Presentation – Action plan for the health sector response to viral hepatitis

Editor's Notes

1. In the WHO European Region, 1 in 50 people are affected by chronic hepatitis B and 1 in 50 – by chronic hepatitis C. Most of these people are unaware of the infection and are at riskt of developing liver cirrhosis and liver cancer if not treated. The epidemiology and burden of viral hepatitis across the Region is diverse, with very low prevalence of chronic hepatitis B and C among the general population in northern Europe and high prevalence in many countries in southern and eastern Europe and central Asia. In addition to this geographical variability, specific populations can be more affected by, or be at higher risk of, viral hepatitis infection. Viral hepatitis is a leading cause of mortality globally and in the WHO European Region it takes over 170 000 lives each year, mostly due to chronic hepatitis B and C related liver disease. Now when we have all prevention interventions available and new treatement options that can sucessfully control chronic hepatitis B and cure chronic hepatitis C in vast majority of cases, thus preventing most of those deaths, inaction should not be acceptable anymore.
2. We are now witnessing exciting times now in the field of viral hepatitis. The World Health Assembly resolutions on viral hepatitis that were adopted in 2010 and 2014 recognized viral hepatitis as a public health threat and the need for governments and populations to take action to prevent, diagnose and treat viral hepatitis. This year in May, the Member States at WHA adopted the first ever Global Strategy on viral hepatitis, expressing commitment to combating viral hepatitis to reach elimination by 2030. This Action plan provides the framework for a comprehensive health sector response to viral hepatitis and adapts the Global Strategy to the European context. The goals and targets are supported by the 2030 Agenda for Sustainable Development, the WHOs Global health sector strategy on viral hepatitis for 2016–2021, and Health 2020, the European policy framework for health and well-being. The Action plan was developed through a Region-wide participatory process including Regional technical consultations in June 2015 and April 2016  and drawing on the expertise of an advisory committee that met in Copenhagen in April 2016. It also sought feedback through direct correspondence with Member States, major partners and civil society organizations, includign patieng groups. The Regional Office also held a broader public web consultation on the action plan.
3. The Action plan is built around three organizing frameworks for action: universal health coverage; the continuum of HIV services; and the promotion of a public health approach in accordance with the Global Health Sector Strategy for viral hepatitis 2016-21. The vision of the Action plan is a WHO European Region in which the transmission of new viral hepatitis infecions is halted, testing is accessible, and people living with chronic viral hepatitis have access to care and affordable and effective treatment. Our goal is aligned with the ambitious global goal of elimination of viral hepatitis as a public health threat by 2030 through: - reduction of transmission, - reduction in morbidity and mortality due to viral hepatitis and its complications, and - ensuring equitable access to comprehensive prevention, and recommended testing, care and treatment services for all. The plan also include sSeven targets to be achieved by 2020 which are essential for reaching the ambitious goal of hepatitis elimination. The first five targets relate to prevention and include targets for: Hepatitis B vaccination coverage and interventions to prevent mother-to-child transmission of hepatitis B; Safe blood and safe injections in and out of health care settings, including introduction of safety-engineered injection devices – that also will protect the health workers from needle-stick injuries; Scaling up prevention and harm reduction interventions among people who inject drugs. Other two targets relate to testing and treatment: 50% of people living with chronic hepatitis infections to be diagnosed and aware of their condition, and 75% of diagnosed and eligible for treatment – started treatment by 2020
4. The action plan proposes priority actions for Member States, accompanied by supporting actions for WHO, under five strategic directions. Strategic direction 1 focuses on the need to generate and use quality strategic information about viral hepatitis epidemics and country responses to those epidemics as a basis for focused national strategic planning, urgent and accelerated programme implementation and advocacy to garner political commitment.
5. Strategic direction 2 describes the essential package of interventions that need to be delivered along the continuum of hepatitis services to reach national (and global) targets. Member States need to identify country-specific interventions relevant to local context, and also to define national targets, aligned with the regional targets (but encouraged to set more ambitious targets, where appropriate).
6. Strategic direction 3 identifies the best methods and approaches for delivering the continuum of hepatitis services to different populations and in different locations, so as to achieve equity, maximize impact and ensure quality.
7. Strategic direction 4 identifies the need for sustainable financing models for the health system response to viral hepatitis and approaches for reducing costs so that people can access the services they need without incurring financial hardship. This is possible when integrated and linked services are delivered under a model of universal health coverage.
8. Strategic direction 5 identifies where there are major gaps in knowledge and technologies in order for those responses to be accelerated and in order the targets to be achieved. Research and innovation provide opportunities to change the trajectory of regional and national health sector responses to viral hepatitis, improve efficiency and quality of services and maximize impact. Innovations are required along the entire continuum of prevention, diagnosis, treatment and care services. These need to be supported by operational research and collaboration between researchers and policy-makers to ensure that research findings are translated into policies rapidly and on a scale sufficient to achieve the desired impact.
9. The draft Resolution request Regional Committee to consider a resolution to adopt the Action plan and urge Member States to: allign, as appropriate, their national viral hepatitis strategies and action plans with the Action plan, ensuring political commitment and resources required to combat the viral hepatitis epidemics; strengthen public health systems for comprehensive viral hepatitis prevention and control interventions, with a particular focus on strangthening strategic information, providing universal childhood hepatitis B immunization, and scaling up testing and treatment of hepatitis B and C; ensure that prevention, treatment and care programmes target individuals most affected by viral hepatitis and at higher risk of transmission, based on the local epidemiological context. And requests the Regional Director to: support the implementation of the Action plan through leadership, strategic direction and technical guidance to Member States, including in national planning for viral hepatitis continue work in partnership to advocate for commitment and resources to strengthen the response to viral hepatitis; identify and facilitate the exchange of best practices and evidence-informed tools for an effective response to viral hepati; monitor implementation and report to the 69th and 72nd sessions of the Regional Committee on the implementation of the Action plan in the WHO European Region.