Pakistan launches its first Hepatitis Strategic Framework

Islamabad: Relying on weak epidemiological data due to the absence of a national hepatitis surveillance system, Pakistan’s 1st National Hepatitis Strategic Framework (NHSF) 2017-2021 was launched here Friday with a target to reduce chronic cases of Hepatitis B and C by 10%, and new cases of Hepatitis B and C by 30%. The target is the first milestone to be achieved by 2021 as part of the larger vision to eliminate viral hepatitis as a major public health threat by 2030.

The NHSF was launched by the Pakistan Health Research Council (PHRC), the Ministry of Health, and the World Health Organization (WHO) in the presence of the Director General of WHO Dr. Tedros Adhanom Ghebreyesus, Regional Head of WHO Dr. Mahmoud Fikri, and the minister and secretary of health Saira Afzal and Muhammad Ayub Sheikh respectively, among others. Consultant gastroenterologist Dr. Huma Qureshi, former head of PHRC, shared the salient features of the NHSF.

One of the key objectives of the strategy is to obtain a yearly increase in the diagnosis and treatment of Hepatitis B and C cases, and a yearly decrease in the number of new infections. How these objectives can be achieved in the absence of real-time data is a tough question to answer. Pakistan does not have a national hepatitis surveillance system, and as such, epidemiological data are weak. Federal and provincial data are often inadequate or not up to date. As such, the NHSF is based on limited epidemiological findings of the 2008 National Hepatitis Survey. The implementation of high-impact and targeted interventions will remain a far cry in the absence of more accurate data.

The NHSF’s vision is to halt viral hepatitis transmission and to ensure everyone living with viral hepatitis has access to safe, affordable and effective prevention, care and treatment services. To this end, Dr. Huma drew the Ministry of Health’s attention to the need for “huge price reduction in hepatitis diagnostics, which are more expensive than treatment.” She also called upon the Ministry to arrange for the new Hepatitis B drug (teno-alafenamide) and the new HCV drug (SOF+VEL), both of which are awaiting registration.

Earlier on, Dr. Huma shared global and national data as evidence to explain why a stepped-up global, regional and national response can no longer be delayed. Globally, approximately 257 million persons are chronically infected with Hepatitis B Virus (HBV) and 71 million with Hepatitis C Virus (HCV). If the number of people living with hepatitis remains at the current high levels for the next 40-50 years, it is estimated that a cumulative 20 million deaths will occur between 2015 and 2030.

Dr. Huma also highlighted the different stages of the participatory process that led to the development of the strategy. These included formation of national and provincial technical working groups and delineation of their roles; formation of a Technical Advisory Group (TAG) which conducted a hepatitis situation analysis with a focus on epidemic trends, changing patterns and population groups; and the holding of a national consensus workshop in which all provincial health departments, TAG members and partners endorsed the final draft.

Addressing the gathering, Dr. Tedros pointed out that Pakistan has the world’s second highest prevalence of Hepatitis C, second only to Egypt. “Without vision, progress is impossible. And without progress, we go nowhere. I am encouraged by the goal of eliminating viral hepatitis by 2030. The numbers are staggering. Pakistan has more than 8 million people living with Hepatitis C and 4 million with Hepatitis B,” he remarked.

Dr. Tedros grouped Pakistan as one of the two countries where transmission is ongoing at a large scale and urgent interventions are required. “You are on the tight track. The number of people receiving treatment has almost doubled. Testing and treatment must be expanded to everyone who needs it. We must also take action to prevent infections,” he added.

Saira Afzal shared some of the practical steps taken by Pakistan to reduce the incidence of hepatitis. “We must encourage people to get tested and treat those who are infected,” he repeated. She said, the role of the provinces will be of critical importance in implementing the strategic framework on ground, as the real test will be the results achieved in terms of decline in hepatitis prevalence and incidence in the country. She thanked WHO, CDC, TAG members and all other partners for lending technical support.

The NHSF outlines five strategic objectives to achieve its targets: to strengthen leadership, governance and advocacy for a coordinated and integrated hepatitis response; to develop and monitor evidence-based strategies; to improve the quality, and scale up coverage of the hepatitis B and C prevention; to improve access to viral hepatitis B and C testing and diagnosis services; and to improve the quality, and scale up coverage, treatment, care and support for hepatitis B and C patients.