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The Potential of Strategic Health Diplomacy in the Fight Against Hepatitis

By Nikki Smith, Hannah Martin

Monday, July 30, 2018

July 28 marked the annual World Hepatitis Day. Such recognition is important at a time when the impacts of viral hepatitis are increasing worldwide; as of 2015, 4.4 percent of the world’s population was infected. In the United States, hepatitis C kills more people than the sum of all other infectious diseases that must be reported to the Centers for Disease Control and Prevention. Globally, annual hepatitis deaths (1.34 million) exceed those from HIV/AIDS (1 million) or tuberculosis (1.2 million). However, in contrast to these other infectious diseases, viral hepatitis is a so-called “silent” epidemic affecting liver function with few outward signs, and deaths are not declining.

Figure 1: Global Prevalence of Hepatitis B and C
Source: World Health Organization

Viral Hepatitis

The two main strains of viral hepatitis are viruses B (HBV) and C (HCV). These blood-borne pathogens kill nearly 890,000 and 400,000 people, respectively, each year, with deaths typically resulting from liver cancer and cirrhosis. However, 80 to 90 percent of infected individuals are unaware of their status, which means they will not seek treatment and risk transmitting the virus to others.

Prevention and treatment for HBV and HCV have improved dramatically over the past 50 years. An effective and affordable vaccine is available for HBV, and recent medications have been developed which can cure the majority of HCV infections within three months. The first dose in the HBV vaccine series is often given at birth. Even though they can cost as little as 20 cents, birth doses are only common practice in half of all countries, and fewer than 40 percent of newborns globally receive this critical vaccination. As of 2015 in the United States, nearly three-in-four infants are vaccinated at birth, and approximately 92 percent of children receive the recommended vaccine series (of two-to-three doses) by three years of age.

Potential for Strategic Health Diplomacy

The prevalence of hepatitis is growing, but eliminating this global scourge is achievable. Doing so by 2030 would prevent nearly 36 million infections and 10 million deaths. However, the cost of vaccines, treatment, diagnostics, education, and coordination currently stand in the way of epidemic control. The same difficulties have been associated with the HIV/AIDS epidemic, but the success of the President’s Emergency Plan for AIDS Relief (PEPFAR) program in reducing mortality and bolstering health infrastructure shows that these barriers can be overcome.

In BPC’s 2018 report, Building Prosperity, Stability, and Security Through Strategic Health Diplomacy: A Study of 15 Years of PEPFAR, former Senate majority leaders Tom Daschle and Bill Frist, M.D., connect the provision of international HIV/AIDS support through PEPFAR to positive impacts on U.S. national security (Figure 2). They suggest that a similar global program to combat viral hepatitis could be another target for strategic health diplomacy in the future, and the disease meets all three of BPC’s identified criteria for strategic health diplomacy: prevalence or rapidity of epidemic growth; potential of treatment or prevention strategies; and the strategic value of the stricken areas.

Figure 2: Pathway for Attainment of Key Benefits of Strategic Health Diplomacy Source: Building Prosperity, Stability, and Security Through Strategic Health Diplomacy: A Study of 15 Years of PEPFAR
Note: Figure 3 shows a visual model of PEPFAR’s SHD effects, starting with health impacts in the outer ring. BPC identified six attributes of PEPFAR (light blue) that have contributed to its success: clearly defined goals, real need and visible impacts, global goals and a local focus, long-term commitment, capacity-building, and transparency. In turn, the health impacts of PEPFAR combined with these attributes have led to secondary effects (dark blue). Through the health impacts and secondary effects, the United States has realized key benefits of SHD (red center).

Already, some U.S. foreign aid goes to building sustainable and resilient health systems and to addressing a range of infectious diseases, including HBV and HCV. But if the United States were to dramatically scale up the global fight against hepatitis, potential benefits, even beyond health impacts, could include improved foreign public opinion, socioeconomic development, and increased diplomatic engagement. Experience with PEPFAR has illustrated that these effects can further lead to greater collaboration and trade between the United States and partner countries, as well as less war and disruption. In considering this type of large-scale global health investment, these strategic impacts cannot be overlooked.