World Hepatitis Day 2025: elimination at a critical juncture

Complementing the WHO report, two new Health Policy papers that gather data on elimination efforts from 33 key countries and territories in 2024 show that progress has been made in putting policies and programmes in place, and some countries had met or were on track to meet some of the WHO elimination targets. However, no countries were on track to eliminate hepatitis B as a public health problem by 2030, and, for hepatitis C, only Egypt had been validated as achieving WHO’s gold tier for the path to elimination, although several other countries (Australia, Georgia, and Spain) looked on track to achieve the silver tier.

Funding for viral hepatitis has long been a problem, with limited support from major global donors; indeed, it is only in the past year that Gavi, the Vaccine Alliance, have resumed support for roll-out of hepatitis B birth-dose vaccination. Thus, at the point where a stimulus is needed to alter the trajectory of progress towards elimination of viral hepatitis, recent reductions in funding for global health could not have come at a worse time. Alongside the chaos caused by the unravelling of US Government support, there are alarming signs that other countries are also retreating from global health. For instance, Gavi’s recent replenishment fell short of its US$11·9 billion target not only because of a withdrawal of US funding, but also due to reduced pledges from key funders such as the UK and Norway. The withdrawal of US support for WHO could also have knock-on effects on WHO’s ability to help to steer the response to viral hepatitis: cuts to funding have resulted in the merging of the department of HIV, hepatitis, and sexually transmitted infections with that of tuberculosis, under new leadership, at a time when a loss of momentum through restructuring and the setting of new priorities can be ill-afforded.

Although the withdrawal of aid could push leaders in low-income and middle-income countries (LMICs) to implement changes that reduce aid dependency in the long run, the brutal way in which cuts have been enacted has had an immediate, catastrophic impact and left an air of uncertainty. To this end, WHO has recently issued operational guidance to help to sustain priority services, and efforts are already being made to plug some of the gaps left by declines in funding—eg, the Africa Centres for Disease Control and Prevention, together with the World Hepatitis Alliance and the African Viral Hepatitis Action Group, recently announced the development of a capacity-building programme for hepatitis elimination and advocacy in Africa. But time is needed for countries to rethink priorities, reallocate resources, and plan for the future. Dedicated domestic funding will be necessary, and difficult choices must be made. A balance should be found to support both prevention (including harm reduction) and testing and treatment programmes, and governments might have to decided whether to focus on key populations or broader integration of services. Although challenging, integrating viral hepatitis services with those for HIV and non-communicable diseases (eg, liver cancer, metabolic liver disease), where there are clear synergies to be exploited, would offer a welcome opportunity to break out of the disease-specific siloes that have long hindered progress.

With events seemingly erecting new obstacles to elimination, the theme of this year’s World Hepatitis Day—”let’s break it down”, calling for urgent action to dismantle the financial, social, and systemic barriers to elimination—could not be more apt. But there are reasons to remain hopeful. Some of the effects of US cuts are being undone—hundreds of employees laid off at the US Centers for Disease Control and Prevention (including in the viral hepatitis lab) have had their jobs reinstated, for example. And headway is still being made: work progresses towards a functional cure for hepatitis B, and the launch of a new centre for real-world research in hepatitis B in LMICs, with philanthropic funding from a foundation not previously involved with viral hepatitis, is a welcome development. We cannot afford to fall into despondency; all stakeholders must pull together to ensure that efforts towards viral hepatitis elimination are not allowed to backslide further.