(Music)
[Thorpe] Welcome to Beyond the Data.
I am Dr. Phoebe Thorpe, and here with me today is Dr. Cowie
from the WHO Collaborating Center on viral Hepatitis
at the Doherty Institute.
Thank you so much for joining us.
[Cowie] It's a great pleasure.
Thank you.
[Thorpe] Our session today was about eliminating Hepatitis B
and C, diseases spread through contaminated blood and sex,
and we're working on eliminating them.
But it's a little bit different for Hepatitis B and C.
So let me ask you first about Hepatitis B. [Cowie] Sure.
[Thorpe] We have, it is transmitted most commonly
from mother to child or from child to child,
and we have a fabulous vaccine that prevents that.
What can we do to use that vaccine more?
[Cowie] Yeah, so look,
the vaccine is highly effective and very safe.
I think the scale up of vaccination,
infant vaccination particularly globally has been proceeding
in particularly in the Western Pacific region
where there's a very substantial burden of Hepatitis B. One
of the critical elements is to ensure
that we can get birth dose vaccinations,
so getting timely vaccination within 24 hours of birth
for all children especially those born to moms
who have Hep B. That requires some programmatic changes
because it's outside the usual delivery mechanisms
of the expanded programs for immunization.
But there's a lot of countries doing really well with this.
So that's one of the things we need to do.
There's also good evidence that Hepatitis B vaccine,
particularly the monovalent vaccine which is given at birth,
is incredibly stable at room temperature,
but it's still required to be in the cold chain
by the regulatory authorities of my most countries.
So doing some reform around the guidelines for the use
of Hepatitis B vaccine out of the cold chain
in what we call a control temperature chain.
Also really important to maximize uptake
of vaccine particularly in more rural or remote areas
where the cold chain presents some real challenges.
Particularly where the visits can't be scheduled
because obviously we don't know when the mom's going to go
into labor and give birth.
There's also some innovations in new vaccines
and so anything even something that's really good
like the Hep B vaccine can be improved.
There's been research on oral administration of vaccines
or transdermal administration of Hepatitis B vaccine
so that work needs to continue.
[Thorpe] And the other part for Hepatitis B is treating those
who have chronic infections
because it can lead to early death.
That's the problem with it if you get it when young.
[Cowie] Absolutely.
[Thorpe] What are the steps that we've been doing
to make treatment more available
and more people getting Hepatitis B treatment?
[Cowie] Yeah, so you're absolutely right.
The vaccine is going to address this issue in decades to come,
but there's still between 250 or 290 million people
in the world living with chronic Hepatitis B
for whom the vaccine unfortunately is not gonna make
any difference, so there's a number of things we need to do.
Most of those people, in fact more than 90 percent,
have no idea they've got Hepatitis B, so we really need
to scale up access to appropriate diagnosis
because people can't be treated unless we know they got Hep B.
So there's been some amazing work going on in a number
of countries around that.
Mongolia for instance, whose got a high prevalence
of both hepatitis B and Hepatitis C,
have set the objective to screen the entire adult population
for both of those conditions and are making huge strides
in actually diagnosing every adult in the country with Hep A
or Hep C to enable those treatment mechanisms to follow.
So for a low or middle income country,
it's an amazing commitment, and there are other sort
of champions of this as well.
So we need to get people diagnosed.
The treatments we have are very effective, but,
similar to HIV/AIDS, they need to be taken in an ongoing sense.
So as well as getting people on to treatment
and making sure those treatments are affordable,
we need to develop the mechanisms to make sure
that people can adhere to those medications and stick
with them for the long term.
And then finally what we need to do is as this just happened
for Hepatitis C, develop cures for Hepatitis B,
and there is a lot of work going into that right now.
[Thorpe] Speaking of Hepatitis C, there is a cure for it
and so getting cured or treated
for it is essential to eliminating it.
[Cowie] Absolutely.
[Thorpe] What is being done
to make sure people get treated for Hepatitis C?
[Cowie] Yeah, so look, these cures,
the direct acting antivirals,
these curative regimens are an absolute.
A breakthrough on a global scale taking a chronic disease
like Hepatitis C which is responsible
for so much morbidity or illness and death in countries
like the US and Australia
and in fact obviously globally it's this huge opportunity right
now to substantially address liver cancer,
the fastest increasing cause of cancer death here
in the United States and back home in Australia as well.
So again, people need to be diagnosed
in the first instance before these treatments can be given.
We need to make sure these treatments are as cheap
as possible, and that's been a real barrier in many countries.
There are ways of, with sort
of innovative financing solutions back home
in Australia.
These treatment courses cost less than $10,000 per course
to the government which is part
of it was a really strong negotiation that went on there
between the government and the pharmaceutical companies.
But, they are revolutionary in the space of 8
to 12 weeks being able to cure more than 95%
of people living with this condition.
It's an absolute opportunity now
and we can eliminate provided we keep a focus on prevention
at the same time we can treat our way toward elimination
of Hepatitis C not just in our lifetime
but in the next 10 years.
[Thorpe] Wow, in the next 10 years.
That's amazing to think about.
That we could eliminate Hepatitis C. I know here
in United States one of the concerns is the opioid epidemic
for Hepatitis C because it has led
to increase injection drug use and that increases your risk
for catching Hepatitis C. So can you tell me some of the things
that have been effective
in preventing and/or treating Hepatitis C
for injection drug use?
[Cowie] Yeah, so I think that prevention aspect is
so important, and having a human rights approach
to address the needs of people inject drugs is really really
important and a public health approach rather
than a punitive approach.
So things like needle and syringe programs,
things like opiate replacement therapy.
Needle and syringe programs are making sure
that people don't have to reuse syringes and needles,
is one of the most cost-effective interventions we
can do in the space.
It's cost-saving in fact.
And so, whilst we're turning off the tap so to speak.
So allowing, giving people access to the means
to prevent themselves
from acquiring these infections then we're able to scale
up treatment and the other point you made.
So amongst people who inject drugs, if we're able
to get the prevalence of Hepatitis C, so the viral pools,
so to speak, down similar to what's been done
for HIV is treatment is prevention.
Then even amongst those who where there is reuse
of needles it'll prevent the transmission so sort
of like a hood treatment effect if you like.
And as a consequence if we're able to access
that priority population and to make treatment
for Hepatitis C something that is not just acceptable
but profoundly encouraged from a public health point
of view then we will see Hep C transmission just plummet.
[Thorpe] Yeah, so there will be less around.
[Cowie] Less Hep C. Less treatment needed
in the long-term.
Substantially less treatment
because we're preventing as well as treating.
[Thorpe] Yes.
In today's session we did hear some about what's being done
in San Francisco, and New Mexico, and obviously
in Australia where you're from.
Can you tell us what's being done globally
to eliminate these diseases?
[Cowie] Yeah, so that now, I mean for a long time
on the international scale you could barely see anything
about viral Hepatitis with the exception of vaccination
for Hepatitis B. At the WHO level there wasn't an office
that dealt primarily with viral Hepatitis until this decade.
So it's been a long time coming.
Some of the real successes for HIV and TB
and malaria control have been having
that global concerted action and clear policies
for countries to follow.
How to adapt into their local health system,
but critically also there has been resourcing things
like the global fund for HIV, TB, and malaria.
The mortality of those conditions has been dropping
since the early 2000's with that concerted political effort
and adequate resourcing.
And so, I think the contrast with viral Hepatitis
where the burden continues to rise year in,
year out is pretty stark.
So we've now got the strategies both globally,
and at the regional level, and at national levels increasingly.
We've got the will certainly most affected communities,
and I think that's the other key missing element here.
Really fundamental to HIV programs here in the USA
and globally has been meaningful collaboration
with in fact leadership by people living with HIV/AIDS.
We yet to see that happen to viral Hepatitis
and that's an urgent priority so that we can match
that strategic guidance with these amazing tools.
We've got vaccinations for Hep B, treatment for both Hep A
and two of Hepatitis C, with the sort of community engagement
and mobilization that was really instrumental
in the HIV response.
[Thorpe] Yeah, it was.
It was amazing, and it's a very important part
to have the people who are affected working on making...
[Cowie] ...at the forefront.
[Thorpe] Exactly.
[Cowie] At the forefront of the response.
[Thorpe] If other people wanted to know where to go to find
out some more information, where where would you direct them?
[Cowie] Yeah, so that there is increasing resources available,
so the World Health Organization websites both globally
and at the regional level have a lot of information.
Some of the resources that I have been talking about.
Also, the World Hepatitis Alliance which is an alliance
of community organizations from around the world has a lot
of resources from that sort of community mobilization and sort
of resorting point of view.
And you know the U.S., CDC here the Centers
for Disease Control website has a lot of resources both
for the public and also for clinicians
around viral Hepatitis both from a policy
and a clinical perspective so those are just some of the areas
that you can go and start your exploration of viral Hepatitis.
[Thorpe] Yes, so we can together work to eliminate Hepatitis B
and C. [Cowie] It's totally possible and so,
therefore, it's necessary.
We just have to do it.
[Thorpe] Yeah.
Thank you so much for joining us.
[Cowie] Thank you Phoebe.
It's been a great pleasure.
[Thorpe] And thank you so much for joining us.
See you next time for Beyond the Data.