Snapshot from a revolution: ILC insights that caught my attention

The author (right), photographed while photographing Gottfried Hirnschall of the World Health Organization at an historic ILC session addressing the WHO viral hepatitis elimination targets.

Jeffrey Lazarus

Looking beyond the headlines

Not surprisingly, some of the biggest scientific news to come out of last week’s International Liver Congress (ILC) in Barcelona related to continuing progress on the hepatitis C treatment front. As a public health and health systems researcher, I was glad to see some ILC attendees calling attention to the larger context in which the direct-acting antiviral (DAA) revolution is unfolding.

Yes, from a biomedical standpoint, the DAA treatment regimens have given us the means to fully eliminate hepatitis C – a remarkable achievement on the part of scientists in this field. For those of us whose work addresses population health holistically, what else did the ILC have to offer?

These were some points that jumped out at me during the four-day meeting.

Thinking beyond direct-acting antiviral cure rates

Progress on the hepatitis C virus (HCV) treatment front is fantastic, but let’s not conflate this with progress toward eliminating HCV.

First, progress on the hepatitis C virus (HCV) treatment front is fantastic, but let’s not conflate this with progress toward eliminating HCV. At a meeting that addressed civil society efforts to drive progress toward HCV elimination, Rafael Bengoa of the University of Deusto aptly noted that no disease can be conquered through clinical advances alone.

The small number of diseases that have been fully or almost fully eliminated took on that status as a result of sound public health strategies and the commitment of significant financial resources.

Thinking beyond hepatitis C

Second, public attention to HCV is very much welcomed but we can’t let it overshadow the unmet health needs of people struggling with other forms of viral hepatitis. The hepatitis B virus (HBV) is imposing a greater burden of disease than HCV in some parts of the world.

There are also countries with seemingly well-resourced health systems but inexcusable gaps in viral hepatitis prevention.

For example, at a workshop that the European Association for the Study of the Liver and the World Hepatitis Alliance organized to discuss the readiness of countries worldwide to pursue the World Health Organization’s first-ever viral hepatitis elimination targets, Anna S. Lok of American Association for the Study of Liver Diseases noted that the United States has only 74% birth-dose HBV vaccine coverage.

Thinking beyond viral hepatitis

Pursuing the elimination of viral hepatitis is hardly the only way in which the field of hepatology can contribute to major population health gains.

Third, pursuing the elimination of viral hepatitis is hardly the only way in which the field of hepatology can contribute to major population health gains. Nick Sheron of the University of Southampton gave a forceful ILC presentation on alcohol-related harm and on the potential for policies such as minimum unit pricing and marketing regulation to have a real impact on this problem.

Professor Sheron discussed the very clear link between alcohol consumption and liver mortality in the European Union (EU) and explained how national alcohol policies are greatly driving trends in alcohol consumption.

He closed his talk with the striking assertion that if the EU countries with the highest levels of liver mortality could be brought in line with the average for EU countries, 14,000 deaths per year would be prevented. If all EU countries were to reduce liver mortality to the lowest level seen in the region, this would prevent 46,000 deaths per year.

In sum, the ILC provided some welcome reminders of the need for a broad swath of experts to focus intently on their own specific goals while also recognizing how and why the other pieces of the picture matter.

Useful link:

Joint Society Statement for Elimination of Viral Hepatitis

Hepatology, Medicine and Policy has launched with BioMed Central. For more information, visit: www.hmap.biomedcentral.com.