07 - Towards Elimination DR Gottfried Hirnschall

Towards the Elimination of Hepatitis B and C by 2030
The draft WHO Global Hepatitis Strategy, 2016-2021

and global elimination targets
Dr Gottfried Hirnschall
HIV DEPARTMENT and
GLOBAL HEPATITIS PROGRAMME
This Presentation
• Making the case: why do we need a global strategy
• Ambitious yet feasible: setting targets towards elimination
• What needs to happen: strategic directions for action
• Building consensus on the global strategy: the process

Why a Global Hepatitis Strategy?
Major global public health threat
Progress uneven and inequitable;

major access gaps; stigma as a
barrier
New opportunities: prevention,

medicines, technologies
New era of ambition and advocacy

- looking towards 2030
Epidemiologic imperative: high and
increasing burden of disease
400 million persons with chronic
HBV or HCV infection
Highest prevalence in
Asia and Africa
Hepatitis mortality rates and virus distribution:
A global public health problem
Courtesy of Graham Cooke based on Global Burden of Disease 2010

Number of deaths/year from selected conditions,
Global Burden of Disease Study 2010 and 2013
GBD 2013 Mortality and Causes of Death Study: Lancet 2014

Disease elimination - Post-2015 agenda
Concrete targets for HIV, TB, Malaria
The Global Hepatitis Agenda
Where are we…?
• Hepatitis is getting on the global agenda

• Advances in treatment result in greater awareness of access
issues
• Several «champion» countries are showing the way…
• Yet, continued limited global and country funding
• Major opportunities to move forward – key interventions
exist
• Action will be cheaper than inaction – preventing and
treating will save costs!
• Building concensus on the global strategy: the process
An emerging call for elimination…
• World Health Assembly requested (May 2014)
 “Feasibility of and strategies needed for the elimination of hepatitis B and
hepatitis C with a view to setting global targets”
• Sustainable Development Goals (Sept 2015)

 “End the epidemics of AIDS, TB, malaria and .. and combat hepatitis,
water-borne diseases and other communicable diseases”
• Growing movement around hepatitis

 Patient voices and demands – civil society momentum builds up
 Increasing number with national plans
 Some global partners expand their scope (e.g UNITAID, CHAI, MSF)
Elimination
 Vision “A world where viral hepatitis transmission is stopped and

everyone has access to safe, affordable and effective treatment and
care”
 Elimination as a public health issue of concern - remove sustained

transmission, remove hepatitis as a leading cause of mortality:
– Elimination and not eradication: long wave of prevalence will
remain for decades
 Technically feasible by scaling up six key interventions to high

coverage
Key interventions for scale up
 Hepatitis B vaccination (including birthdose)
 Safe injection practices and safe blood
 Harm reduction for injecting drug users
 Safer sex (including condom promotion)
 Hepatitis B treatment
 Hepatitis C cure
For the first time: global hepatitis targets
• Impact targets across hepatitis B and C – incidence and

mortality by 2030
• Supported by coverage targets for key interventions

 Balance feasibility with ambition
 Set agenda to 2030 with milestones for 2020
Coverage targets
Intervention 2030 2020 Baseline 2015
1. HBV vaccination 90% 90% 81%
2. HBV MTCT; 90% 50% 38%

birthdose
3. Safe injection 90% 50% coverage 5%
4. Harm reduction 300 200 20

(75% coverage) (50% coverage)
5. HBV Treatment 80% <1%

8 million treated
6. HCV Treatment 80% (5m HBV, 3m HCV) <1%
Impact targets for elimination
90% reduction in new cases of 65% reduction in deaths from
of chronic HBV and HCV infection chronic HBV and HCV
6-10 million infections (in 2015) to 1.4 million deaths (in 2015) to under
900,000 infections (by 2030) 500,000 deaths (by 2030)
How can elimination be made affordable?
• Radical reductions in treatment costs

– Includes ineffective treatment and care costs in middle and high
income countries
• Shared costs with other strategies

– Harm reduction costs, immunization and blood safety
– Co-infection with HIV and service delivery
• Innovations and efficiencies over time

– Simplified treatment package, non-specialist care
– hepatitis B cure
• Building concensus on the global strategy: the process
The Global Hepatitis Strategy, 2016-2021
Elimination targets and milestones
Strategic Strategic
Direction 1: Strategic Strategic Direction 4: Strategic
Information Direction 2: Direction 3: Financing for Direction 5:
for focus and Interventions Delivering for sustainability Innovation for
accountability for impact quality and acceleration
equity
The “who”
and The “what” The “how” The The future
“where” financing
Strategy Implementation: Leadership, Partnership, Accountability, Monitoring &

Evaluation
18 |
Viral Hepatitis Strategy – Timeline
Regional 137th
136th WHA68 WHO WHA69
Committees
WHO Executive
Executive Board
Board
WHO Regional Development and

Finalization
Consultations Donor Partner
Process
Consultations
December
September
November
February
February
October
January
January
March
March
August
April
April
June
June
May
May
July
Online ADOPTION
Consultation
Expert Civil Society
Meetings Reference
Groups
Moving toward elimination
Dr Safaa Mourad, Egypt:
“10 per cent of people in
Egypt are infected with
Hepatitis C.”
• What we have:
– Prevention: effective tools to prevent all routes of
transmission
– Treatment: safe and effective medicines to control (HBV)
and cure (HCV) hepatitis infection
• What we need:
– Stronger advocacy
– Political and financial commitment
– Innovation
Raquel Peck, World Hepatitis Alliance:
“We have to drive down prices of
treatment.”
WHO Director General, Dr Margaret Chan: “Next year
the World Health Assembly will address strategies for
HIV, viral hepatitis and sexually transmitted infections .”
What it will take …..?
Energy, Commitment and Resources
A public health approach (simplification,

integration, affordability, equitable access)
Partnerships (governments, civil society,

private sector, ...)
Concrete and tailored action in countries

(guided by national plans)
Consultation website:
www.who.int/hepatitis

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Towards the Elimination of Hepatitis B and C by 2030

The draft WHO Global Hepatitis Strategy, 2016-2021

• Making the case: why do we need a global strategy

• Ambitious yet feasible: setting targets towards elimination

• What needs to happen: strategic directions for action

• Building consensus on the global strategy: the process

Major global public health threat

Progress uneven and inequitable;

New opportunities: prevention,

New era of ambition and advocacy

Courtesy of Graham Cooke based on Global Burden of Disease 2010

GBD 2013 Mortality and Causes of Death Study: Lancet 2014

• Hepatitis is getting on the global agenda

• Sustainable Development Goals (Sept 2015)

• Growing movement around hepatitis

 Vision “A world where viral hepatitis transmission is stopped and

 Elimination as a public health issue of concern - remove sustained

 Technically feasible by scaling up six key interventions to high

 Hepatitis B vaccination (including birthdose)

 Safe injection practices and safe blood

 Harm reduction for injecting drug users

 Safer sex (including condom promotion)

• Impact targets across hepatitis B and C – incidence and

• Supported by coverage targets for key interventions

2. HBV MTCT; 90% 50% 38%

3. Safe injection 90% 50% coverage 5%

4. Harm reduction 300 200 20

5. HBV Treatment 80% <1%

• Radical reductions in treatment costs

• Shared costs with other strategies

• Innovations and efficiencies over time

Strategy Implementation: Leadership, Partnership, Accountability, Monitoring &

WHO Regional Development and

Energy, Commitment and Resources

A public health approach (simplification,

Partnerships (governments, civil society,

Concrete and tailored action in countries

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