Viral hepatitis in the COVID-19 pandemic
There was a time when hepatitis C patients and advocates who were fighting for change and improved access to medical care, treatment, resources, and funding were able to make an ignominious claim: HCV was the deadliest disease in the United States, and it was more deadly than the next 59 infectious diseases combined. We would use this terrible statistic to highlight the suffering that comes from not sufficiently addressing a preventable and curable disease.
We can no longer say that, as we have a new infectious disease that has proven itself far more deadly: COVID-19. At the time of this writing, the U.S. surpassed more than one million deaths from COVID-19. This is a devastating and overwhelming number, but one that could have been so much worse were it not for a massive effort to study COVID-19, build a massive public health response, and develop a vaccine. I think it’s fair to say that the U.S. was far from perfect in our response to COVID-19, but we did have our successes that we can learn from and apply to other public health issues, including viral hepatitis.
What lessons has the COVID-19 epidemic taught us?
The NIH made the following statement about COVID-19 testing: “Testing of all people for SARS-CoV-2, including those who have no symptoms, who show symptoms of infection such as trouble breathing, fever, sore throat, or loss of the sense of smell and taste, and who may have been exposed to the virus will help prevent the spread of COVID-19 by identifying people who are in need of care in a timely fashion. A positive test early in the course of the illness enables individuals to isolate themselves—reducing the chances that they will infect others and allowing them to seek treatment earlier, likely reducing disease severity and the risk of long-term disability or death.”
Although there are challenges to overcome to develop an HCV vaccine, the mobilization of resources to develop COVID-19 vaccines is a model of inspiration for HCV vaccine advocates.
Replace the word “SARS-CoV-2” with hepatitis B or hepatitis C and you can pretty much say the same thing. Most folks with viral hepatitis don’t know that they have it: HCV is called the “silent epidemic” because most people who have it are asymptomatic: 67% of people with HBV and 51% of people with HCV don’t know they have it. If we launched a mass viral hepatitis awareness and testing campaign, we could reduce those numbers dramatically and connect people to medical care and treatment. A “positive test early in the course of the illness” for HBV or HCV means getting people engaged in care and treatment in the case of HBV, or cure in the case of HCV, and preventing long-term complications from cirrhosis like liver cancer or death. Treating and curing HCV among people who inject drugs reduces the risk of transmission and reinfection.
Vaccines save lives
The speed with which COVID-19 vaccines were developed was remarkable. The genetic sequence of COVID-19 was discovered and widely published in January 2020, and the race to develop a vaccine was on! It was a united effort between world governments, corporations, foundations, international health bodies, and universities, spending billions of dollars and implementing innovative clinical trial models. The result was a therapeutic vaccine that was effective in preventing serious illness and death in less than a year.
The COVID-19 vaccines worked: Even for people who acquired COVID, the vaccines reduced serious illness and hospitalizations, saving countless numbers of lives!
We have a vaccine for hepatitis B. It’s a safe and effective vaccine that prevents infection. It’s recommended for essentially everyone. Of course, if someone already had HBV, the vaccine isn’t necessary, but for these people we can monitor the health of their liver and offer treatments to slow down the course of the disease until a cure is found. We don’t yet have a vaccine for HCV, and to date we have invested limited resources in the development of one. Although there are challenges to overcome to develop an HCV vaccine, the mobilization of resources to develop COVID-19 vaccines is a model of inspiration for HCV vaccine advocates.
Health disparities and inequities in care need to be overcome
The social determinants of health—including racism, poverty, and access to healthcare and other services—had a dramatic impact on our COVID-19 outcomes. We know this is also the case for viral hepatitis, with the added barrier of stigma and criminalization of drug use that pushes people to the margins. If we want to eliminate viral hepatitis, we need more than just testing, vaccines, and medications: We need a fair and equitable system of healthcare delivery that people trust will be responsive to their needs in a non-judgmental manner.
Again, our response to COVID-19 was not perfect by any measure. That said, we did so much and we have had many victories that we can build upon to address viral hepatitis. Changing hearts and minds, and strengthening our political will, can help us overcome the failures in our COVID response. And it can certainly do the same for our response to viral hepatitis.