Many people, Thais included, do not take liver health seriously. Hepatitis quietly takes its toll, often going unnoticed until it’s too late.
Dr. John Ward, a prominent voice at the recent APAC IRIDS conference on infectious diseases, likened hepatitis to a “silent dragon,” infecting livers with minimal symptoms before progressing silently to severe stages.
“The liver is a very stoic organ; it doesn’t cause many symptoms. So you live for years without knowing that you have this chronic viral infection that’s slowly destroying your liver until it reaches the end stage. Eighty per cent of all liver cancer around the world is caused by Hepatitis B and C. Liver cancer has a poor survival rate,” he said.
Globally, hepatitis claims a staggering one million lives annually, surpassing even HIV in mortality rates in the Asia-Pacific region threefold.
Despite these alarming statistics, awareness and prevention efforts lag behind the escalating reality. Liver cancer, primarily caused by viral hepatitis, ranks as the third-leading cause of cancer-related deaths worldwide, with Thailand bearing a disproportionate burden.
The 2023 APAC Liver Disease Alliance report finds that the region witnesses 63% of global liver disease deaths, with viral hepatitis and liver cancer, predominantly Hepatocellular carcinoma or HCC, being major contributors. In 2020, the region reported 610,000 liver cancer cases.
“The tragedy is that nearly all infections are preventable,” Dr. Ward said.
Fast Forward to 2030
Looking ahead to 2030, the World Health Organization (WHO) aims for a 90% reduction in hepatitis cases, yet the path is fraught with challenges.
Roberta Sarno from the APAC Liver Disease Alliance said the numbers showed that the Asia-Pacific region lacks an optimal national action plan for eliminating viral hepatitis.
Many countries either don’t have a plan or have incomplete and inadequate ones, leading to uncoordinated efforts and insufficient prevention.
Political commitment is also vital to sustainably curbing the prevalence of disease.
“Taiwan and Japan are good examples. Both are on track to eliminating viral fatalities,” Sarno noted.
Prof. Saeed Hamid from Aga Khan University said in the case of Pakistan, a national plan exists but it not fully implemented. He stressed the need for emergency declarations in high-burden countries, akin to the successful responses seen during Covid-19, to curb escalating hepatitis cases.
“At the current rate, most countries in Asia Pacific will not meet the 2030 elimination target. We need to declare an emergency in all of these countries,” said Prof Hamid, adding that declaring the battle against hepatitis as an emergency could allow the region to meet the WHO target.
Policymakers sometimes lose focus as other diseases are competing for attention. In the case of Pakistan, Prof Hamid noted that the country has the highest burden for hepatitis C, but is also having to cope with high rates of diabetes, which affects 25% to 30% of total population.
Since the HepB vaccines became available in 1981, most infants are vaccinated and therefore the disease mostly occurs in those over the ages of 35-40.
The most effective solution is testing everyone for Hepatitis B and C and treat those found to be sero-positive.
Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV), transmitted through bodily fluids such as blood, semen, and vaginal fluids.
It can spread from an infected person to others through unprotected sex, sharing needles or syringes, sharing personal care items like razors or toothbrushes if contaminated with blood, and from mother to child during childbirth if the mother is not vaccinated.
The Cost of Inaction
“Early detection is key,” affirmed Dr. Ward, advocating for widespread screening and vaccination programs.
Prof Hamid also mentioned that there are currently no effective hepatitis C vaccine candidates, although there is ongoing interest and work, particularly from the US National Institutes of Health.
The cost of prevention pales in comparison to the economic and human toll of inaction. “The cost of eliminating hepatic disease is much, much lower than the cost of doing nothing,” Sarno said.
“The perception of cost is still problematic. If hepatitis is not defeated, direct health care costs will increase and the productive workforce will decline.
In Thailand, the Public Health Ministry encourages all those born before 1992 to take the tests, which amounts to approximately 42 million people.
Newborns in Thailand have been given the hepatitis vaccines since 1992. “We’ve put effort into reducing the cost of testing and now the cost is very low at less than US$2 per test,” said a Thai physician from Siriraj hospital.
He added that at present the National Health Security Office offers any Thai aged 34 and over free HepB testing.
The APAC-IRIDS 2024 Symposium convened experts who echoed a call for robust national strategies, sustained political commitment, and equitable healthcare access.
As nations grapple with health disparities, the Asia-Pacific faces a critical juncture. Investment in comprehensive liver disease management, aligned with global expertise and resources, remains paramount to altering the disease’s trajectory.
“Let’s not lose sight of the lives at stake. Together, we can rewrite the narrative of hepatitis in Asia-Pacific,” Prof Hamid stressed.
By Veena Thoopkrajae
