We, African medical experts in liver diseases, involved in the diagnosis, prevention, treatment and care of Hepatitis B & C in Africa, meeting on the occasion of the Second Hepatitis B and C - The African Experience Exchange Conference, in Mauritius from 2nd - 4th April 2009;
CONCERNED about the increasing burden of hepatitis B and C virus infections, cirrhosis and liver cancer in Africa;
AWARE that some African countries are making various efforts to improve access to diagnosis, prevention, treatment and care of hepatitis B and C virus infections and their sequelae but that these efforts still remain limited and costly;
RECALLING that African leaders have made commitments as contained in the Abuja Declaration and Plan of Action on Roll-Back-Malaria of April 2000, the Abuja Declaration and Plan of Action on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases of April 2001 both of which were reaffirmed in the Maputo Declaration on Malaria, HIV/AIDS, Tuberculosis and Other Related Infectious Diseases in July 2003, the AU/NEPAD Health Strategy of 2003, and AU Assembly Decision 55(IV) on the Interim Report on HIV/AIDS, TB, Malaria and Polio of Abuja, January 2005, to increase access to care and treatment of preventable diseases;
FURTHER RECALLING the recommendations of the International Conference on Population and Development (ICPD), United Nations General Assembly Special Session on AIDS (2001) and on Children (2002) and the commitment to the attainment of the Millennium Development Goals (MDGs) adopted in the Millennium Declaration 2000;
RECOGNISING the leadership provided and efforts made by the World Health Assembly through the WHO and the Global Programme for Vaccines and Immunization as shown in documents such as WHA45.17, the WHO position paper on Hepatitis B Vaccines (Weekly Epidemiological Record No. 28, 2004, 79, 255–263), Expanded Programme on Immunization. Global Advisory Group – Part I.
Weekly Epidemiological Record, 1992, 67: 11-15 and Introduction of hepatitis B vaccine into childhood immunization services (WHO/V&B/01.31).
ACKNOWLEDGING the commitments made by the G8 and other development partners;
NOTE that most hepatitis B virus (HBV) infection in Africa occurs in the age group 0-5 years, from mother to child transmission (risk of transmission ranges from 30 to 90%) and transmission during early childhood, and this results in increased chance of chronicity of up to 90% of such cases, thus perpetuating the high prevalence on the continent. HBV is 100 times and hepatitis C virus (HCV) 10 times more infectious than HIV and both lead to liver cirrhosis and liver cancer, the prognosis of which is very poor, with people dying in their prime of life resulting in loss of valuable human resource and labour force. Liver cancer is the commonest cause of cancer in males and the third cause of cancer in females in many African countries and HBV is responsible for at least 75% of this cancer.
FURTHER NOTE that the best intervention for the control of HBV infection is universal HBV immunisation and that some African countries have incorporated this in their National Programme of Immunisation. However, there is need for an aggressive implementation strategy to increase coverage and to prevent future transmission of infection. However, the strategy of immunisation alone will take decades to achieve the control and ultimately the eradication of hepatitis B and its sequelae unless it is combined with treatment and care of those presently infected. At the moment Africa has a very large reservoir of HBV infected people who are at risk of dying prematurely from the complications of HBV and HCV infections and, for women of reproductive age, in transmitting the infection to their children. Treatment of these infections are very expensive, not affordable and not readily available in most African countries;
FURTHER NOTE the high prevalence of hepatitis B and C in areas of Africa with violence and displacement of people;
RECOGNISE the leadership of the WHO Regional for Africa in providing direction for cancer prevention and control in Africa (Document AFR/RC58/4 24 June 2008) and that hepatitis B diagnosis, prevention, treatment and care provides a great opportunity to achieve the aims of the AFRO cancer prevention and control strategy;
CONCERNED that whereas HBV and HCV are more prevalent and more infectious than HIV, we observe that African governments and the world, in general, have not paid the required attention to the ravages of HBV and HCV infection on the continent. Ministries of health do not have programmes for the diagnosis, prevention, treatment and care of hepatitis B and C in most African countries;
FURTHER CONCERNED that the drugs for the treatment of chronic hepatitis B and C, even in cases where the same drugs are used to treat HIV/AIDS, are far more costly than antiretroviral drugs and far more difficult to obtain their generic formulations;
ALARMED by the persistently high levels of infection of hepatitis B and C on the African continent (life time risk of infection >60%), high levels of childhood infection, maternal to child transmission of infection, high prevalence of chronic hepatitis B and C infections (>8%), high morbidity, mortality and disability due to these preventable and curable conditions;
FURTHER ALARMED by the high prevalence of cirrhosis, liver failure and liver cancer resulting from hepatitis B and C infections in young adults in their productive age on the African continent;
CONVINCED that the MDGs and the Vision and Mission of the African Union and the objectives of the New Partnership for Africa’s Development (NEPAD) on our continent cannot be achieved without urgent and concerted effort at controlling hepatitis B & C infections in the African continent;
WE HEREBY:
Support the World Hepatitis Day celebrations;
FORM an African Expert Committee in conjunction with the African Association for the Study of Liver Diseases (AASLD) and the Association Africaine Francophone de Formation Continue en Hepato Gastro Enterologie (AAFFCHGE) to:
Continue to monitor the magnitude of the problem of hepatitis B and C on the African continent;
Continue to monitor the World’s and African response to this ongoing catastrophe;
Review the current international guidelines for the management of HBV and HCV and modify them to suit the local African situation;
Provide a frame work for action and
Continue to commit ourselves to the promotion of best practices in the management and prevention of Hepatitis B & C in Africa
REQUEST the World Health Assembly to include the diagnosis, prevention, treatment and care of hepatitis B and C on the world health assembly agenda;
REQUEST the World Health Organisation to:
Develop a strategy for accelerated hepatitis B and C diagnosis, prevention, treatment and care in the African Region;
Provide technical support to Member States in the development and implementation of action plans for acceleration of hepatitis B and C diagnosis, prevention, treatment and care interventions;
Mobilise more resources and long-term international support for scaling up effective hepatitis B and C diagnosis, prevention, treatment and care;
REQUEST the Board of the Global Fund for the Fight against AIDS, Tuberculosis and Malaria to include the diagnosis, prevention, treatment and care of hepatitis B and C in the diseases to be funded by the Fund;
URGE African states to
Scale up the diagnosis, prevention, treatment and care of hepatitis B and C using proven effective medicines and vaccine; in this wise we urge the implementation of universal immunisation with Hepatitis B vaccine and ensuring the widest possible coverage including catch-up immunisation of children of school-going age, health workers and family members of hepatitis positive people and all those are high risk of infection
Make efforts to reduce the costs of medicines for the diagnosis, prevention and treatment of hepatitis B and C by waiving taxes and other charges on them and ensuring their populations have access to low cost but effective medicines;
Strengthen Health Systems to promote universal access to hepatitis B and C treatment and care by implementing the Abuja Recommendation of allocating at least 15% of the national budget to health;
Create national hepatitis B and C control programmes to co-ordinate and implement evidence-based best practices to control and eventually eradicate hepatitis B and C infections;
URGE pharmaceutical companies manufacturing medicines for the diagnosis, prevention, treatment and care of hepatitis B and C to:
Reduce the prices of these medicines to the same level as those for HIV/AIDS and
Develop country programmes to support patients on treatment
URGE the International Community, the G8, G20 and other donor countries to
Fulfil their commitment to honour their pledges to ensure availability of resources for sustainable access to treatment and care of hepatitis B and C for the achievement of the millennium development goals in Africa.
Increase funding to African countries to cover this new initiative of improving the diagnosis, prevention, treatment and care of hepatitis B and C.