Achieving viral hepatitis elimination: 5 years to go

Today is World Hepatitis Day, providing an opportunity to reflect on progress towards achieving the 2030 goal of eliminating viral hepatitis as a public health threat.

The 2030 targets

In 2023, the World Health Organization published their latest guidance on country validation of viral hepatitis elimination. This guidance sets out a range of targets, including absolute impact targets for incidence and mortality, as well as programmatic targets that focus on the coverage of services and interventions. Countries aiming for validation of elimination need to demonstrate that they have achieved these targets.

Successes to celebrate

Our latest Hepatitis C in England report highlights the substantial progress that has been made towards achieving elimination of hepatitis C. The number of people living with chronic hepatitis C has declined by 56.7% between 2015 and 2023, largely due to the scale-up in testing and treatment. Surveillance data show that 78.3% of individuals diagnosed with chronic hepatitis C in that period were recorded as having initiated treatment. Hepatitis C-related mortality was 0.41 per 100,000 in 2023. These indicators show that England has nearly achieved the WHO target for treatment coverage (≥80%) and exceeded the target for mortality (≤2 per 100,000).

For hepatitis B, high levels of antenatal screening and vaccination coverage in the selective neonatal immunisation and universal childhood programmes have resulted in a very low rate of mother to child transmission in England at <0.1% (WHO target ≤2%). The latest Hepatitis B in England report shows that antenatal hepatitis B screening coverage is over 99%, coverage for timely hepatitis birth dose vaccination is over 98%, and coverage of the universal childhood immunisation programme is over 91%, all above the WHO ≥90% target.

Key challenges and barriers

Despite the successes, substantial challenges remain.

For hepatitis C, there needs to be a renewed focus on harm reduction services to prevent new and re-infections. Surveillance data shows that people previously cured of hepatitis C are acquiring new infections and therefore at continued risk. Survey data suggest that a third of people who have recently injected drugs have inadequate access to needle and syringe programmes. There is limited programmatic data on needle and syringe provision for people who inject drugs in England, which means that it is not possible to estimate the WHO target for NSP provision.

For hepatitis B, current estimates show that less than half of people living with hepatitis B have been diagnosed and there are no national data available to estimate treatment coverage. Nearly 269,000 individuals in England were estimated to be living with chronic hepatitis B in 2022, yet between 31% and 47% had been diagnosed based on experimental data. This falls well below the WHO target of ≥90% of people being diagnosed.

The scale of undiagnosed hepatitis B has been highlighted through the emergency department opt-out testing programme for bloodborne viruses, where the virus accounts for the greatest proportion of new diagnoses. It is unlikely that England will achieve the hepatitis B targets for diagnosis and treatment by 2030 unless there is a concerted effort across the system to raise awareness, to ensure equitable pathways are in place for diagnosis and treatment, and that robust systems are in place to monitor this.

Looking forward

The progress made towards hepatitis C elimination so far has been driven through multi-sector partnership working across the system involving NHS England’s HCV Elimination Programme, local services, community organisations, public health professionals and the private sector.  This progress demonstrates our ability to achieve and evidence the WHO elimination goals but sustained commitment for hepatitis C and a significant scaling up of work on hepatitis B will be required to ensure we both achieve and maintain elimination.