States must act against viral hepatitis now to eliminate the ongoing epidemic by 2030


As the United States enters its third year in the fight against COVID-19, Americans have seen firsthand the importance of a strong, comprehensive response to public health emergencies and disease outbreaks. The same goes for chronic viral hepatitis, a condition that affects approximately 3.3 million Americans. Without comprehensive plans to eliminate viral hepatitis, the United States will fall short of the World Health Organization (WHO) goal of completely eliminating the virus by 2030. We call on policymakers at the states to advance comprehensive and equity-focused proposals that adequately address and achieve the WHO goal of eliminating viral hepatitis by 2030.

Viral hepatitis is an infection that can cause severe liver disease, liver cancer and death, and is rightly considered a serious threat to public health. Hepatitis B and C, the most common types of viral hepatitis in the United States, can be spread through contact with an infected person’s blood and can cause acute and chronic infection. All forms of viral hepatitis are largely preventable through immunizationsterile supplies for injecting drugs, test, processing, and funding programs that improve access to and awareness of these measures. Addressing the viral hepatitis epidemic also requires coordination among partners at the federal, state, and local levels, as well as with community organizations and advocacy groups, to ensure that the needs of all people living with hepatitis are satisfied.

Despite vaccines that protect against hepatitis A and B and highly cost-effective treatments that cure hepatitis C in 95% of cases, we are losing ground in the fight against viral hepatitis. New infections have increased due to the ongoing opioid epidemicwhile levels of hepatitis C treatment declined worryingly between 2014 and 2020, according to recently published data from the Centers for Disease Control and Prevention (CDC). Many people are unaware they are living with the virus due to a lack of testing. And longstanding barriers to accessing treatment for people of color, people who use drugs, people incarcerated, and other vulnerable populations continue to exacerbate health inequities and stigma around the disease.

Now is the time for state policymakers to act. While a roadmap for elimination of viral hepatitis exists at the federal level, each state’s health departments must develop their own plans to address their unique circumstances. All states that receive funding for viral hepatitis surveillance and prevention should develop comprehensive, system-wide strategies to improve their ability to prevent, diagnose, and link to care for viral hepatitis.

Hepatitis elimination: a national assessment of states’ capacity to eliminate viral hepatitis is the first ranking system to date to assess states’ ability to eliminate viral hepatitis. Based on a rating scale developed in consultation with over 40 stakeholders, including advocates, clinicians, government partners and people with lived experience of viral hepatitis, Hep Elimination is an advocacy tool to raise awareness among policy makers, public health agencies and communities. on a wide range of key elimination considerations.

Hep EliminatiNATION assesses the policy landscape and programmatic strategies impacting the elimination of viral hepatitis in all 50 states, Washington, DC, and Puerto Rico. When released, Hep Elimination gave six jurisdictions an “A” rating based on their current ability to eliminate hepatitis: California, Indiana, Louisiana, Michigan, New York, and Washington State. Going forward, the platform will offer guidance and a toolkit for states’ ongoing efforts to develop viral hepatitis elimination strategies.

Multiple states have released disposal plans since early 2019, including in New York, Michigan, Indiana, Hawaii, Louisiana and Washington. State plans address critical issues that impact a state’s ability to address viral hepatitis, including the legality of needle service programs; specific budgetary allocations for the elimination of viral hepatitis; training and education programs; access to treatment for state Medicaid recipients; and attention to health disparities and inequalities, among other important elements.

Beyond comprehensive disposal plans, states across the country are redouble efforts to remove barriers to treatment access, especially for Medicaid recipients who are often the most vulnerable populations. These barriers include eliminating liver damage, sobriety, and prescriber requirements for access to treatment. As of January 2022, 11 states have removed prior authorizations for hepatitis C treatment.

New progress in jurisdictions will compel Congress to invest more in eliminating viral hepatitis through relevant agencies, including the CDC, Health Resources and Services Administration, Indian Health Services, and Substance Abuse and Mental Health Services Administration. Consistent with model federal commitments to end the HIV epidemic and the overdose crisis, such resources can strengthen jurisdictions’ ability to eliminate viral hepatitis through targeted infusions of resources for evidence-based strategies. evidence, including full and equitable implementation of federal hepatitis guidelines. vaccination B and for screening for hepatitis B and C.

As representatives of political and advocacy organizations actively working to eliminate viral hepatitis, we urge state decision makers to respond comprehensively to the viral hepatitis epidemic with actions commensurate with its magnitude. Along with the ability to apply lessons learned from the COVID-19 pandemic, we encourage jurisdictions to use elimination of hepatitis as a guide in developing or improving their viral hepatitis elimination plans. We owe it to the millions of people living with hepatitis to fully fund programs that prevent, detect and eliminate preventable disease.

Author’s note

The National Roundtable on Viral Hepatitis, the O’Neill Institute for National and Global Health Law, and the Center for Health Law and Policy Innovation are all involved in viral hepatitis advocacy and policy space.


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