From Science to Solidarity: Beating Hepatitis the ‘Silent Killer’

Why is Hepatitis known as a silent killer?

Catarina: Hepatitis is actually a generic term for inflammation of the liver. It’s known as a killer because, if they are left untreated, the viruses that cause Hepatitis B and C can lead to cirrhosis and liver cancer. It’s the leading cause of liver cancer worldwide.
It is silent because most people have no symptoms until the disease is advanced. There are actually four types of Hepatitis: A, B, C, D. Hepatitis A is a mild illness. But B and C are the viruses we need to prevent, diagnose and treat. Hepatitis D develops only in people who already have Hepatitis B. WHO believes more than 300 million people worldwide have Hepatitis B or C. Of these around 252 million are unaware of their infection – when you consider the population of the US is 340 million people, that gives you an idea of the scale of the problem.

Can Hepatitis be treated or prevented?

Catarina: Yes. There is a cure for Hepatitis C. It takes 12 weeks to be fully clear of the virus by taking a course of antiviral drugs. Hepatitis B cannot be totally cured but a course of drugs such as Tenofovir, Entecavir and TAF reduces the risk of liver cancer and cirrhosis significantly. The Hepatitis B vaccine can prevent the virus at any point in life from birth onwards. If a pregnant woman gets vaccinated she can also pass on that protection to her unborn child (though a baby still needs vaccinating for guaranteed protection). There is no vaccine for Hepatitis C.

The really good news is that diagnosis and treatment for Hepatitis C is becoming simpler and more affordable. In terms of diagnosis, WHO pre-qualified last year the first self test, while for treatment, there are new Hepatitis C medicines, (pan-genotypic direct-acting antivirals, DAAs) that can treat all types of the virus by stopping it from spreading in the body – many of which are more affordable even in low-income settings. This wasn’t always the case.

Until 2012, a person with Hepatitis C would most likely go on to develop liver cirrhosis and potentially liver cancer over a course of years. Thankfully, that needn’t be true today. However, while access to Hepatitis C treatment is improving, it remains limited. Of the 50 million people living with Hepatitis C infection globally in 2022, an estimated 36% people knew their diagnosis, and of those diagnosed with chronic Hepatitis C infection, around 20% (12.5 million) people had been treated with direct-acting antivirals by the end of 2022.

If there is a vaccine and a cure, why do so many people have the virus?

Catarina: There are several reasons. They come down to: awareness, access, affordability and stigma.

Getting a timely diagnosis is a huge challenge and a barrier to treatment.

At present the diagnosis for Hepatitis C takes place in two steps and this often leads to delays, and results in people being ‘lost’ in the system. For a lot of people living far from a city or a major health facility a vaccine, a diagnosis and access to treatment isn’t an option.

Innovative new one-step diagnostic tests are in the pipeline and we would expect to see more people being successfully diagnosed as a result of this more efficient protocol.

Finally, there is the shame, stigma and fear of having a virus that can be passed on to other people. People fear they won’t be treated with respect. Shaibu Issa, a health advocate from Tanzania, for example has spoken  about the fact that even a hospital doctor refused to touch him after his Hepatitis B diagnosis. In sum, it is a reflection of health inequity. Around 12 countries in the world account for 8 out of 10 Hepatitis cases. WHO wants to change that, and we want to help them.

What is the WHO Foundation doing about it?

Catarina: We are working closely with WHO to mobilize more resources to improve access to diagnosis, treatment and prevention for Hepatitis B and C. There is so much potential here. The aim is for 9 out of 10 people with Hepatitis B and C to be diagnosed and 8 out of 10 of those to be treated. If this is achieved, we would expect to see more than 2 million fewer cases of liver cancer by 2030. Not only are drug treatments becoming more affordable but there are options for diagnosis that mean people living far from a health facility can potentially test themselves for the virus.

Since 2015, WHO has created and regularly updated guidelines for HBV and HCV prevention, testing, treatment, care and service delivery, based on public health principles. Awareness is the first step to saving lives. People need to know whether they have the virus, then they need to know what to do, and finally, of course, they need to be able to access vaccines and treatment.

We have come so far in the past 20 years. I really believe it is one illness where the tide can be turned. We have the vaccines, we have the diagnosis and the drugs, we have the expertise at WHO.

We need financial support, and the political will to roll out the programs. Raising awareness of both the needs and the solutions is the first step to breaking down the barriers to beating Hepatitis for good.

Preventing 9.5 million new infections

The WHO Foundation is supporting WHO to raise funding for a 5-year program to scale up access to diagnosis and treatment services for Hepatitis B and C in seven countries: Cambodia, Cameroon, Indonesia, Pakistan, South Africa, Uganda, and Vietnam

When fully implemented the program aims to:
Prevent 9.5 million new infections.

Avert 2.1 million cases of liver cancer.

The long-term goal by 2050 is to prevent 53 million infections, 15 million cancer cases, and save 23 million lives.

Contact Caterina Mastellaro: c.mastellaro@who.foundation for more details of the program.

Read about WHO’s World Hepatitis Day Campaign 2025.