Tomorrow is World Hepatitis Day. Rippling with excitement? Juddering with enthusiasm?
It depends on who you are, I guess. To the ordinary human this… event? observance? is unlikely to generate much interest. Even, possibly, a vague queasiness…
After all, hepatitis has never had the avant-garde mystique of tuberculosis… once seen as a disease of artists, or even leukaemia which, I distinctly recall, had a certain cachet late last century. Both these diseases left the victim wasted, waifish, pale and gothic. I remember the reverential terms with which a cousin of mine described my mother, when he visited her in a TB sanatorium before my birth. She was angelic. Like a thing from another world. Her skin the white of her sheets. I still don’t think I’ve seen a more beautiful woman.
No such poetry with hepatitis. You turn yellow, not white. And it’s gastrointestinal.
World Hepatitis Day (hereafter WHD) is primarily a thing for those who work with the disease and its victims – whether directly, or on a policy front. The health-workers, the advocates, the strategists, the politicians, the modern-day alchemists and their business managers …
For these people it’s a day to assess what has passed, to be mindful of the future, to shout out loud about what they’re doing, and to make World Hepatitis Day resolutions.
For many who carry the disease, any sort of increased awareness may amount to torture. But there are others carrying virus (knowingly or not) who really do need to raise their level of awareness, for their own safety and that of others. A designated event like World Hepatitis Day (hereafter WHD) provides a platform for outreach, and events are often held to attract people into settings where they may be educated about transmission and treatment.
The World Health Organisation (WHO) is the public health arm of the United Nations. In 2010 they ‘resolved’ that July 28 should ever after bear the moniker ‘World Hepatitis Day’. It is, to quote, an opportunity for education and (for the fostering of a) greater understanding of viral hepatitis as a global public health problem.
Principally, the day is intended to remind the nations of the world that their prevention and control measures require strengthening. Hepatitis, in the sum of its forms ‘is one of the most prevalent and serious infectious conditions’ on Earth. It is therefore an obvious concern that ‘many people – including health policy makers – remain unaware of its staggering toll on global health‘.
Of course, when they refer to hepatitis, they are grouping six or seven rather different virus types by a single point of similarity: the taste for human liver.
In times gone by, Hepatitis A (with its faecal transmission route and its 1.4 million victims a year) or Hepatitis B (which has infected about a third of the world’s population at one point in their lives) would have taken centre stage on something like WHD. But year by year, Hep C has stolen more of the limelight – and currently it is the glamour child of viral hepatitis.
After all, as I have written previously, it is now considered the most deadly infectious disease in the USA. Not only this, but, using techniques indistinguishable from magic, scientists have developed fantastically reliable cures which, in many parts of the world, are presently being rolled out – leaving in their wake thousands of grateful humans with changed lives.
Before our eyes, a disease that has harrowed us for decades is being trammelled into the earth. And, to my mind, that’s the news that’s fit to print when it comes to Hepatitis – and why Hep C should be well and truly centre stage.
The cure has been a long time coming – long years of plodding development seem to have converged as suddenly a lightning flash. The last few years have been break-out years for Hep C treatment, no doubt. The ultimate solution appears to be congealing before our very eyes – and it is no surprise that the complete elimination of the disease is already on people’s minds
Among the events surrounding WHD, Melanie Eagle (CEO Hepatitis Victoria) delivered a speech entitled Mobilisation for Elimination.
I only have her power-point presentation to go by, but I will attempt to use it as a vague guide to how people working in the sector are thinking. Melanie appears to unpack the process by which the cure came to Australia, and then looks forward to what remains to be done. The administrative structure for treatment has been set in place (with the exception perhaps of fully bringing GPs into the fold) and the first wave is being treated – but the truly hard part is still to come and Melanie is very aware of it.
She offers ‘people power’ as a possible means of crossing the last few yards towards the elimination of HCV in our country. But here lies the rub. Because of Hep C’s association with intravenous drug use, the illegality of that drug use and the attendant criminality, the kind of people involved may be a little harder to wrangle than average. Grass roots movements work best when they’re organic rather than manufactured, and performers dressed as bright healthy livers may not gain traction with hardened users.
To my mind, this next step towards elimination of the disease is the most important thing we could speak about on this WHD.
Without delving too deeply into the issues right here, I’ll just say that I believe drug peer organisations like Harm Reduction Victoria seem most well placed to deliver, or at least oversee, the final push. They are unique in having close contact with the demographic that will likely prove hardest to treat, and are already encouraging that demographic to be tested, to seek treatment, and (of course) to employ safe using practices. It may be a very frustrating road ahead, and HRVic will be able to provide realistic street-level information to legislators and administrators to assist them in negotiating it.
As for what has been achieved thus far – I believe it deserves to be celebrated.
Australia still remains part of only a handful of countries whose citizens have free access to the new drugs – and this is no small thing. It was brought to be by a vast amount of work across the sector, and these efforts should be honoured.
But still the hardest part is yet to come. In her presentation, Melanie used this image to characterise it.
To my mind, it’s an accurate representation of the trials ahead.
As for the day itself… it’s been preceded by a week of events arranged by Hepatitis Victoria, and subsequently will evolve into the LIVERability Festival
I’ll conclude with the words of the World Health Organisation itself:
Every action is an action towards elimination of viral hepatitis
This year sees the first ever World Health Organisation’s Global Strategy for Viral Hepatitis, which sets a goal of eliminating viral hepatitis as a public health threat by 2030.
Let’s join together on World Hepatitis Day (28 July) to make the elimination of viral hepatitis our next greatest achievement.
The Golden Phaeton