Proposed measures include formulating a strategic plan, improving screening and harm reduction programmes, and providing training to primary care doctors and more accurate data on chronic hepatitis.
Photo: Prof. Tammy Meyers, Head of International Exchange at the CGH (left), Prof. Joseph Sung, CEVHAP founding member and Vice Chancellor of CUHK (right). (credit: James Johnston)
The Centre for Global Health (CGH) under the Chinese University of Hong Kong (CUHK) compiled a study titled Viral Hepatitis Policy in Asia, in collaboration with the Coalition to Eradicate Viral Hepatitis in Asia Pacific (CEVHAP). The study raises awareness and advocates for proactive action to be taken by governments in the region. Despite the city having the healthcare infrastructure and resources needed to take a strong initiative, the study report shows that there is a lack of a government strategic plan to eradicate hepatitis related diseases in Hong Kong, in addition to the implemented vaccination programmes and other services.
The hepatitis B virus (HBV) and hepatitis C virus (HCV) cause high mortality rates relative to other hepatitis related diseases, hence prioritising focus towards HBV and HCV. Particularly in the early 2000s, hepatitis “was rather ignored” among the global community, shown by the absence of hepatitis initiatives under the United Nation’s Millennium Development Goals (MDGs). Since then, the World Health Organisation (WHO) has set an ambitious target towards the elimination of hepatitis related diseases by 2030, under the Global Health Sector Strategy on Viral Hepatitis, 2016-2021. The study represents a “snapshot in time” explained Prof. Tammy Meyers, Head of International Exchange at the CGH, of the regional environment of national policies towards the control and prevention of HBV and HCV, in mid-2016, providing a benchmark of progress.
Hepatitis related diseases are occult diseases as people infected are initially unaware, raising the priority of screening. Furthermore, HBV can be effectively transmitted sexually, from mother to infant, recreational piercings and tattoos, as well as needle sharing for drug users. In contrast, HCV is primarily transmitted through blood products, while mother to child and sexual transmission is relatively low.
The policy survey interviewed an expert from each of the 13 selected jurisdictions situated in the Asia Pacific region, with a range of high income and developed, to low income and developing countries. Four criteria were used to analyse the countries and their progress in combating the disease, including; comprehensive public health policy on viral hepatitis; prevention and screening; care and treatment; and funding for diagnosis and treatment. According to the study, Hong Kong is the only jurisdiction with no national strategic plan to address the issue of hepatitis. Prof. Joseph Sung, CEVHAP founding member and Vice Chancellor of CUHK, added: “The guidelines published by the Asia Pacific Group, most of them apply to the whole territory including Hong Kong. But it would be ideal if the government could come up with their own strategic plan, on an individual and policy level.”
In terms of prevention, Hong Kong has been providing free vaccinations to all newborns and infants under the age of 6 free vaccination since 1988, which has been very effective. “Bringing the young children’s rate down to 0.78%, we were sitting at 10% before,” stated Dr Nancy Leung Wai-yee, specialist in Gastroenterology & Hepatology, and a CEVHAP member. Chronic HBV can be treated, though the antiviral treatments that suppress and delay the onset of cirrhosis or liver cancer are not cures and tend to be taken on a life-long basis. HCV is potentially curable with the use of direct acting antivirals (DAAs), despite the absence of a HCV vaccine. Though the overriding issue for both diseases in most countries is the high levels of cost incurred by those affected.
The Hong Kong government has funding schemes for hepatitis patients, in terms of diagnosis, the government pays only for people who have been admitted with abnormal liver function. Furthermore, the government pays for both HBV and HCV treatment, though funding for DAAs is limited. Screening of vulnerable populations such as pregnant women is crucial for the prevention and control of chronic hepatitis, Hong Kong conducts routine screening of pregnant women only for HBV. Regarding developing a facilitating healthcare infrastructure for hepatitis related diseases, Sung recommended more training for primary care doctors. “Because HBV management cannot be and should not be confined to experts,” he stressed. By training family and primary care doctors even with basic knowledge of hepatitis related diseases, they can promote the control and prevention of the virus, while raising awareness of the threat it poses.
The presenters suggested that the Hong Kong government should take the lead in striving towards the current positions of Australia and Taiwan on the prevention, control and management of viral hepatitis. This includes the formulation of a strategic plan, improved screening and harm reduction programmes (needle-exchange programmes), providing training to primary care doctors and more accurate data on chronic hepatitis. Lastly the government can address the discrimination and stigma experienced by those affected by hepatitis, and should be tackled by programs within the community along with better education of the disease.
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