In 2016, Canada was one of 194 countries that endorsed the World Health Organization’s Global Health Sector Strategy on Viral Hepatitis, vowing to eliminate both hepatitis B and hepatitis C by 2030.
Since then, progress has been middling in tackling these silent killers, and that’s a shame given the magnitude of the problem and the opportunity to have an impact.
Hepatitis B and hepatitis C are liver diseases caused by different viruses. An estimated 230,000 Canadians live with HBV and another 240,000 with HCV. The slow-moving viral illnesses are the leading causes of liver cancer and cirrhosis which, in turn, are fuelling the growing demand for liver transplants.
The insidious viruses also kill about eight Canadians a day – 2,692 HCV deaths were recorded in 2019, and another 445 from HBV.
Globally, the situation is much more dire. Hepatitis B accounts for 820,000 deaths, and hepatitis C another 290,000 annually, and those numbers are climbing because infections are so common.
An estimated 296 million people worldwide live with chronic hepatitis B, and 58 million more with hepatitis C.
Because they are blood-borne, the viruses are spread readily during childbirth, some sexual activities, dirty needles (through intravenous drug use or tattooing), and (in some countries) blood transfusion. A report published this week warns that if nothing changes, viral hepatitis deaths could outnumber HIV, tuberculosis and malaria deaths combined by 2040.
What makes this all the more tragic is that viral hepatitis can be managed much more readily than many other infectious diseases.
Hepatitis B is vaccine-preventable, and transmission of both HBV and HCV can be greatly reduced with some pretty basic harm reduction measures, like needle exchanges.
Hepatitis C can even be cured with a simple (but costly) antiviral drug regime: One pill daily for eight to 12 weeks.
But, as a new report shows, Canada’s provinces and territories are not exactly rushing into action to prevent, treat and cure viral hepatitis.
Action Hepatitis Canada, a coalition of groups interested in liver disease, just published a 52-page progress report on how Canada is faring on its promise to eliminate viral hepatitis.
The short version is that seven of 10 provinces are on track to eliminate hepatitis C by 2030. Unfortunately, the two most populous provinces, Ontario and Quebec, along with Manitoba, are the laggards. When it comes to hepatitis B, not a single province or territory is on track to meet the elimination goal (with more data needed).
The federal government, for its part, has published some good material, like a five-year action plan. But jurisdictions under federal control, such as the country’s 43 federal prisons, are not doing especially well. And those who are hardest hit by HBV and HCV, including Indigenous people, immigrants and refugees, are not getting equitable access to preventive, suppressive or curative treatments.
“Elimination” doesn’t mean HBV and HCV will disappear – that’s simply not realistic with the viruses circulating so widely.
But the metrics for “elimination” are clear: A 90-per-cent reduction in new cases of HBV and HCV; a 65-per-cent reduction in deaths; having 90 per cent of infections diagnosed (today fewer than half of those infected know it); 80 per cent of HBV patients receiving treatment; and 80 per cent of HCV patients cured.
All those goals are achievable. But provinces need to embrace sensible, evidence-based policies.
For example, the WHO recommends that every child receive the hepatitis B vaccine within 24 hours of birth. But only New Brunswick, the Northwest Territories and Nunavut offer this. Most provinces do the shots at the age of 11 or 12, assuming it is strictly a sexually-transmitted infection. During the pandemic, the vaccine programs also fell behind.
HCV infection is increasing principally among injection-drug users, but harm reduction programs are under attack.
Those most likely to be infected with HCV are Baby Boomers – those born between 1945 and 1975. Many countries now screen people in this demographic routinely, but not Canada. Why not?
And while we have the ability to cure many people of hepatitis C, and prevent them from developing grave illnesses like cirrhosis, fewer than one in three patients eligible for treatment are getting access.
Giving life to a viral hepatitis elimination plan matters to the more than half a million Canadians already infected, and those who could be. It’s not enough to make promises, you have to follow through on them.
As Dr. Curtis Cooper, director of the viral hepatitis program at Ottawa Hospital, says: “Before we can eliminate viral hepatitis in Canada, we have to eliminate inertia.”
André Picard