GUEST COLUMN: HEPATITIS NEEDN’T KILL
This World Hepatitis Day, on July 28, set off yet another year of grim diagnosis and treatment. An estimated 1.4 million people die each year in the world from Hepatitis B, about 4,000 a day, due to liver cirrhosis (shrunken hard liver) or liver cancer. This is a staggeringly high number, higher than the counts for HIV/ AIDS and tuberculosis combined. At 40 million, India has the maximum number of people infected with the hepatitis B virus (HBV), next only to China, 1-2 per cent of whom die.
This year, however, there is some silver lining to rejoice over. The Union ministry for health and family welfare has taken up the task of eradicating hepatitis on top priority. A full-scale National Viral Hepatitis Elimination Program has been launched, assuring free diagnosis and treatment for every hepatitis B and C patient. Not just at the Centre, the programme mandates the states too adopt it. A new web-based approach is on the cards, to facilitate the registration and treatment of infected people, ensuring anonymity.
Anonymity is important: millions of victims of this littleunderstood infection suffer wrenching discrimination. Testing positive for hepatitis B means one is infected—most likely for a lifetime—and can spread the virus to others through blood. This also means ruined dreams, hopes and aspirations. Often transmitted from an infected mother to a child, it can entail termination of jobs, broken marriages, forced abortions, imposed celibacy and social isolation.
Not just patients, doctors too do not escape the scourge, as exposure to hepatitis B from patients is an occupational hazard. Instead of being compensated, they are often marginalised. Truth is, today drugs can rapidly suppress HBV, making it safe for those who handle patients. It is the responsibility of the government and private hospital owners to vaccinate and confirm immunisation of all healthcare workers and waste handlers, and to treat them, in case they contract such infections. It’s hard to afford hepatitis B treatment—about Rs 8,000 for tests and Rs 12,000 for drugs a year, for a lifetime—without that support. We need greater resources and commitment for hepatitis B. It is time the government of India selects and aggressively treats the infected.
The biggest challenge lies elsewhere: how to find and treat the millions. The largest pool of hepatitis B is of blood relatives and spouses. For hepatitis C, a deadly blood-borne liver virus afflicting 8 million Indians, causing cirrhosis and liver cancer, we need to screen those who received blood or had major surgeries before 2001—when Indian blood banks started testing for HCV—or are on dialysis or are HIV positive. Sadly, hepatitis B or C positivity is equated with HIV positivity, and is a deterrent to voluntary testing. Indeed, those who test positive rarely disclose and take treatment, resulting in chronic and advanced conditions. The infected need to be protected by a civil rights law. Indians need to change their mindset, embrace and support the infected. ‘Empathy’ (Empowering People against Hepatitis), a public awareness initiative, was launched this July 28 by the Institute of Liver and Biliary Sciences along with the Airports Authority of India.
Drugs for hepatitis B and C are effective, safe and reasonably priced in India. Like the DOTS (Directly Observed Treatment, Short Course) centres for tuberculosis, HEP (Hepatitis Elimination Program) centres are needed for on-site diagnosis and drug dispensing. A blood drop with a needle prick can diagnose hepatitis B and C while doing blood sugar tests. Minimal training can enable frontline health workers, like ASHA, anganwadi and auxiliary nurse midwives (ANM) to treat hepatitis. We need a bottom-up approach. And we need preventive services: vaccinating all newborns as well as adults against hepatitis B and a pill a day to cure hepatitis C (Rs 6,000 per person for 12 weeks). Longer term, we need an antiviral pill to suppress hepatitis B, en route to elimination of the infection in the next five or six decades.
Until then, every Indian needs to repeat the mantra: ‘Healthy Liver, Healthy India’.
ANONYMITY IS IMPORTANT: MILLIONS OF VICTIMS OF THIS LITTLEUNDERSTOOD INFECTION SUFFER WRENCHING DISCRIMINATION