Hepatitis is still a silent killer in Africa and elsewhere

The Nobel Prize in physiology or medicine was awarded this week to three researchers who discovered the virus that causes hepatitis C.

According to the announcement, “For the first time in history, the disease can now be cured, raising hopes of eradicating hepatitis C virus from the world population.”

New blood tests and drugs for this deadly disease have already saved millions of lives. But for millions more around the world, the celebration is bittersweet and the revolution in diagnosis and treatment remains a distant dream.

In Africa, dying from viral hepatitis is becoming a bigger threat than dying from HIV/AIDS or malaria. Although there are five types of viral hepatitis (A, B, C, D, and E), chronic B and C cause nearly all hepatitis-related sickness and untimely deaths.

In my home country, Nigeria, nearly 8% of the population is believed to be infected with hepatitis B and over 1.1% with hepatitis C. This year, in Africa alone these diseases will kill 200,000 people.

The majority of those who have viral hepatitis don’t know it. And in most countries, including my own, the vast majority of those who are sick are not getting diagnosed and treated until it is too late to save them.

One of these was my mother. No one knew she had hepatitis, even though we took her to the hospital over and over again each time her eyes “turned yellow.” The doctors would dismiss it as a mild fever, prescribe some painkillers, and send her home. Fifteen years after these symptoms started, she was diagnosed with end-stage liver cancer caused by the infection. It was too late to save her.

Some people get the virus from their mothers at birth. Some get it through sexual contact, or because health care providers do not properly screen blood transfusions or sterilize equipment. Shared needles, sharp objects at home, and traditional practices such as circumcision, tattooing, and scarification also spread the disease.

Hepatitis B and C may cause few obvious symptoms for many years, one reason it often goes undetected. Another is that many of those infected are children and the poor, marginalized people with little access to health care. And those who do not know they have thee virus infect others.

It doesn’t have to be this way. Like hepatitis C, hepatitis B can be detected, even in people who exhibit no symptoms. Hepatitis B infection is preventable with vaccinations and treatable if caught early.

In awarding the 2020 prize to researchers Harvey Alter, Michael Houghton, and Charles Rice, the Nobel Committee noted that while the earlier discoveries of the hepatitis A and B viruses had been critical steps forward, before their work on hepatitis C most blood-borne hepatitis cases remained unexplained.

“The discovery of hepatitis C virus revealed the cause of the remaining cases of chronic hepatitis and made possible blood tests and new medicines that have saved millions of lives,” it said.

Except in places like Nigeria, where these lifesaving tests and treatments are either unaffordable or inaccessible. It costs only 20 cents to vaccinate a baby against hepatitis B, but this vaccine is not available in most countries. The price for the generic drug that can cure hepatitis C is about $900. The medicine for treating chronic hepatitis B costs about $15 per month. Yet in Nigeria, at least half of the population lives on less than $2 per day. More than 90% of Nigerians lack health insurance, and there is no government-funded hepatitis treatment program. Most people can’t even pay for the $100 blood test needed to start treatment, let alone for the drugs themselves. Those who try to fund their own treatment out of pocket find themselves driven into poverty.

The majority of those who have viral hepatitis don’t know it. And in most countries, including my own, the vast majority of those who are sick are not getting diagnosed and treated until it is too late to save them.

One of these was my mother. No one knew she had hepatitis, even though we took her to the hospital over and over again each time her eyes “turned yellow.” The doctors would dismiss it as a mild fever, prescribe some painkillers, and send her home. Fifteen years after these symptoms started, she was diagnosed with end-stage liver cancer caused by the infection. It was too late to save her.

Some people get the virus from their mothers at birth. Some get it through sexual contact, or because health care providers do not properly screen blood transfusions or sterilize equipment. Shared needles, sharp objects at home, and traditional practices such as circumcision, tattooing, and scarification also spread the disease.

Hepatitis B and C may cause few obvious symptoms for many years, one reason it often goes undetected. Another is that many of those infected are children and the poor, marginalized people with little access to health care. And those who do not know they have thee virus infect others.

It doesn’t have to be this way. Like hepatitis C, hepatitis B can be detected, even in people who exhibit no symptoms. Hepatitis B infection is preventable with vaccinations and treatable if caught early.

In awarding the 2020 prize to researchers Harvey Alter, Michael Houghton, and Charles Rice, the Nobel Committee noted that while the earlier discoveries of the hepatitis A and B viruses had been critical steps forward, before their work on hepatitis C most blood-borne hepatitis cases remained unexplained.

“The discovery of hepatitis C virus revealed the cause of the remaining cases of chronic hepatitis and made possible blood tests and new medicines that have saved millions of lives,” it said.

Except in places like Nigeria, where these lifesaving tests and treatments are either unaffordable or inaccessible. It costs only 20 cents to vaccinate a baby against hepatitis B, but this vaccine is not available in most countries. The price for the generic drug that can cure hepatitis C is about $900. The medicine for treating chronic hepatitis B costs about $15 per month. Yet in Nigeria, at least half of the population lives on less than $2 per day. More than 90% of Nigerians lack health insurance, and there is no government-funded hepatitis treatment program. Most people can’t even pay for the $100 blood test needed to start treatment, let alone for the drugs themselves. Those who try to fund their own treatment out of pocket find themselves driven into poverty.

Geography is another barrier. Most Nigerians live in rural communities, often far from major cities and hospitals where doctors have the training and equipment they need to diagnose, treat, and manage hepatitis. And these infections hit low-income, rural, and marginalized populations the hardest.

The Covid-19 pandemic has exacerbated these problems by disrupting pharmaceutical supply chains. Drug prices have shot up and patients who were on hepatitis C drugs can no longer get them.

No one who could step in to stop this epidemic is doing it. Governments, and international funders, like the Global Fund, PEPFAR, and the Gates Foundation, are focused on other diseases such as HIV/AIDS, tuberculosis, and malaria. The billions of dollars they have spent have changed the landscape for these diseases and offered hope.

Viral hepatitis, though, remains an orphan. According to the Joint United Nations HIV/AIDS program report, the estimated funds available for responding to HIV/AIDS in low- and middle-income countries in 2014 stood at $19.2 billion, compared to less than $100 million invested in fighting hepatitis across the globe.

This has real consequences on the ground. People with HIV now get the antiviral drug tenofovir for free, provided by international funders like PEPFAR. But tenofovir is also used to treat chronic hepatitis B, and people with hepatitis can get it only if they are able to pay full price for it.

Unlocking the mystery of hepatitis C was a towering achievement. But the next, essential step is to ensure that this discovery reaches its potential to alleviate the suffering and save the lives of millions of people in countries like mine. The global response to HIV and now Covid-19 has shown us what can be achieved when government, civil society, international organizations and the private sector work together with a common goal. It’s time to make eradicating hepatitis such a goal.

Danjuma Adda is the executive director of CFID Taraba and Chagro-Care Trust, a Nigerian nongovernmental health care organization, the national coordinator of the Civil Society Network for Viral Hepatitis in Nigeria, the umbrella organization of hepatitis patient groups in Nigeria, and a 2020 New Voices Fellow at the Aspen Institute.

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