Dr. Ronald ValdiserriThis past Sunday, July 28, was World Hepatitis Day. To mark this global observance in the United States, the White House hosted an event on Friday, July 26, 2013 which brought together more than 200 stakeholders from the domestic and global viral hepatitis communities along with representatives of numerous federal agencies to put an important spotlight on U.S. efforts to confront this global health concern. For those of you who were not able to attend or watch the live stream of the event on the White House’s website, I wanted to share some highlights from this exciting event.
White House Officials Address Viral Hepatitis
In her opening remarks, Ms. Tina Tchen, an Assistant to President Obama and Chief of Staff to First Lady Michelle Obama, brought the scope of the global viral hepatitis epidemic into focus observing that, according to the World Health Organization (WHO), more than 390 million people around the world are chronically infected with hepatitis B or hepatitis C and those viruses, along with hepatitis A, D and E, take the lives of nearly 1.4 million people every year worldwide. She also highlighted that in the U.S., viral hepatitis has a disproportionate impact in some communities, including Asian Americans and Pacific Islanders, African Americans, and “baby boomers”. Ms. Tchen noted that one of our biggest challenges in combating viral hepatitis is simply raising awareness about it both here and abroad. She quoted the President’s 2013 World Hepatitis Day proclamation, observing “viral hepatitis is a silent epidemic, and we can only defeat it if we break that silence.”
The White House Offices of National AIDS Policy (ONAP) and National Drug Control Policy (ONDCP) jointly organized the event. Dr. Grant Colfax, Director of ONAP, remarked on the promise of several important developments since the White House hosted its first observance of World Hepatitis Day four years ago. He pointed to the release of the Action Plan for the Prevention, Care and Treatment of Viral Hepatitis, the U.S. Preventive Services Task Force’s (USPSTF) recently expanded recommendations on screening for hepatitis C, and the availability of an FDA-approval rapid test for the hepatitis C virus (HCV) as meaningful advances that are strengthening our domestic response to viral hepatitis. Dr. Colfax noted several important parallels between HIV/AIDS and viral hepatitis, in particular the disproportionate impact the diseases have on several of the same key populations – gay, bisexual, and other men who have sex with men, African Americans, and persons who inject drugs – and the unfortunate stigma that continues to pervade both diseases, preventing too many Americans from getting tested and, if diagnosed, treated. Given these and other parallels, Dr. Colfax observed that to successfully combat both diseases our efforts cannot remain isolated in disease-specific “silos.”
Representing ONDCP, Mr. Michael Botticelli, the office’s Deputy Director, discussed the intersections of viral hepatitis and HIV with substance abuse and remarked that continued coordination of national responses to each are vital to the success of both. The 2013 National Drug Control Strategy, he noted, supports and complements the goals of the Action Plan for the Prevention, Care and Treatment of Viral Hepatitis; pursuing the Drug Control Strategy’s goals of preventing drug use and identifying and treating those struggling with addiction and substance use disorders will also reduce new cases of viral hepatitis. He observed that ensuring the availability of substance abuse treatment is critically important to achieve these goals and that the implementation of the Affordable Care Act will aid substantially in this regard since it will make access to substance abuse and mental health services more accessible to millions of Americans. Mr. Botticelli also pointed to two areas in need of further attention: an emerging trend of increasing injection drug use and HCV infection among young persons in rural and suburban communities (the topic of a consultation convened by my office earlier this year) and a recent report from the Substance Abuse and Mental Health Services Administration (SAMHSA) noting that only 42 percent of substance abuse treatment facilities offer onsite HCV testing, suggesting an important opportunity for improvement.
In his remarks, Ambassador Eric Goosby, MD, who leads the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), observed that high rates of hepatitis B and C in some parts of world are closely correlated with significant rates of HIV infection since the viruses share common routes of transmission. As a result, in many countries served by PEPFAR, there are not only significant rates of mono-infection with viral hepatitis, but also co-infection with HIV and hepatitis B or hepatitis C. Ambassador Goosby noted that U.S. support –through PEPFAR and other activities – has strengthened the capacities of many countries around the globe to meet more of the broader health needs their populations, including efforts to prevent, diagnose and treat viral hepatitis. These actions have included promoting universal precautions in health care settings, expanding HIV prevention and treatment programs for people who inject drugs, educating about safer injection practices, and working to reduce demand for unnecessary injections as well as implementing systems to ensure the safety of the blood supply.
Spotlight on Domestic Viral Hepatitis Response
Assistant Secretary for Health Dr. Howard Koh thanked the many members of the viral hepatitis community present at the meeting as well as the members of the inter-agency work group coordinating implementation of the Action Plan for the Prevention, Care and Treatment for Viral Hepatitis (the Viral Hepatitis Implementation Group, or “VHIG”). Dr. Koh stated that without their passion and commitment as well as their efforts to coordinate, collaborate and lead, recent progress in combating viral hepatitis would not have been possible. The Assistant Secretary for Health shared several significant highlights from the two-year cross-agency effort to implement the Action Plan, including CDC’s launch of two important public awareness campaigns: Know More Hepatitis to raise awareness about hepatitis C and Know Hepatitis B to raise awareness among the Asian American and Pacific Islander communities. He also pointed to the recent harmonization of the CDC and USPSTF HCV screening recommendations and recent joint efforts by the U.S. Departments of Education, Justice, and Health and Human Services to address potential discrimination against students living with hepatitis B seeking admission to or attending health professions schools. Finally, noting that the implementation of the Action Plan is a government-wide effort, Dr. Koh acknowledged that in addition to agencies and offices from across the Department of Health and Human Services, the Action Plan is being supported and strengthened by the efforts of the U.S. Departments of Housing and Urban Development, Justice, and Veterans Affairs. He concluded by observing that all those federal partners are currently working to develop a renewed three-year action plan to guide efforts for the next three years.
Much of the half-day White House event was devoted to two panel discussions. I was honored to facilitate one of them, a conversation about U.S. viral hepatitis health policy, programs and research. The panel, comprised of health department representatives, clinicians, researchers, a fellow federal employee, and a community advocate whose family was personally affected by hepatitis B virus, shared a wealth of information. A few highlights included:
- Information on research underway at NIH’s National Institute on Drug Abuse (NIDA) to better understand intersection of drug use and viral hepatitis (see related NIDA blog)
- Details on how Massachusetts responded to the identification of a trend of new HCV infections among young persons who inject drugs with enhanced education for providers, expanded HCV screening, and taking a closer look at the extent to which outreach and support to drug users was effectively reaching younger populations.
- A discussion of obstacles to addressing the disparate impact of HCV among African Americans -- HCV is two times more prevalent in African Americans than in Whites and it is associated with more severe outcomes. Those obstacles include lack of health coverage and lack of awareness of the significance of this disease and current treatment opportunities.
- Highlights of how offering HCV testing in STD clinics serving an inner-city population in Baltimore has proven to be one way to increase testing rates among vulnerable populations. The city has paired this with widespread patient education about HCV and supports for those diagnosed with HCV to navigate the confirmatory test and linkage to care.
- A compelling personal account from someone who lost two family members to hepatitis B that reminded us that silence is HBV’s greatest weapon. The key to more effectively combating hepatitis B is convincing others to break the silence that surrounds viral hepatitis in many communities.
- Observations about the importance of investment from federal, state and local governments to support systems that better track who is diagnosed with HCV, who initiates treatment, and what the outcomes are. In New York City, community based organizations as well as both diagnostics and pharmaceutical firms have collaborated with the local health department to support demonstration projects designed to increase HCV testing and linkage to care.
The event concluded with a panel on innovative programs and partnerships working to address viral hepatitis around the world. Led by my colleague Dr. John Ward, the organization which organizes World Hepatitis Day as well as interesting perspectives from Scotland, Vietnam, and our own HHS Office of Global Affairs spoke about the WHO’s just-released first-ever country hepatitis survey, covering 126 countries. The report, Global Policy Report on the Prevention and Control of Viral Hepatitis in WHO Member States , identifies successes as well as gaps at the country level in the implementation of four priority areas: raising awareness, evidence-based data for action, prevention of transmission, and screening, care and treatment. Dr. Harmanci observed that the U.S. Action Plan for the Prevention Care and Treatment of Viral Hepatitis was one of most comprehensive national plans their survey found and that WHO plans to use it to inform a template they are preparing for other countries to use in developing their own comprehensive national plans.
The 2013 White House observance of World Hepatitis Day underscored the Administration’s ongoing commitment to addressing this epidemic that has, for too long, been silent. Importantly, it also signaled the impact of both domestic and global activities undertaken by community members as well as the U.S. government to generate greater awareness of viral hepatitis and build meaningful momentum toward a day when these infections are prevented whenever possible and when they do occur, those living with the viruses are diagnosed in a timely manner and connected to lifesaving and curative treatment.