In Honor of World Hepatitis Day: Q&A with Coalition for Global Hepatitis Elimination Director John Ward, MD
Featured Image: A “Chakma” student holding a “Find the Missing Millions” board to support the initiative. The Chakma tribe is the largest indigenous tribe in Bangladesh. They live in Rangamati, Chittagong hills which is in the South-East Bangladesh. A “Find the Missing Millions” free hepatitis B and C screening and awareness program organized by the National Liver Foundation of Bangladesh among the people of the Chakma tribe at Rangamati.
Courtesy of Zunaid Murshed Paiker, National Liver Foundation of Bangladesh
By The Task Force for Global Health
Tuesday, July 28, marks World Hepatitis Day as a call to action against a preventable and curable disease that kills more than 1.3 million people each year. We spoke with John Ward, MD, Director of The Task Force’s Coalition for Global Hepatitis Elimination, about the disease, the role of the Coalition in hepatitis elimination, and what can be done for the more than 300 million people living with viral hepatitis and the millions of people at risk of new infections each year.
- Why is it important to have this global World Hepatitis Day?
World Hepatitis Day is particularly important as the enormity of this global health threat is underappreciated due to the silent nature of the disease. People with hepatitis have few symptoms until they develop liver disease that can progress to severe scarring (cirrhosis) or liver cancer. While both hepatitis B and C infections can be prevented with safe healthcare and injection practices, and can be detected and treated with reliable tests and medications, hepatitis C prevention has yet to benefit from an effective vaccine like hepatitis B. So World Hepatitis Day calls for action to seize these opportunities to protect people from infection and to test and treat to prevent premature mortality so we can eliminate hepatitis in the near future.
- Looking back on the first year of the Coalition for Global Hepatitis Elimination, what have been some of the main highlights?
The Coalition fills a key role in the global effort to eliminate hepatitis, which all countries committed to in 2015, by bringing partners together to share information and challenges and to leverage those partnerships to develop solutions and resources.
For example, access to credible data sources to inform program and policy development has long been a challenge in the hepatitis community. Now for the first time, we have what I like to call the “Wikipedia for Hepatitis Elimination.” We bring together data for over 190 countries regarding their burden of disease, the status of hepatitis policy and program development, and the status of implementing key interventions that make elimination possible. Bringing this data together has helped everyone monitor progress toward elimination and identify gaps, and also motivates countries to develop and implement their own programs by observing the success of others.
We have also overseen two systematic reviews to bring together evidence to guide timely hepatitis B immunization of newborns to prevent mother-to-child transmission of the virus and to analyze the strengths and weaknesses of hepatitis action plans, which are often the main strategy documents guiding program implementation. Other highlights include launching an operational research study with partners across four countries and a technical assistance project to support country planning for hepatitis testing scale-up.
- How successful do you think the Coalition has been in bringing together the hepatitis community?
We have a unique vantage point by being part of The Task Force. The Task Force has a long legacy of supporting disease elimination around the world. Because of our access to global partners and our expertise of management in disease elimination, we’ve built relationships and worked with various programs, ministries of health and others on the national and global levels. A lot of the work on our website reflects these collaborations; we have over 100 partners globally that have signed on to be part of the Coalition, and we are seeking to build a community of practice for hepatitis elimination. Each of these partners has a program profile listing their goals and activities, which brings visibility to the work in their respective countries. We want to continue engaging stakeholders, industry partners, technical assistance providers and civil societies to reach our global elimination goals.
- COVID-19 is on everyone’s mind and it has affected efforts to fight other diseases like hepatitis. Tell us about some of the hepatitis-related challenges and lessons learned during this pandemic and how the Coalition is addressing them.
The pandemic has sent a shockwave around the world that has impacted many facets of society. Hepatitis elimination is no exception. Our first concern was that people with chronic liver disease had more severe outcomes from coronavirus infections than others. So, in the first few months of the pandemic, we compiled all the evidence from previous coronavirus epidemics [like SARS and MERS] and observations from the early stages of the COVID-19 pandemic, mapping the clinical progression of people with chronic liver disease to share with our partners and others working on hepatitis. The shift in medical care priorities toward COVID-19 has implications for the management of patients with hepatitis. We compiled and shared recommendations both on particular COVID-19 response strategies and to identify areas that may need more research. Lastly, current global efforts to increase diagnostic capacity to test and care for people with COVID-19 can eventually be shifted toward testing for hepatitis and other diseases, which have historically suffered from limited resources. Leveraging expanded national testing capacity would greatly increase our reach to care for people with liver disease. We look forward to working with our partners to realize these opportunities.
- The Coalition recently honored some “hepatitis elimination champions.” Why is it important to highlight key people in the hepatitis community?
When we launched the Coalition last year, we recognized the many individuals that have made remarkable contributions to improving hepatitis political commitment, policies, and programs and who are helping to make global hepatitis elimination possible. This year we selected six people who through their passion and ingenuity have greatly advanced progress toward hepatitis elimination. These remarkable individuals promoted hepatitis vaccination of children in Mexico, started civil society organizations to increase awareness and provide education in Uganda and Burundi, sometimes even at a threat to their own physical health, and have fought to reduce the stigma and discrimination that limit employment and educational opportunities for viral hepatitis victims in China. Readers can learn more about all of these inspiring hepatitis elimination champions on the Coalition’s website.
- The Coalition works globally and in the U.S., tell us about some of the work in the home city of The Task Force, Atlanta, GA.
Last year, we recognized a local Atlanta elimination champion, Lesley Miller, MD, who developed a primary liver clinic at Grady Hospital, the fifth-largest public hospital in the United States and one of the busiest trauma centers in the country. Miller implemented routine screening, trained the interns and residents to test and care for people living with hepatitis and developed an affordable model of care regardless of one’s ability to pay. As a result of the increased number of patients who received care at the clinic, Grady Hospital has become a national role model of how to scale up treatment and care for persons with hepatitis in urban and low-resource settings. Miller has now become a trainer, working with other health partners in the state of Georgia to train and implement this methodology of care. We were able to profile this collaboration and share the information with partners so that they may do the same elsewhere.
- The Coalition publishes data dashboards on your website. How do you see these being useful for the hepatitis community?
These first-ever dashboards provide a “Wikipedia” for hepatitis elimination because they bring together multiple sources of data from over 190 countries. Using the dashboard, you’re able to learn the burden of hepatitis transmission and disease, the status of policy and program development, the success rate of implementing key interventions and more details that can contribute to local, national and global hepatitis elimination goals. In addition, programs are contributing their lessons learned, experiences and effective tools to collaborate with each other, leading to stronger partnerships and successes.
- Tell us about the new project that is helping to increase testing for Hepatitis B and Hepatitis C, both of which put people at high risk for liver cancer.
The Hepatitis Evaluations to Advance Testing (HEAT) project was launched this year to provide technical assistance to support countries in three ways:
- To assess their disease burden in populations at risk for hepatitis
- To evaluate their capacity to diagnose individuals living with hepatitis and the best testing strategies for scaling-up testing programs
- And to estimate the budget needed to achieve these goals
We are working with countries like Thailand, Vietnam, and Ghana to apply this HEAT model to inform updated testing policies and strategies, with the aim that these countries will be better positioned to reach elimination.