AN estimated 15m Pakistanis are infected with hepatitis B and C viruses, with only a fraction being diagnosed and even fewer receiving treatment. Such is the baseline we have to work with to eradicate this major public health threat by 2030, in line with the UN’s SDGs. Left untreated, these two strains can lead to cirrhosis and liver cancer, and are responsible for 96pc of hepatitis-related deaths. Along with greater awareness and increased diagnosis, some key interventions are needed. For example, the prevalence of HBV and HCV in Pakistan is mostly attributed to poor healthcare standards — transfusions of unscreened blood, improper sterilisation of medical devices and reuse of syringes — putting both healthcare workers and patients at high risk of contraction. The first line of prevention, therefore, requires the Ministry of National Health Services to ensure that health and safety regulations, including proper medical waste disposal, are enforced in public and private facilities, while the provincial blood transfusion authorities must ensure that blood banks are monitored and all donations screened for pathogens.

Prevention must also include a concerted effort for universal HBV immunisation. Even though it is recommended that all children be given their first immunisation dose within 24 hours of birth, many newborns are not, owing to vaccine shortages. While there is no vaccine for HCV, recently developed direct-acting antivirals have revolutionised its treatment. But despite locally produced DAA sofosbuvir having the lowest price in the world, treatment is still beyond most patients’ reach. Meanwhile, approval of the recommended price cap for another DAA, daclatasvir, is still pending. The government ought to take a page out of Egypt’s book, which like Pakistan suffers from a high prevalence of hepatitis, to negotiate deals with manufacturers that enable the large-scale, local production of drugs and vaccines, and to develop a health exchange for free and/or subsidised vaccinations, screenings, and treatment. ‘Eliminate hepatitis’ — the theme for World Hepatitis Day 2017 — is a blunt message Pakistan ignores at its own peril.

Published in Dawn, July 28th, 2017