Regional workshop on scaling up health sector response to viral Hepatitis in SEAR

10-12 April 2017, New Delhi, India

Distinguished participants, Mr Charles Gore, Dr Hirnschall, our esteemed partners,

As we gather today we can be proud of what we’ve achieved in the past year.

Proud that together we have developed a regional action plan to end viral hepatitis.

Proud that together we are pushing hepatitis prevention, care and control to the fore of public health programming.

And proud that together we are taking discussions on hepatitis beyond public health, making it a key social, economic and political issue.

Our joint action is vitally important.

At present hepatitis infects millions of people in the Region each year. More people die of the disease than HIV and malaria combined.

Across the Region, hepatitis is a common cause of liver cancer and cirrhosis and is a substantial contributor to premature morbidity and mortality. It also impacts economic growth and the push for inclusive development.

Though Hepatitis B and C attract much of the focus globally, our Region faces specific challenges. Inadequate access to safe water and sanitation, for example, mean transmission of hepatitis A and E is an ongoing problem, and one that requires multisectoral solutions.

So the need to take comprehensive action is clear. It is reflected in the Sustainable Development Goals, which include specific mention of strengthening efforts to combat the disease. It is also reflected in the World Health Assembly’s 2016 endorsement of a Global Health Sector Strategy on Hepatitis. The Strategy calls for elimination of viral hepatitis as a public health threat by 2030 – a very ambitious goal.

I am pleased to note the Region’s Member States have much experience to draw on: With GAVI’s sustained and generous contributions, all countries of the Region have had hepatitis B vaccine in their national immunization programmes for more than a decade.

I am also pleased to note the Region’s commitment to maintaining and strengthening these programmes while at the same time taking a comprehensive approach to address all forms of hepatitis as per the Global Strategy.

Myanmar and Timor-Leste, which are classified as high hepatitis B prevalence countries, have each developed and implemented comprehensive national strategic action plans. DPR Korea, which also has high hepatitis B prevalence, is now finalizing one.

Indonesia and Thailand, both of which have intermediate hepatitis B endemicity, have also implemented comprehensive national plans. At present, they are scaling up public sector diagnosis and treatment of hepatitis B and C in line with these plans.

While India is making efforts to develop a national strategy, Punjab and Haryana – two states with high hepatitis C burdens – have started diagnosis and treatment within the public sector. Notably, the bulk of these programmes are funded through domestic financing.

Both Nepal and Bangladesh, meanwhile, are still developing their national strategies to address all forms of hepatitis. Nevertheless, each has developed treatment guidelines that will help their country standardize treatment and management of hepatitis cases.

Across the Region, investments in surveillance are facilitating progress.

Bhutan’s efforts to conduct hepatitis B sero-surveillance, for example, will be instrumental in guiding and fine-tuning policy interventions. So too will the efforts of India’s National Centre for Disease Control, which is working to scale up surveillance across the country. Indeed, effective surveillance is key to diminishing the disease’s public health threat.

The efforts of our Member States are commended. I am pleased to reiterate WHO’s determination to match them.

As you know, WHO has been providing normative guidance on testing, treatment, monitoring and surveillance. We appreciate the unique challenges you face, and are developing effective, evidence-based tools and strategies to overcome them.

As I mentioned earlier, with your input we have now devised a regional action plan. This plan will give shape and purpose to efforts across the Region, with each country encouraged to adapt it to their needs.

But we’re also looking at more specific challenges.

As I’m sure you’re aware, last year WHO released a report on how difficulties regarding access to medicine can be overcome. I understand these barriers – particularly for the treatment of hepatitis C – have inhibited progress, and that the evidence-based recommendations in the report provide a way out.

As momentum to tackle hepatitis gathers pace, I am pleased to note a wider spirit of cooperation and solidarity. The close collaboration between health and development partners, civil society and academia, is proving to be a force multiplier in our battle. It is one that I trust will continue throughout this meeting and beyond.

Ladies and gentlemen,

As you continue to develop national plans and fine-tune your interventions, there are seven points I would like to stress here as fundamental to our cause.

First is the need to generate and sustain robust political commitment matched by adequate resource allocations. A shared resolve to ending hepatitis as a public health threat, and a broad understanding that this is indeed possible, is key to driving Region-wide progress, both in the immediate and long-term. As part of this, effective convergence and integration of health issues is needed, with hepatitis prevention, control and management being embedded in all that we do.

Second is the need for greater community awareness and understanding of hepatitis. Community awareness is essential to creating momentum at the grassroots, and will ensure greater uptake of hepatitis testing. At present, it is estimated just one in 10 people know their hepatitis status, meaning increased awareness will magnify our ability to control the disease many times over.

Third is the need to make the hepatitis B vaccine birth dose a mandatory part of early post-natal care. Despite being entirely preventable, mother-to-child transmission of hepatitis B continues to be a matter of concern. Every newborn in the Region should receive the birth dose, followed by at least two more doses during the first year of life. To this end I am excited to note the development of an Asia Pacific Framework for triple elimination of mother-to-child hepatitis, HIV and syphilis.

Fourth is the need for effective infection prevention measures. This includes ensuring safe and rational use of injections, ensuring the safety of blood transfusions and blood products, and ensuring greater safety in medical and dental procedures. Not only will these interventions protect against hepatitis, they will also protect against other blood-borne diseases such as HIV.

Fifth is the need to make point-of-care rapid diagnostics widely available. Though in recent years efforts to do so have shown results, there is still work to be done, particularly in low-resource settings. As part of this, new innovations should be harnessed and integrated with existing protocols, while efforts to expand the reach of primary health care services should be scaled up.

Sixth is the need to guarantee access to medicines. As I’m sure you know we now have effective medicines that can treat hepatitis B and cure hepatitis C. Within the Region, India, Bangladesh, Indonesia and Thailand have the capacity to manufacture generic versions of these medicines, meaning there can be no reason for a lapse in coverage.

Finally, and above all, is the need to recognise that information is power. Not only do we require robust surveillance to understand hepatitis’ prevalence and spread, but we also need it to monitor progress. Effective use of information technology is critical to making this happen, and to devising innovative and localised strategies to achieve our goals.

Ladies and gentlemen,

We are witnessing renewed vigor and momentum among Member countries for addressing pressing health issues. Last month each of the Region’s health ministers signed a Call for Action promising to tackle TB. This was followed by senior officials of all 11 countries registering their desire to see HIV, TB and malaria brought under the aegis of a single, empowered national body. As part of this approach we need to include hepatitis and all other diseases mentioned under SDG 3.3. The deadlines of our time-bound targets are approaching; we have zero time to lose.

Beyond this point of interest our three day consultation will cover a lot of ground; there is much to discuss and reflect upon.

I am confident that with your engagement and input this meeting will be a success, and I look forward to the recommendations for action that come out of it.

As I know you appreciate, our opportunity to forge dramatic, path-breaking progress on this issue is unparalleled in the history of our Region.

Let us make the most of that opportunity.

Indeed, together we can end hepatitis as a public health threat, and free our Region of its onerous and costly burden. Together we can achieve a healthier, more prosperous South-East Asia Region.

Thank you very much.