What is viral hepatitis elimination about?
Key points
Section titled “Key points”- People in prison have a disproportionately high burden of viral hepatitis and as part of WHO’s global strategy for the elimination of hepatitis, this setting has been highlighted as a priority.
- Access to viral hepatitis prevention and control services in prisons, including vaccination, harm reduction, testing and treatment, remains generally low compared to community settings with variation across countries.
- Implementing and scaling up viral hepatitis services in prison settings is crucial for testing and treating individuals with hepatitis B and C.
- The elimination of viral hepatitis in prisons will prevent the possibility of further onward transmission when individuals re-enter the community, benefiting community health
- Efforts towards the elimination of viral hepatitis in prisons should be embedded in national planning to minimise the heterogeneity across prisons in one country.
Chronic viral hepatitis, caused by HBV and HCV, is a global concern targeted for elimination under the UN’s Sustainable Development Goals and WHO’s plan to eliminate viral hepatitis as a global public health threat by 2030).
The WHO elimination plan aims to reduce new chronic infections of hepatitis B and C by 90% and hepatitis-related deaths by 65% (WHO, 2023).
Globally, few countries are on track to meet WHO targets and there is an urgent need for governments to more adequately respond and for services to be scaled up if the 2030 hepatitis elimination targets are to be reached.
The WHO’s European action plan 2020–2025 – ‘United Action for Better Health’, backed by 53 member states, sets even higher goals for the region, recognising the existing systems and prevention efforts in place.
Prioritising viral hepatitis elimination is also in line with the European Commission’s ‘Beating Cancer Plan’, which recommends a focus on strengthening services related to the prevention and control of viral hepatitis to reduce liver cancer. Furthermore, the recent European Council Recommendation (C/2024/4259) on vaccine-preventable cancers, advocates for a strengthening of national efforts to reach the elimination targets including greater attention for scaling up vaccination services for target groups including people who inject drugs and people in prison.
Despite this renewed recognition and focus, most EU/EEA countries are not on track to meet the elimination goals (ECDC, 2024a; EMCDDA, 2023) and a large number of cases of chronic hepatitis C and B remain undiagnosed in the community and are not linked to care, while access to prevention and harm reduction services in many countries is sub-optimal.
Strategies to meet the hepatitis elimination targets in the community also need to address viral hepatitis in prisons, as shown by studies looking at hepatitis C transmission following prison release (Stone J, 2017). The prison setting therefore plays a crucial role in achieving the WHO elimination targets.
The widespread availability of fast-acting, highly efficacious direct-acting antiviral (DAA) therapies for the treatment of hepatitis C, as well as effective vaccination and antiviral treatment for hepatitis B, offer a great opportunity to reduce the burden of viral hepatitis in the prison setting and contribute towards a country’s ability to meet the WHO elimination targets (WHO, 2023).
Not incorporating the prison population, a key population group disproportionately affected by hepatitis, within the broader elimination efforts could undermine efforts to achieve elimination, and further drive societal inequalities.