On July 28^th, the World commemorated World Hepatitis Day. This year’s theme, It’s Time For Action, sets emphasis on bridging the “know-do” gap in implementation and scaling up of viral hepatitis interventions.

Viral hepatitis remains a major global public health threat in Africa. The World Health Organisation (WHO) 2024 Global Hepatitis Report clearly highlights the urgency of the viral hepatitis problem in Africa. It is estimated that 73 million people in Africa are living with chronic hepatitis B and C infection. Among these, only 4.2% with hepatitis B and 13% with hepatitis C have been diagnosed and 0.2% and 3% of people with hepatitis B and C respectively were receiving treatment as of 2022. A direct impact of this low coverage of and access to diagnostics and treatment is the high mortality from chronic viral hepatitis infections. The WHO estimates that 25% of the total 1.3 million deaths from hepatitis B and C recorded in 2022 were in Africa. This represents 272,000 deaths from hepatitis B and 35,000 from hepatitis C annually.

More concerning than the high burden of disease and death from viral hepatitis is the sustained high transmission of hepatitis B and C in Africa. Despite an effective and cheap vaccine against hepatitis B, two-thirds of all new infections globally occur in Africa, estimated at 771,000 new infections annually. A recent systematic review estimates that in 2022, 172,000 babies born in Africa acquired hepatitis B infection through mother-to-child transmission. The low coverage of both hepatitis B testing and prophylaxis in pregnancy and timely hepatitis B birth dose vaccination in Africa are main drivers of the high rate of mother-to-child transmission. As a result, the region has the highest global prevalence of chronic hepatitis B infection among children aged less than 5 years. Individuals infected with hepatitis B at birth have a higher risk of developing severe liver disease and liver cancer in adulthood. As a result, these sustained hepatitis B infections both increase the number of individuals living with the virus in Africa and the likely deaths from hepatitis B infection.

Similar to hepatitis B, Africa has a high burden of new hepatitis C infections, estimated at 172,000 new infections each year. A WHO survey estimates that 13.5% of these new hepatitis C infections are due to unsafe injecting drug use and 5% from unsafe medical injections. However, poor surveillance systems and limited data on probability of transmission suggests that both the number of new infections and the estimated contribution of transmission routes could be underestimated.

The rationale to action against viral hepatitis is therefore strongest in Africa. SOLDA hosted a World Hepatitis Day webinar to highlight the burden and challenges of viral hepatitis across the 5 regions in Africa, and to share best practice from champion countries like Egypt. A second webinar, led by the African Viral Hepatitis Action Group (AVHAG) and the African Union Scientific, Technical and Research commission (AU-STRC), provided a platform for building partnerships towards hepatitis elimination in Africa. The two webinars brought together community representatives, members of parliament, healthcare workers and technical experts to discuss strategies to increase domestic funding, access to diagnostics and treatment, and enhance policy at national and continental levels to scale up intervention strategies. These webinars build on other efforts like the UN Group of Friends to Eliminate Hepatitis, to advance health diplomacy and national/continental commitments to achieve WHO targets of hepatitis elimination by 2030.

Indeed, there are unique opportunities that African countries can leverage to regain the trajectory needed to achieve hepatitis elimination. The WHO 2024 hepatitis B guidelines offer an opportunity to expand access to treatment in Africa and to decentralise and integrate viral hepatitis care into various levels of the healthcare system. The guidelines substantially simplify and expand eligibility for treatment for adults and adolescents, and eligibility for prophylaxis for pregnant women to prevent mother-to-child transmission. These simplified and expanded criteria can rapidly scale up diagnosis and treatment which are critical to reduce morbidity and mortality and reduce new infections.

Leveraging on the global commitment to triple elimination of HIV, syphilis and hepatitis B; the Global Fund support toward triple elimination; and the GAVI support for lower-income countries to introduce the hepatitis B birth dose, will further reduce new infections in Africa. Validating available data on hepatitis B and C burden will measure progress, identify gaps and guide national strategies; therefore, countries must strengthen measures for improved surveillance. Existing continental partnerships can advance pooled procurement mechanisms, allow countries access to reference pricing for diagnostics and generic drugs, and support South-South collaboration for sharing of experience. Continuing the engagement with law makers at national, continental and global levels can unlock funding, including domestic financing, and influence policies that increase awareness, reduce barriers and promote viral hepatitis elimination.