In 2006, I was struck by two things – the huge mortality caused by viral hepatitis and its lack of priority and awareness. That was the motivation behind the establishment of World Hepatitis Day and the World Hepatitis Alliance. It seemed incomprehensible that as many people were dying each year from viral hepatitis as from HIV, TB or malaria, and yet no one seemed to care. Within the World Health Organization (WHO), it was effectively invisible. Not a single one of the more than 8,000 people working at WHO had hepatitis in their job title.

Since then, the annual mortality from HIV, TB and malaria has been falling because of political leadership and, of course, funding, while that from viral hepatitis has, if anything, been rising. It is currently 1.3 million. That is two and a half deaths every single minute. What makes each one of these deaths so heartbreaking is that they are preventable. We have the tools to vaccinate, to test and treat, to prevent people from ever progressing to cirrhosis and liver cancer that will kill them. Not only do we have the tools, but they are extraordinarily cheap, a good example being the price of treatment for hepatitis B and for hepatitis C, as a result of public health voluntary licences mostly through MPP.

In 2016, the world’s countries set themselves targets to eliminate viral hepatitis B and C as a public health concern by 2030. One of those targets was to reduce annual mortality to below 500,000.

In 2025, we are clearly way off track.

At a harm reduction clinic in Rwanda, people are encouraged to test for hepatitis.

And it is not going to be easy to get back on track. The funding environment in global health has dramatically changed this year. Although hepatitis has received very little Official Development Assistance, it has nonetheless benefited, for example from HIV funding, through the investment in health systems, but also because tenofovir – which is part of the first-line HIV treatment – is very effective in suppressing hepatitis B. Additionally, WHO has done enormously important work in developing the global strategy, creating guidelines and introducing awards to highlight countries’ efforts towards elimination. A very small team at WHO has done this, but that team is likely to be cut back, because the TB department is being merged with the HIV, hepatitis and STI department with a significant budget cut and hence in workforce. There is a real danger of hepatitis disappearing in WHO.

The importance of the voice of the affected community in ensuring that it doesn’t happen cannot be overstated. And ensure that the impetus we have is not lost because good things have been happening. Both Pakistan and Indonesia have recently announced plans to tackle viral hepatitis, and they are two of the key countries with large burdens whose actions will significantly affect whether we achieve global elimination or not.

Also, the United Nations General Assembly High Level Meeting in New York in September on non-communicable diseases is a unique opportunity to position viral hepatitis testing and treatment as a key cancer prevention method. Liver cancer has the third highest mortality of any cancer, and three-quarters of it is caused by hepatitis B or C. The Director of IARC, WHO’s cancer institute in Lyon, has said: “We cannot treat our way out of the cancer problem.” This is particularly true of liver cancer, where treatments have not advanced in the same way they have in other cancers. Prevention is therefore critical.

Testing and treating viral hepatitis can thus help eliminate an infectious disease while at the same time prevent a non-communicable disease such as cancer. Two bangs for your buck!