Current position paper in the fight against hepatitis B and C

There are highly effective therapies against hepatitis C – now, with education, prevention and early detection, the aim is also to bring them to those affected and eliminate viral hepatitis in Germany by 2030. Experts from medicine, science, politics and health care practice agreed on appropriate measures at the “Strategy Meeting on Viral Hepatitis”.

Chronic viral hepatitis is a worldwide problem: estimates suggest that approximately 240 million people are infected with hepatitis B virus (HBV) and over 70 million with hepatitis C virus (HCV). Every year, more than one million people die from the consequences – making viral hepatitis one of the deadliest infectious diseases of all. Six years ago, the WHO therefore declared its goal of eliminating viral hepatitis worldwide by 2030. “We have excellent medical resources for this,” says Prof. Heiner Wedemeyer, MD, co-director of the European Hepatitis B & C Public Policy Association (HepBCPPA) and director of the Department of Gastroenterology, Hepatology and Endocrinology at Hannover Medical School. With the help of new antiviral therapies, the infection can be controlled with virtually no side effects, and in the case of HCV infection, a complete cure is even possible within a few weeks. An effective vaccination against hepatitis B is also available. “Now it’s an ethical issue to bring the therapy to the people,” said Wedemeyer, who chaired the strategy meeting organized by the German Liver Foundation and the HepBCPPA.

The first hurdle, however, is already to even grasp the extent of the virus spread. Surveys by the Robert Koch Institute (RKI) indicate that several hundred thousand people in Germany are infected with hepatitis viruses. However, exact figures are lacking, as Dr. Ruth Zimmermann, an epidemiologist at the RKI, explained at the meeting. “Although it has long been known that the infection rate is significantly higher among people with intravenous drug use, detainees, homeless people and people with a migration background, the data situation is still thin here as well,” criticizes Prof. Dr. Stefan Zeuzem, Vice Chairman of the German Liver Foundation and Executive Director of the Center of Internal Medicine at the University Hospital Frankfurt am Main. One of the goals set out in the position paper is therefore to better record infection rates in the groups most at risk, as well as in the population as a whole. The expert panel considered the recently introduced screening for hepatitis B and C as part of the “health check-up” (formerly “Check-up 35”) to be an important step towards diagnosing previously unknown HCV and HBV infections.

However, experience shows that it is precisely the vulnerable groups that are less well reached by Check-up 35. Outreach strategies are needed here, he said, to offer testing to people where they are – such as in drug or homeless services facilities. In this setting, the patients are very open to tests and possible therapy, which is then usually followed through, contrary to common prejudices. In order to reduce treatment barriers, especially in the addiction field, the Strategy Roundtable also calls for decriminalizing minor drug offenses – this could also make it easier for people with intravenous drug use to access safer use practices. However, if imprisonment were to occur, the stay in the correctional system would theoretically also offer health opportunities. This is because prison facilities – just like addiction clinics – are often consistently tested and treated for hepatitis viruses.

In the field of combating viral hepatitis, medical and sociopolitical issues are closely aligned. “Patients with viral hepatitis are still often affected by stigma,” Prof. Wedemeyer said. In addition to the fear of stigma, lack of knowledge is also a reason for many affected individuals not to face the diagnosis. “The assumption that there are no effective drugs available or that they are only available with very severe side effects is still very widespread,” emphasizes Prof. Wedemeyer.

Last but not least, legal hurdles that make elimination difficult also came up in the round. Although psychiatrists and addiction physicians have an above-average number of patients infected with viral hepatitis, they rarely prescribe the effective antiviral drugs for fear of recourse claims. “Here it would be important to create legal certainty,” said Prof. Wedemeyer – a message that the politicians who attended the strategy meeting will take back to their committees.

Because implementing the required measures costs money. Therefore, an important requirement in the current position paper is to designate and adequately fund the elimination of viral hepatitides as a public health priority. “On the one hand, this is about financing the therapy itself,” says Prof. Wedemeyer, referring to the frequently uninsured patients in the risk groups. On the other hand, however, local facilities such as drug help centers would have to be better staffed in order to cope with the additional tasks involved in hepatitis testing and treatment initiation. “Therefore, it is important to prioritize viral elimination on the part of policy makers,” said Prof. Dr. Ulrike Protzer, Director of the Institute of Virology at the Technical University of Munich (TUM) and at Helmholtz Munich, at the final discussion, which included Prof. Dr. Andrew Ullmann (FDP), a member of the German Bundestag. The Corona pandemic shows how much is possible when policymakers recognize the need. The prerequisite for this, he said, is to recognize viral hepatitides in their many facets beyond pure medicine – this became clear at the strategy meeting. “The WHO target can only be achieved by science, medicine, industry, patient organizations and politics working together,” sums up Wedemeyer.