affordable generic medicines availability, treatment coverage is –

21% for Hepatitis C
0% for Hepatitis B

Viral Hepatitis in India – A Glance

The WHO report also underscores several areas of concern. Hepatitis remains a major cause of morbidity and mortality worldwide, with an estimated 1.34 million deaths annually due to hepatitis B and C-related complications.

Notably, Hepatitis has become a major health concern, along with the “big 3” communicable diseases – HIV/AIDS, malaria, and tuberculosis. No wonder, the growing burden of hepatitis B and C in the nation highlights the magnitude of the challenge.

Challenges Hindering Prevention and Control Efforts

The WHO report for 2024 paints a detailed picture of the global hepatitis burden, highlighting both progress and persistent challenges.

Let’s take a look at some of the challenges in the points below –

Lack of Awareness
People are unaware of the Hepatitis B and C risks. This results in delayed diagnosis. To spread awareness and information, educational campaigns and outreach programs are essential. These measures will also promote preventive steps.

Inadequate Healthcare Infrastructure

The infrastructure of India’s healthcare, specifically in rural and underdeveloped regions lacks resources for screening and treatment of the virus infection. Moreover, the vaccination rate is low.

Expensive Treatment

The extremely high cost of Hepatitis treatment is a huge barrier for many individuals, particularly those from low-income backgrounds. Government initiatives to cut down on treatment costs and make medications affordable are important to ensure everyone’s access to healthcare.

Stigma and Discrimination

The stigma surrounding hepatitis and liver diseases remains pervasive in Indian society, leading to discrimination against affected individuals. The call of the hour is to destigmatize hepatitis. Thereby, encouraging individuals to seek diagnosis and treatment without fear of judgment.

Moreover, the WHO report emphasizes the importance of integrating hepatitis services into broader health systems to ensure continuity of care, even in times of crisis.

Pathways to Prevention and Control

In response to these challenges, the WHO advocates for a comprehensive approach to hepatitis prevention, testing, and treatment. Addressing the ever-rising Hepatitis B and C health issues in India needs a multifaceted approach.

Now, let’s see WHO-suggested steps to prevent and control the HBV and HCV infections in India.

Promoting Vaccination

Vaccination against hepatitis B is highly effective in preventing transmission of the virus. Introducing routine vaccination programs for infants and high-risk populations can significantly reduce the burden of Hepatitis B in the long term.

Expanding Screening and Testing

For early detection and treatment of HBV and HCV, affordable and accessible screening tests have to offer increased access.

WHO and myriad other international programs have released updated recommendations for –

Vaccination
Prevention of mother-to-child transmission
Strategies to increase testing uptake include self-testing and newer diagnostics

Moreover, community health centers, outreach programs, and mobile clinics facilitate testing initiatives to reach the underprivileged masses.

Enhancing Treatment Accessibility

Other crucial steps to fill this gap are to –

Strengthen primary healthcare systems
Expand access to testing and treatment services
Negotiate with pharmaceutical companies for lower drug prices

Raising Awareness

To raise public awareness –

Campaigns are launched that dispel myths
Stigma is reduced
Testing and treatment are promoted

Moreover, healthcare professionals and media can play a significant role in reaching diverse audiences.

Strengthening Healthcare Systems

Important measures to build sustainable prevention and control programs are –

Training healthcare workers
Integrating hepatitis screening and treatment services into existing healthcare systems
Investing in healthcare infrastructure

Safe practices include safe blood banking, dialysis, injections, and biomedical waste disposal.

Treatment

As of today, hepatitis treatment is readily available at a low cost. Even hepatitis C is now entirely curable, and the medication is easily accessible. Generic medicines are very affordable, enabling people to access treatment easily. However, many countries still struggle to provide these medicines to their citizens.

In some developed countries, the prices of hepatitis medicines remain excessively high.

Consequently, individuals without insurance or government support struggle to afford these expensive drugs. However, a contrasting scenario arises in some developing countries like India, where certain hepatitis medicines are available under voluntary licenses. As a result, the prices of hepatitis medicines in India are significantly lower compared to those in developed countries. But Many patients worldwide still face challenges in accessing these affordably priced drugs due to policy and access barriers within their countries’ legal systems.

Global overview of hepatitis B and c medicines

Hepatitis C is curable; however, finding a cure for Hepatitis B remains a challenge. Hepatitis B is treatable, and the virus can be managed with some medications. The top hepatitis B medicines include ETV (Entecavir), TDF (Tenofovir disoproxil), and TAF (Tenofovir Alafenamide).

These medicines are also used for HIV treatment. Entecavir (ETV) and TDF (Tenofovir Disoproxil) are off-patent and easily available in most countries. However, TAF (Tenofovir Alafenamide) is still under patent, but the originator company has granted licenses to some generic companies, such as those in India, to manufacture and market the generic version of these drugs.

Hepatitis C treatment is readily available, yet many patients worldwide still struggle to access it due to various reasons such as lack of education, awareness, or government support. However, the originator companies of hepatitis C medicines have granted licenses to numerous generic companies. For instance, in 2014, Gilead Science Inc. licensed several generic companies in India to manufacture and market generic versions of their hepatitis C medicines, including sofosbuvir/daclatasvir, sofosbuvir/ledipasvir, and sofosbuvir/velpatasvir. These generic versions are easily accessible in India at affordable prices. If patients in other countries are unable to receive treatment locally, they have the option to import medicine from India for personal use. However, they must ensure they have a doctor’s prescription and comply with their country’s import regulations.

Conclusion

In a nutshell, the WHO report serves as a vital roadmap for policymakers and healthcare professionals to navigate the complexities of hepatitis in the global health landscape. The study is helpful in the elimination of hepatitis as a public health threat by 2030, in line with the Sustainable Development Goals.

It is a call to action to redouble our efforts, strengthen partnerships, and invest in innovative solutions to achieve a country and eventually world free from the burden of hepatitis for future generations. Collective efforts and preventive as well as control measures will surely eradicate HBV and HCV infections as a public health threat and ensure a healthier future for its citizens.