Health Departments are Key to Eliminating Hepatitis in the United States

Cross-Posted from the ASTHO. Read the original here.

World Hepatitis Day takes place every year on July 28 to raise awareness around hepatitis and opportunities to eliminate this disease. Despite significant strides in prevention and treatment, hepatitis remains one of the biggest global health threats. Ahead of this year’s observance, Murray Penner, executive director of NASTAD, reflects on what it will take to end this global epidemic and the critical role public health plays in accomplishing this important work.

NASTAD believes that eliminating viral hepatitis should be a top public health priority. Unless we act boldly and urgently, we will continue losing ground in the battle against hepatitis and new generations of Americans will become infected. It is not often we can say that we have the tools to eliminate an epidemic that affects millions of people in the United States, but we can definitively eliminate hepatitis B and C. The question is whether we will step up and increase our response at this pivotal moment in history, or if we will allow the current trajectory of a worsening epidemic to continue. Health departments are key to efforts to eliminate viral hepatitis, but require additional support to most effectively respond to these epidemics.

CDC estimates that up to 5.3 million people in the United States live with hepatitis B or C, many of those infected are unaware of their status, and new cases are being fueled by the opioid crisis. In 2015, for example, there were an estimated 33,900 new hepatitis C infections, a threefold increase in cases since 2010.

Even as we’re seeing these unacceptable increases, we have scientifically validated, effective prevention and care modalities that make ending this epidemic a real possibility. A safe and highly effective hepatitis B vaccine has been available for more than 30 years and yet only 33 percent of adults have been vaccinated. Due to the risk of acquiring hepatitis B or C through injection drug use, we must make comprehensive harm reduction services—including syringe services programs (SSPs), medication-assisted treatment (MAT), and supervised injection facilities—a centerpiece of our prevention efforts.

Health departments play a critical role in this response and we must build momentum at the state and local levels. Health department hepatitis programs have been at the forefront of responding to hepatitis by educating communities about prevention, offering free to low-cost testing, linking people to treatment, and other critical services including mental health and substance use treatment. Unfortunately, many state Medicaid programs have discriminatory restrictions that keep treatment out of reach for populations who need it the most.

Although impressive work is happening across the country with very limited resources, more needs to be done and health department leadership is key to reaching elimination goals. Medicaid programs, for example, are slowly loosening restrictions, but we will not be able to effectively treat the most vulnerable populations until all restrictions are removed and people who use drugs are prioritized for hepatitis C treatment.

Health officials should also consider convening hepatitis elimination teams which include infectious disease, immunization, behavioral health, and Medicaid program representatives. By working collaboratively, these health department programs can continue to identify common goals, coordinate funding priorities, and ensure populations most at risk for hepatitis B and C receive needed services. In addition to supporting internal actions, health officials should consider making the elimination of viral hepatitis a legislative priority and should make sure that people living with and/or cured of hepatitis are part of these efforts. The time has come for a comprehensive response to preventing viral hepatitis. The piecemeal approach thus far will not achieve our goal of eliminating these epidemics. Around the globe, while eliminating hepatitis has become a real possibility, U.S. efforts continue to be stymied by a lack of political will and the fact that hepatitis is not often recognized as a public health priority.

Since 2000, NASTAD has supported health department hepatitis activities by providing capacity building assistance, program guidance, and federal advocacy. Since 2006, hepatitis has been formally incorporated into NASTAD’s mission and is a part of our Chair’s Challenge to End the Epidemics. We will soon be assessing the current infrastructure for hepatitis elimination at health departments and tailoring our support to meet these needs. NASTAD also supports viral hepatitis program staff in state and local health departments. Finally, NASTAD convenes the Hepatitis Appropriations Partnership, a coalition dedicated to increasing the resources appropriated to CDC’s Division of Viral Hepatitis within the National Center for HIV, Hepatitis, STD, and TB Prevention, which ultimately funds health department hepatitis programs.

Eliminating viral hepatitis will require a significant financial investment. With an increased focus on the opioid crisis, there have been opportunities to highlight the infectious disease consequences. Congress has appropriated small increases to CDC’s hepatitis programs, but the current budget is far short of what CDC reports it needs to effectively respond. NASTAD advocates for a $95 million increase in CDC’s budget to respond to the viral hepatitis epidemics.

NASTAD is also working to increase the urgency of the U.S. response. Last year, NASTAD released a call to action urging policymakers to prioritize hepatitis and devote more attention and resources toward a comprehensive response. Elimination of HCV is not possible without urgently focusing efforts toward the right people, in the right places, right now. This means implementing a strategy to prevent transmission within, and identification and treatment of, hepatitis among people who inject drugs. If you have not already read this call to action and shared it with key stakeholders in your states, I urge you to do so.

Controlling and eliminating hepatitis in the United States is possible. NASTAD urges stakeholders at the national, state, and local levels to join our efforts to make elimination of hepatitis in the U.S. a reality. Our nation has a unique opportunity to not only eliminate a serious public health threat domestically, but to also become a leader globally. We cannot do this alone and we cannot do it without your leadership.