n World Hepatitis Day, as doctors and public health researchers focusing on Pakistan’s healthcare system, we note that the country now leads the world hepatitis-C infections with 8.8 million cases. We also realise that family physicians can transform this crisis through a prevention-focused approach that no other healthcare model can deliver.

This year’s World Hepatitis Day theme—Hepatitis: Let’s Break It Down—calls for urgent action to dismantle the financial, social and systemic barriers that stand in the way of hepatitis elimination. In Pakistan, family physicians represent our most powerful tool for breaking down these barriers and achieving the global goal of hepatitis elimination by 2030.

As we mark World Hepatitis Day on July 28th, Pakistan faces a sobering reality. With one in twenty adults infected, we face a health emergency that kills 366,000 Pakistanis annually. The numbers are alarming: 44 per cent of all new global hepatitis C infections from unsafe medical injections occur in Pakistan. Provincial disparities are stark—Balochistan has 25.77 per cent prevalence while Sindh has 2.55 per cent.

Unlike hepatitis-A and -E, which spread through contaminated water, hepatitis C transmits primarily through blood contact. Most patients contract infections during medical care without realising it—therapeutic injections account for 15 per cent of new cases, hospitalisation for 14 per cent and dental treatment for 13 per cent.

Family physicians hold Pakistan’s best hope for turning this tide. Unlike specialists who see patients episodically, family doctors build long-term relationships with entire families across generations. This continuity positions them uniquely to implement comprehensive prevention strategies that address both individual risk factors and community-wide transmission patterns.

Research shows that hepatitis-C treatment outcomes in primary care settings using simplified diagnostic algorithms match those at specialist centres, proving family doctors can deliver effective care at the community level. Their practice model allows them to track families over time, identifying shared risk behaviours and household transmission patterns.

This World Hepatitis Day theme of “breaking down barriers” finds its most practical application through family physicians, who are uniquely positioned to dismantle the obstacles that prevent hepatitis elimination in Pakistan.

Family physicians break down financial barriers by delivering screening and treatment at community level, eliminating expensive specialist consultations and reducing patient travel costs. They dismantle social barriers by understanding their patients’ social contexts, living conditions, and health behaviours. This insight allows them to provide culturally sensitive education about transmission risks, particularly around unsafe injection practices. In our communities, patients trust family doctors more than distant specialists. This is crucial for hepatitis-C prevention because many transmission routes involve personal behaviours like sharing razors at barber shops or accepting used syringes.

Family physicians eliminate systemic barriers by integrating hepatitis care into routine primary healthcare. The WHO’s 2024 guidelines emphasise this integration, allowing them to combine hepatitis-C screening with diabetes management, hypertension control and routine preventive care.

Family physicians can screen systematically, treat effectively and prevent transmission through community education and advocacy. Used effectively in both public and private sector healthcare facilities, they can be Pakistan’s most promising pathway to achieving hepatitis elimination by 2030.

Hepatitis-C is a “silent killer” because patients remain asymptomatic for years while unknowingly transmitting the virus. Family physicians’ continuous care model enables systematic screening of at-risk patients before complications develop. By integrating hepatitis-C testing into routine primary care—during annual check-ups, chronic disease management visits or pre-procedure assessments—family doctors can identify infections early when treatment is most effective. Their practice records allow them to track risk factor accumulation over time, implementing risk-stratified screening protocols that maximise detection whilst optimising resource utilisation.

When family doctors identify hepatitis-C infection, they enable comprehensive care coordination. They can manage both hepatitis-C treatment and patients’ co-morbid conditions, ensuring drug interactions are avoided and treatment adherence is maintained through the ongoing relationship. Their longitudinal care model supports the monitoring required for hepatitis-C treatment and post-treatment surveillance. Unlike specialist referrals that may involve months of waiting periods, family practice provides immediate access to care and rapid treatment initiation.

Family physicians must advocate for proper infection control in all healthcare settings. They can lead by example, implementing universal precautions in their own practice and using their referral power to drive system-wide safety improvements. Their position allows them to identify patterns of healthcare-associated transmission and report these to public health authorities. When multiple patients from the same facility develop hepatitis-C, family physicians are often the first to recognise the pattern and trigger investigation.

The hepatitis pilot programme’s remarkable success in Gilgit-Baltistan demonstrates the feasibility of comprehensive hepatitis-C elimination through family practice leadership. Launched in MC Chilas (Diamer district) and UC Mirkhunja (Shigar district) in partnership with the Aga Khan Development Network, this initiative achieved extraordinary results. In just 10 days, the pilot programme successfully screened 14,000 people, with plans to screen the entire 1.7 million population of Gilgit-Baltistan. This rapid screening capability demonstrates how family physicians, when properly supported and coordinated, can deliver population-level health interventions efficiently.

With the Prime Minister’s National Hepatitis C Elimination Programme providing Rs 68 billion over two phases, family physicians now have the resources and mandate to lead this fight. The programme aims to eliminate hepatitis-C by 2029, mirroring Egypt’s successful achievement. The national programme builds on a strong foundation—the hepatitis unit was first launched at the Pakistan Kidney and Liver Institute and later expanded. The federal government provides Rs 35 billion based on matching contributions from provincial governments, with plans to expand first to Islamabad, Gilgit-Baltistan and Azad Jammu and Kashmir, then nationwide.

Family physicians should implement systematic risk assessment for all patients, asking about injection history, surgeries, dental procedures and hospitalisations. High-risk patients should receive hepatitis-C testing regardless of symptoms. Practice-based registries can track screening efforts and treatment outcomes, contributing to the national surveillance system Pakistan desperately needs. Prevention through family practice is cost-effective. Every hepatitis-C infection prevented saves not only immediate treatment costs but also long-term costs of managing cirrhosis, liver cancer and liver transplantation. This step-wise approach will help minimise risk of transmission and hence cost of treatment.

Pakistan’s hepatitis-C crisis demands systematic action to dismantle the barriers to elimination. Family physicians represent our most effective tool for breaking down the financial, social and systemic obstacles that stand between Pakistan and a hepatitis-free future.

The evidence is clear: family physicians can screen systematically, treat effectively and prevent transmission through community education and advocacy. If this cadre is utilised effectively in both public and private sector healthcare facilities they can represent Pakistan’s most promising pathway to achieving hepatitis elimination by 2030.

For policymakers and the public, this World Hepatitis Day message is simple: support family physicians with training, resources and recognition. This will be cost-effective in the long run. In addition, it will promote nationwide, standardised screening, early identification, counselling and appropriate management of chronic hepatitis. For healthcare administrators: prioritise family practice strengthening over specialist expansion. For communities: trust your family doctor to lead this fight.

Pakistan’s hepatitis-C crisis demands a family medicine solution. The question isn’t whether elimination is possible—it’s whether we will recognise and empower the family physicians who can break down barriers and make it happen.

Dr Tehzeeb Zulfiqar, is a research fellow at Australian National University, Canberra

Dr Hina Jawaid is an associate professor in family medicine at Health Services Academy, Islamabad.