LAST year, the World Health Assembly adopted the Global Health Sector Strategy on Viral Hepatitis (2016–20) with the goal of eliminating viral hepatitis as a major public health threat by 2030. The target: to reduce new viral hepatitis infections by 90 per cent and reduce deaths due to viral hepatitis by 65 per cent, with a focus on hepatitis B and C, both of which can cause chronic liver disease, including cirrhosis and liver cancer.
Although viral hepatitis caused 1.4 million deaths in 2015, more than HIV or malaria, it has received sub-optimal attention from policymakers and donors.
We have three types of viral hepatitis in Malaysia: hepatitis A, B and C.
Eliminating Hep A should not be too difficult in a high middle-income country like ours. Hep A is one of the world’s most common infectious diseases; it is highly contagious and sometimes fatal. Generally, the prevalence of Hep A is declining because of improvement in personal hygiene and environmental standards, the availability of safe and adequate water supply and Hep A vaccine.
More than two billion people are infected with hepatitis B worldwide.
Between 1 and 1.5 million die each year from Hep B infection and there are about 400 million chronic carriers worldwide, 75 per cent of whom live in Asia.
Hep B is 100 times more infectious than the human immunodeficiency virus (HIV).
The good news is that there is a vaccine to prevent the disease and is recommended for intravenous drug users, dialysis patients, HIV-infected individuals, pregnant women, sexual and household contacts of HB carriers and healthcare workers.
There are 500,000 patients in Malaysia who are infected with Hep C. It is estimated that 2,000 new cases are reported every year.
In September, the Health Ministry issued a statement that Hep C is a major public health concern. The minister said it was crucial to increase access to treatment. He announced efforts to make available cheap drugs to treat Hep C, as “the cost of treatment for Hep C is exorbitantly expensive”.
The cabinet had approved the use of Rights of Government under Patent Act 1983 (Act 291) by exploiting the patented invention of Sofosbuvir tablet 400mg.
The implementation of the Rights of Government for the tablet is for use in government facilities only (public and armed forces hospitals), where at the initial phase it will be offered only at 12 public hospitals. The selection criteria of patients who will receive the treatment will follow the guidelines set by specialist.
While I laud the ministry for making Sofosbuvir 400mg available for Malaysians, it makes little sense to limit the use of the drug to 12 public hospitals.
Furthermore, the treatment for Hep C involves the use of at least two drugs, not one. How can we eliminate Hep C if treatment is restricted to some hospitals and with only one drug?
The minister had assured me that a new drug combination will soon be made available to all public and private hospitals at affordable prices.
But, time is of the essence. To eliminate Hep C, other strategies must be implemented. These include educating the public on the disease and encouraging doctors to screen patients for Hep C in addition to the usual tests they normally do.
This is imperative as the disease is asymptomatic (showing no symptoms) and there is lack of awareness, education and medical coverage for this disease.
Not many have been diagnosed and those who have may not have received treatment because of ignorance or inaccessibility and unaffordability to obtain the new antiviral agents.
If cheap treatment is available, then all patients should be treated, including those in the high-risk category. Otherwise, eliminating Hep C with the new effective drugs will remain a pipe dream.
We have the tools needed to move towards elimination targets, such as an effective vaccine for Hep B and a curative treatment for Hep C.
What we need is the political will to scale up prevention, diagnosis, and treatment programmes and the involvement of all stakeholders, including the Malaysian Liver Foundation, which is ready to work with Health Ministry to eliminate hepatitis.
You cannot fight alone. Let us share the burden together.
Tan Sri Dr Mohd Ismail Merican, President, Malaysia Liver Foundation and former director-general of health