CEVHAP: Coalition to eradicate viral hepatitis in Asia Pacific

StephenW

CEVHAP hosts agenda-setting meet on hepatitis policy

While, it has taken far too long to get viral hepatitis the   attention it deserves, global experts cautiously hope that with successful partnerships   and learning from the HIV/AIDS experience, the Asia-Pacific region can be an   example to the rest of the world in controlling viral hepatitis, reports Viveka   Roychowdhury

The spread of viral hepatitis got special attention at this year's Conference   of the Asia Pacific Association for the Study of the Liver (APASL) which was   held in February in Taiwan. Even though viral hepatitis, especially B and C,   affect approximately 340 million people across the Asia-Pacific region, most   governments do not have a public health policy in place to tackle this disease.   This is in sharp contrast to the efforts of HIV/AIDS advocacy, which over the   last three decades, has helped to shape public health policy.

  Hoping to adopt and adapt key learnings from HIV/AIDS experience, The Coalition   to Eradicate Viral Hepatitis in Asia Pacific (CEVHAP), organised the 'CEVHAP   Symposium: Better health through better public policies—What Viral Hepatitis   can learn from the HIV experience', on the last day of APASL. The purpose of   the Symposium was to identify advocacy models that might be effectively adapted   within the Asia Pacific region to lobby governments to improve public health   policies to cope with the threat of viral hepatitis.

  Such efforts seem long overdue. In fact it was as late as May 2010, that the   World Health Assembly ratified a resolution on viral hepatitis (WHA63 R18),   which for the first time recognised the full scale of the challenge and finally   put viral hepatitis on the global healthcare agenda, alongside HIV/AIDS, TB   and malaria. The strategy provided a framework for national governments to respond   to the challenge of viral hepatitis within their own borders but also as part   of a cohesive approach to tackle the disease across regions. This was followed   by the World Health Organization (WHO) issuing its Global Hepatitis Strategy   which combines a wide range of its products to assist countries in the development   of national responses to viral hepatitis.

The   CEVHAP Symposium attracted leaders from the global and Asia Pacific viral hepatitis   community as well as WHO regional experts. Giving the welcome address, PASL   Jia-Horng Kao, President of A2012 and Professor and Director, Graduate Institute   of Clinical Medicine, National Taiwan University College of Medicine highlighted   the fact that viral hepatitis is considered endemic in some parts of the Asia-Pacific   region and hoped that the takeaways from the CEVHAP Symposium would assist policy   makers to tackle the situation.

Prof Ding-Shinn Chen, Immediate Past Dean of the National   Taiwan University College of Medicine and Chair of CEVHAP, then kicked off the   Symposium, with an overview of CEVHAP's goal to be the “bridge between   the medical and scientific community as well as other stakeholders.” While   he admitted that the ultimate goal to eradicate hepatitis would take many years,   even generations to achieve, he stressed that the short term goal is to focus   on improving public health policies to reduce the health, social and economic   burden of viral hepatitis in the Asia-Pacific region. He emphasised the power   of collaborative partnerships, the importance of keeping patients at the centre   of advocacy and ended his presentation by speculating on what would be the catalyst   for mobilising a movement behind viral hepatitis.

Lessons learnt

  Giving the keynote address, titled 'Learning from the Past', David L Thomas,   MD, Director of the Division of Infectious Diseases, Johns Hopkins School of   Medicine stressed that the viewpoint has to shift from the individual to the   population. While the first lesson, is that hepatitis treatment saves lives,   but unlike ARVs, this is not yet the case at the population level. Lesson two   followed that improved efficacy means improved urgency, but not necessarily   effectiveness. Lesson three was about reap what you sow, in terms of the impact   on public health being directly in proportion to resources devoted. So while   the massive resources devoted to HIV/AIDS (through PEPFAR, etc.) saw a reduction   in mortality due to HIV/AIDS, the same is not the case with viral hepatitis   because the political will is absent, as are the celebrities endorsing and supporting   advocacy movements.

  Thomas' fourth lesson is that there is more to the disease than the virus, as   borne out by the fact that a study showed that there was markedly lower survival   for HIV/HCV co-infected persons in Denmark during highly active anti-retroviral   therapy, from 2000-2005. The fifth and final lesson is that prevention is better   than treatment. He pointed out that the annual incidence of liver cancer in   children in Taiwan was markedly reduced by HBV vaccination. Elimination is of   course, the best form of prevention, with small pox being the best example.   

  Looking ahead Thomas said, controlling chronic hepatitis in the population requires   more work on improving safety and efficacy of treatments, expanding testing   and treatment access, educating to expand political and societal commitment.   Preventing new infections, together with curing existing infections will ultimately   lead to the elimination of hepatitis.

Successful collaborations

The   next two speakers, Ali Sulaiman, Lecturer in Internal Medicine, Department of   Medicine University of Indonesia and Benjamin Cowie, WHO Regional Reference   Laboratory for Hepatitis B, VIDRL Board of Directors, Australasian Society for   HIV Medicine were a classic example of the importance of leveraging partnerships   and collaborations in containing diseases like HIV/AIDS in the past and now   viral hepatitis. Developing countries like Sulaiman's home country Indonesia,   bear the greatest disease burden and challenges due to viral hepatitis. For   instance, Sulaiman said that only five per cent of hepatitis cases have access   to medicine, clearly pointing to barriers that go beyond the clinic. But hopefully   this will change. Sulaiman pointed out that while his government spearheaded   the celebration of viral hepatitis day in the past two years, the backbone of   such programmes is medicine access programmes.

  Cowie spoke about translating the Australasian Society for HIV Medicine's (ASHM's)   learnings from HIV to hepatitis, pointing out that while there is increasing   evidence for HBV antiviral therapy as a cancer prevention strategy, antiviral   effect on disease progression is reduced when resistance develops. Therefore   partnerships with clinicians like ASHM's preceptorship programme, imparting   primary care management of HCV for Indonesian primary care doctors and internists,   are crucial. Cowie expressed the hope that maybe the Asia-Pacific region can   be an example to the rest of the world in controlling viral hepatitis.

  There is no doubt of the patient's role as an important stakeholder and even   catalyst to policy change, hence patient advocacy groups (PAGs) have a very   crucial role. Speaking about the development of PAGs in viral hepatitis, Charles   Gore, President, World Hepatitis Alliance, himself a patient of hepatitis C   and cirrhosis, spoke about the need to raise viral hepatitis up the agenda and   the role conferences like APASL and associations like CEVHAP need to play to   build up the patient voice in the Asia-Pacific region.

The WHO viral hepatitis strategy

  Professor Stephen Locarnini, Head, WHO Regional Reference Laboratory for hepatitis   B, Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia   and Joint Secretary, CEVHAP outlined the four key priorities of the WHO Viral   Hepatitis Strategy. Partnership, mobilisation and communication come first,   followed by collection of data to help shape for policy and action. Prevention   of transmission forms the third axis followed by screening, care and treatment.

  Locarnini cautioned that there were many challenges, not least the need to fully   staff the WHO HQ team as well as fully fund the 2012-2013 work plan. Operationalising   the global hepatitis network, translating the HQ strategy at the regional level,   contributing to country strategy and technical support as well as finally producing   results and actually impacting viral hepatitis are the many challenges in the   path ahead.

  Speaking as the co-founder of CEVHAP, he summarised its work since its inception,   saying that it has established a solid base, with strong membership and a unique   position. Current and planned projects can provide strong data and evidence   to influence policy but will require strong follow-up on the ground. Therefore   he stressed that it is imperative that CEVHAP works closely with other groups   at global, regional and national levels to share data and best practices and   maximise impact

The Symposium concluded with a panel discussion, chaired   by Locarnini, with the panellists (Gore, Rosmawati Mohamed, University of Malaya,   Kuala Lumpur, Henry Lik-Yuen Chan, The Chinese University of Hong Kong and Jack   Wallace, La Trobe University, Melbourne) giving their views on what the viral   hepatitis sector needed to catalyse a movement.

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