Around 300 million new cases of Hepatitis B virus (HBV) are diagnosed annually across the globe — of these, more than 75% of the cases are found in Asia (specifically South and South East Asia), with low-income communities often being impacted the most.
Hepatitis B is caused by a virus belonging to a family of Hepadnaviridae viruses and can result in long-term liver damage, cirrhosis (liver scarring) and liver cancer in patients. The virus comes in both acute and chronic forms. Four out of five cases are acute and patients can recover within a few months. However, chronic Hepatitis B is a long term condition and currently has no cure.
The increasing prevalence of the Hepatitis B virus in South and South East Asia can be attributed to a variety of socioeconomic factors including insufficient public awareness of risk factors and the modes of transmission in these impacted areas. According to UNICEF, only about 26 million children in South Asia consistently have access to primary and secondary school education — about 69% of the population of children. Furthermore, approximately 81% of girls never step foot in a school.
The limited access to a quality education plays a significant role in the spread of Hepatitis B. Populations in these regions are often unequally educated on how the disease is spread — through contact with bodily fluids or via birth. This lack of education — combined with common cultural practices, such as clubbing or acupuncture, in which needles and medical equipment are shared from person to person — has fostered an environment for the escalation of the disease in recent years. Even in medical settings, such as hospitals, Hepatitis B is still transmitted through infected blood products and reused needles.
Chronic Hepatitis B is known as a ‘silent killer’ — by the time that symptoms, such as abdominal pain or distension appear, it is often too late to get treatment. Once the virus enters the body, it can take years or even decades for symptoms such as cirrhosis and liver cancer to present themselves. By then, these secondary diseases become difficult to treat and have a high impact on an individual’s quality of life.
While blood tests and liver biopsies can catch the Hepatitis B virus early on, external societal stigmas present in South and Southeast Asia often prevent individuals from getting diagnosed or even treated.
A study conducted by Dr. Jayne Smith-Palmer, a Swiss health economist at Ossian Health Consultancy, found that among patients living with Hepatitis B, a large portion perceived structural or institutional stigma: 20% of patients believed that they would be denied healthcare and 30% stated that they experienced workplace discriminnation due to Hepatitis B.
Another study conducted by Dr. Min-Jin Kim, an assistant professor at the University of Cincinnati, found that there is a large misconception amongst Asians that Hepatitis B was a genetic disease. Because a positive outcome could lead to discrimination or outcasting by their family and society, many individuals are unwilling to get tested for Hepatitis B.
Furthermore, while an effective Hepatitis B vaccine has been introduced to all affected countries in Asia, it has proven to be unsustainable thus far. For example, in India, the country with the largest birth cohort in the world, the government has yet to introduce vaccine coverage to rural or remote regions of the country — where it is needed the most. However, even in regions that the vaccine is available, it is too expensive for the average consumer to afford.
Despite all of these internal and external factors, joint efforts are being made by South Asian and Southeast Asian governments to curb the spread of this deadly disease. For example, in 2015, the Coalition to Eradicate Viral Hepatitis in Asia Pacific (CEVHAP) gathered leading hepatitis experts from Bangladesh, India, Indonesia, Malaysia, Pakistan, the Philippines and Thailand to identify the common challenges posed by Hepatitis B and to discuss new sustainable approaches.
The meeting resulted in a commitment to a joint national strategy by 26 Asian countries. Taiwan, a country with a well-developed clinical infrastructure for hepatitis, was used as a case study and framework.
Additionally, new, more affordable vaccines have been developed to provide better outreach to individuals in low-income communities. In fact, developers have been able to reduce the cost of a universal Hepatitis B vaccination by 58%. This has already allowed Asian countries like Vietnam, whose governmental funds are limited, to distribute vaccines to a larger portion of its population.
“This is one of those rare cases where the intervention actually can save money over the long run and improves people’s quality of life,” said Dr. David Hutton, associate professor of health management and policy at the University of Michigan’s School of Public Health. “Over the long run, if you’re going to prevent cirrhosis or liver cancer, and the need for liver transplants — those can get very, very expensive — you’re going to save money and improve people’s lives.”