More than 91 million Africans live with Hepatitis B or C, which are the deadliest strains of the virus, according to a World Health Organization (WHO) scorecard that was launched yesterday – ahead of today’s World Hepatitis Day.

The Viral Hepatitis Scorecard 2021 looks at data from the African region but focuses on Hepatitis B and C, both of which cause liver cirrhosis and cancer. It found that in 19 countries, more than 8% of the population is infected with Hepatitis B, while in 18 countries, more than 1% of the population lives with Hepatitis C.

In 2020, the African region accounted for 26% of the global burden for Hepatitis B and C and 125,000 associated deaths.

Around 70% of Hepatitis B infections worldwide occur in Africa. It can take decades after infection from the virus before an individual starts manifesting symptoms. Thus, what is particularly worrying for the future is that the region accounts for 70% of the global Hepatitis B cases found among children younger than 5 years, with 4.5 million African children infected. Currently, 33 countries have a Hepatitis B prevalence of more than 1% among children younger than 5 years, which is a small improvement from 40 countries in 2019.

“Hepatitis has been called the silent epidemic, but this scorecard is sounding an alarm for the region and the world to hear,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “We must do better and stop this disease from stealing away our children’s future. There is a safe and effective vaccine that offers nearly 100% protection against Hepatitis B, one of the deadliest strains of the virus. We must ensure that all African children are vaccinated within 24 hours of their birth and are followed up with two or more doses of the vaccine.”
The scorecard finds that coverage for routine childhood vaccination against Hepatitis B is 72% for the region, well below the global target of 90% needed to ensure that the virus is no longer a public health menace. The number of countries with more than 90% coverage has increased, from 23 in 2019 to 27 in 2021. Additionally, while the birth dose vaccine is administered in only 14 African countries, at an overall coverage of 10%, it is an increase from 11 countries in 2019.

Hepatitis can be spread through contaminated blood products, and much more progress is needed to ensure blood safety. In the African region, only 80% of blood donations are screened with quality assurance, while 5% of syringes are re-used. Only six syringes are distributed per injecting drug user, compared to the global annual target of 200.

Diagnosis and treatment rates are alarmingly low, the scorecard shows. In 2021, only an estimated 2% of persons infected with Hepatitis B were diagnosed, and only 0.1% were treated. For Hepatitis C, an estimated 5 per cent of infected persons were diagnosed, with close to 0% treated.
“To turn the tide, hepatitis services must move out of specialized clinics to decentralized and integrated facilities where most Africans still seek care. More primary health care workers need to be trained to diagnose and treat the virus,” said Dr Moeti. “While there has been progress in making hepatitis medications affordable, still more needs to be done.”

This year’s World Hepatitis Day bears the theme Bringing Hepatitis Care Closer to You. It is a call to action for countries to rapidly improve access to services to prevent, diagnose and treat all strains of hepatitis.

To advance countries towards decentralized care, WHO is launching targeted training materials to support health workers in scaling up delivery of simplified Hepatitis B and C services, in line with Universal Health Coverage principles.

WHO has been providing technical support to countries for their national hepatitis response, and 28 African countries now have a national hepatitis programme, either as a standalone programme or integrated with HIV services. Hepatitis strategic plans have been developed in 21 countries, while 17 countries have testing and treatment guidelines aligned with WHO guidelines.

In 2021, WHO established the 2021–2030 Framework for an Integrated Multisectoral Response to Tuberculosis, HIV, Sexually Transmitted Infections and Hepatitis in the African region. The aim is to support milestones that include the introduction of the Hepatitis B birth dose vaccine in 35 Member States, diagnosis of at least 30% of those with chronic hepatitis infections, and the achievement of 30% of people with Hepatitis B and C on treatment.

Hepatitis remains an important public health threat in Africa. Progress in prevention, diagnosing and treatment was impeded between 2019 and 2021 due to the insufficient implementation of hepatitis interventions in countries.

To make a difference and fast-track the elimination targets, countries must consider the hepatitis threat a priority and bring hepatitis care closer to their communities by: increasing domestic funding for the elimination of tuberculosis, HIV, sexually transmitted infections and hepatitis; establishing a platform for the integrated delivery of interventions (including the life-course approach; reproductive, maternal, newborn, child and adolescent health care; and immunizations), and investing in information and surveillance for action.