Vaccine hesitancy, budgetary constraints hinder hepatitis control in the Philippines
Overcoming budgetary constraints and addressing vaccine hesitancy are among the key challenges in hepatitis control in the Philippines, according to the Department of Health (DOH).
“Currently, budgetary funding is insufficient for the prevention and treatment of hepatitis,” said the DOH when asked for specific challenges or barriers to hepatitis prevention and treatment in the Philippines.
“Vaccine hesitancy is also identified as one of the bottlenecks in hepatitis,” the Health Department, led by DOH Secretary Teodoro Herbosa, added.
The DOH said it is lobbying for fund augmentation for the 2025 budget.
“Further, the DOH together with other organizations is intensifying health promotion and education through information dissemination to increase the vaccination uptake,” the agency said.
Hepatitis in the Philippines
With millions of people affected by the disease, hepatitis remains a “significant public health problem” globally and in the Philippines, according to DOH.
The DOH explained that it uses “screening test data” to understand the prevalence of hepatitis in the Philippines.
“Current test design and protocols are limited, which requires careful interpretation of the numbers,” DOH said. “Best available data in 2023 show around 60,500 Filipinos reactive to Hepatitis B, with around 4,000 Filipinos reactive to Hepatitis C,” it added.
DOH noted that in 2020, liver diseases accounted for 27.3 cases per 1,000 deaths, of which five percent were from Viral Hepatitis. As such, one out of 20 liver-related deaths are due to Viral Hepatitis.
“The main types of Viral Hepatitis prevalent in the Philippines are Hepatitis B and Hepatitis C,” DOH said.
Despite Viral Hepatitis being highly preventable and treatable, DOH noted that one out of 10 Filipinos, or around 10 million nationwide are affected by Chronic Hepatitis B while six out of 1,000 Filipinos are affected by Hepatitis C.
“If we extrapolate the estimates in our Strengthening Integrated Treatment and Care for Hepatitis (STITCH) project pilot implementation site, Tarlac, the numbers indicate approximately 155,000 with Hepatitis B and 6,000 with Hepatitis C,” the DOH said.
“Many of those infected do not know they have it. One of the challenges therefore is to find the infected so they can be linked to care,” it added.
Citing a global study, DOH said: “If the status quo is maintained – that is, we see no action done to improve the cascade of care for viral hepatitis - it is projected to kill more people annually than malaria, tuberculosis and HIV/ AIDS combined by 2040.”
Symptoms, diagnosis, and treatment options
DOH noted that in the Philippines, although estimates vary, more than 10 million people are estimated to have hepatitis B, and close to half a million have Hepatitis C.
The symptoms of Hepatitis B, according to DOH, include weakness, stomach upset, dark urine or very pale stools, and jaundice.
People who suffer from Hepatitis C, on the other hand, may experience headache, nausea, vomiting, abdominal pain, jaundice or the skin turns yellow, weakness and fatigue, dark yellow urine, light-colored stools, and yellowish eyes.
For Hepatitis B, DOH said Surface Antigen (HBSAG), a protein on the surface of the Hepatitis B virus, is used for diagnosis.
“It can be detected in the blood during acute or chronic Hepatitis B virus infection. The body normally produces antibodies to HBSAG as part of the normal immune response to infection,” DOH said.
The DOH explained that Hepatitis B Surface Antibody (anti-hbs), an antibody that is produced by the body in response to the Hepatitis B surface antigen, is also used for diagnosis.
Other diagnoses for the disease include Total Hepatitis B Core Antibody (anti-hbc) which is an antibody that is produced by the body in response to a part of the Hepatitis B virus called the “core antigen.” The meaning of this test, DOH explained, “often depends on the results of two other tests, anti-hbs and HBSAG.”
Other options include IGM Antibody to Hepatitis B Core Antigen (IGM antiHBC) which is used to detect an acute infection; Hepatitis B “e” Antigen (HBEAG), a protein found in the blood when the Hepatitis B virus is present during an active Hepatitis B virus infection; Hepatitis B e Antibody (HBEAB or anti-hbe) which is an antibody that is produced by the body in response to the Hepatitis B “e” antigen; and Hepatitis B Viral DNA which refers to a test to detect the presence of Hepatitis B virus DNA in a person’s blood.
DOH said “there are now newer medications developed” to treat Hepatitis B and C.
“Patients are encouraged to visit their nearest hepatologist clinic regarding this matter,” it added.
Battling hepatitis
Despite the challenges faced in battling hepatitis, DOH said there have been efforts by the government and various organizations to address the disease.
“Our programs, including Viral Hepatitis, are implemented under various pillars of the Eight Point Action Agenda of the Department of Health,” DOH said.
“Our current public health strategy and approach is anchored with the Triple Elimination Initiative, or the Triple Disease Elimination Framework on mother-to-child transmission (MTCT) of HIV, syphilis and hepatitis B virus (HBV),” it added.
Asked to provide any specific prevention strategies or vaccination programs for hepatitis in the Philippines, DOH said it implements public health strategies and interventions for special populations across a life-stage approach including all newborn infants, women who are of childbearing age, persons living with HIV (PLHIV), sex workers, persons who use drugs (PWUD), persons who inject drugs (PWID), males having sex with males (MSM), and other persons at high risk as may be identified by its Hepatitis Technical Expert Group.
DOH said it also focuses and allots the “bigger pie” of its resources for prevention.
The agency needs to implement compulsory immunization under Section 2 of Republic Act No. 7846 which mandates the inclusion of Hepatitis-b immunization in the basic immunization services for infants and children below eight years old in the Philippines, with a specific provision for newborns of Hepatitis-b positive mothers to receive immediate immunization within 24 hours after birth.
“This law aims to protect infants and children from the Hepatitis-b virus, which can cause liver disease and other serious health complications,” DOH said.
As mandated under Republic Act No. 10526, the DOH said the DOH is implementing a comprehensive public education and awareness program on Liver Cancer and Hepatitis through interagency and multisectoral efforts as led by the Health Promotion Bureau (HPB) and the Disease Prevention and Control Bureau (DPCB).
Aside from these, DOH said there are various initiatives by the government and organizations to address hepatitis in the Philippines. For monitoring, DOH said Acute Viral Hepatitis was included as a notifiable disease under Republic Act No. 11332 and DOH Administrative Order No. 2021-0057.
“The Acute Viral Hepatitis surveillance shall be strengthened in all regions and health facilities to ensure timely case detection, registration, reporting, laboratory testing, analysis, interpretation, and report generation and dissemination,” DOH said.
There is also the DOH Full Devolution Transition Plan effectively devolved screening and testing to local government units (LGUS) last 2023.
Moreover, DOH said it procures Hepatitis B and Hepatitis C medicines, and “recently redistributed proportionally to all regions or those with requests” — prioritizing allocation in focus regions including Metro Manila, Central Luzon, Central Visayas, and Davao Region, as well as selected priority regions as agreed by the Hepatitis Technical Expert Group.
DOH said it also submitted to the Department of Budget and Management (DBM) for inclusion in the National Expenditure Program the projected forward estimates, requesting the approval of the allotted budget for Viral Hepatitis and other related commodities and services amounting to ₱125 million for the fiscal year 2025.