The countdown to the 2030 viral hepatitis elimination goal continues, but time is running out and progress is not keeping pace. Viral hepatitis remains a major public health challenge; we need to take action now to mobilize resources and focus efforts.

This year, on World Hepatitis Day, we are at a critical point in the quest to eliminate viral hepatitis by 2030. The burden of viral hepatitis remains high: there are >2 million new cases of viral hepatitis each year with more than 300 million people worldwide living with viral hepatitis. With only 6 years to left to meet this global goal, action is needed.

In April 2024, the WHO released their global hepatitis report 2024, detailing the latest estimates on disease burden and coverage of essential viral hepatitis services from 187 countries worldwide and a focus on action for access in low- and middle-income countries1. The statistics were sobering, the estimated number of deaths from viral hepatitis increased from 1.1 million in 2019 to 1.3 million in 2022 globally, with 83% of deaths caused by hepatitis B and 17% caused by hepatitis C. Every day, 3,500 people die globally due to hepatitis B virus (HBV) and hepatitis C virus infections. Stark gaps in diagnosis and treatment were noted. Across all regions, only 13% of people with chronic hepatitis B had been diagnosed and around 3% (7 million) had received antiviral therapy by the end of 2022. For hepatitis C, 36% had been diagnosed and 20% (12.5 million) had received curative treatment. Both are well below the global targets to treat 80% of people living with hepatitis B and hepatitis C by 2030.

Overall, the WHO global hepatitis report1 highlighted that focused efforts (such as developing investment in priority countries or shifting from policies to implementation for equitable treatment) in key high-burden regions were essential to get back on track to meet the 2030 Sustainable Development Goals. An update to a Lancet Gastroenterology & Hepatology commission on progress towards elimination of viral hepatitis published in February 2024 had similar sentiments2. The top 20 highest-burdened countries (in disability-adjusted life years, including China, India and Russia) accounted for >75% of the global burden of viral hepatitis. Although progress in elimination policy has been made in 14 of these 20 countries (most substantial gains in Bangladesh, India and Russia, among others), progress towards elimination varied greatly by country and key themes emerged in terms of recommendations, including simplified models of care, the importance of access to appropriate diagnostics and funding of hepatitis care (costs to achieve the elimination goals currently far outstrip current investment levels in hepatitis service; unlike HIV infection and tuberculosis, there are no specific international funding bodies for viral hepatitis).

Focusing on a specific example in which change can be enacted, in this issue, Nartey and Bockarie highlight that mother-to-child transmission of HBV remains a key mode of transmission in regions with a high burden of disease such as Southeast Asia and Africa. The tools to reduce mother-to-child transmission exist, including screening for disease during pregnancy, antiviral prophylaxis with nucleotide analogues (such as tenofovir disproxil fumarate) and timely birth-dose HBV vaccination, as noted in updated WHO recommendations on the management of hepatitis B3, but equitable access is paramount to ensure that interventions are available. For example, Nartey and Bockarie note that routine birth-dose HBV vaccination is not yet implemented in the majority of West and Central African countries, with only 18% of newborns receiving timely birth-dose vaccination in Africa despite the region accounting for 63% of new HBV infections1, and that it is critical that birth-dose coverage improves in Africa.

“equitable access is paramount to ensure that interventions are available”

Governments, policymakers, health-care providers and other stakeholders need to prioritize viral hepatitis going forward to accelerate progress, including efforts to improve education and raise awareness. With this prioritization, such as the public health efforts to eliminate hepatitis C in Egypt (the first country to achieve ‘gold tier’ status)4, true progress can be made. The call to action from the World Hepatitis Day campaign to end the viral hepatitis epidemic by 2030 is simple and clear. Test. Treat. Vaccinate. We already have these tools at our disposal, we need to use them optimally and intensify efforts in high-burden regions that would benefit the most.