By Ghulam Haider

Pakistan has attained the ‘distinction’ of a country which home to the world’s largest population of hepatitis C patients, with nearly 10 million people infected by the virus amid rampant use of unclean syringes and unhygienic health services.

Around half a million new infections have been detected in Pakistan between 2015 and 2021, while overall, there about 10 million people infected with the Hepatitis C virus in the country, according to the US Centre for Disease Analysis (CDA). The findings are the result of a two-year research and analysis conducted jointly by the CDA and Pakistan’s provincial health departments.

“Pakistan is now home to the world’s largest population of patients living with hepatitis C, surpassing even China, India and Nigeria,” Epidemiologist Dr Homie Razavi from the Centre for Disease Analysis (CDA) in the United States said.

The growing burden of the virus, which transmits through blood-to-blood contract and can cause severe liver complications if untreated, is expected to further strain a public health system identified by the World Health Organization (WHO) as one of the globe’s worst.

Over 15 million people suffer from Hepatitis B and C in Pakistan, making hepatitis the biggest killer among communicable diseases. Both viral infections are blood-borne diseases spread through unsafe injections, unsanitary practices at hospitals, dental clinics and tattoo parlours, among other causes.

The reuse of needles and syringes, unscreened blood transfusions and sharing of razors by barbers and surgical instruments by dentists are the main reasons for the spread of hepatitis C in Pakistan.

The country also has one of the highest rates for therapeutic injections per capita in the world.

Unfortunately, we have poor infection prevention control. Also, pregnant women are not vaccinated for hepatitis B, resulting in transmission of the virus from mother to child.

Disease is a ‘ticking bomb’

The recent floods have exacerbated the situation by damaging nearly 900 health facilities across the country and exposing 75,000 pregnant women to infection. Many pregnant women were forced to give birth in partially flooded and unhygienic homes, in cramped refugee camps or in makeshift tents – often without a midwife or doctor.

Even as the government has committed to eliminating all hepatitis viruses by 2030, the growing prevalence of the disease shows that Pakistan is sitting on a “ticking bomb.” The persistent rise in hepatitis C cases is attributed to the absence of a comprehensive, population-wide screening programme that can identify the “missing millions of people who require treatment,

“There are several challenges that hinder the elimination of HCV from Pakistan including the lack of patient awareness about the causes and transmission of disease, lack of affordability for investigations and drug treatment and lack of experienced healthcare professionals,” said Dr. Yasir Waheed, a leading Pakistani virologist.

The lack of effective drugs and robust epidemiological data are also major contributors to the growing prevalence of the disease, he added. But Dr. Waheed believes the elimination of hepatitis from Pakistan by 2030 will be impossible under current initiatives.

In Pakistan, the control of hepatitis has so far remained a low political priority, with poor implementation of health-related policies and government-sponsored treatment programmes by the devolved provincial health ministries.

However, the establishment of the National Blood Transfusion Authority in Pakistan has been a major development that addresses one of the biggest sources of infection in the country: contaminated blood units.

“It will be a significant development if the country succeeded in reducing the annual hepatitis deaths from 200,000 to less than 25,000. The control of hepatitis epidemics requires political will, financial investment and support from pharmaceutical, medical and civil societies around the globe,” Dr Razavi said.

Pakistan gets half a million new infections every year and if it continued the gap between the country and other nations would widen. Pakistan needs to scale up testing and treatment to reach the WHO target by 2030.

The good news is that Hepatitis C is a treatable infection and treatment of Hepatitis C is cheapest in Pakistan as compared to the rest of the world. Any person who is infected with Hepatitis C can get rid of this virus within three months by regularly taking medicines.

Pakistan can learn from Egypt which was number four in the burden of Hepatitis C cases in 2015 but now it is number 17, adding that it launched a national programme to screen its entire population and treated all those who were infected with the infection.

Understanding the seriousness of the situation, the Government of Pakistan launched its first National Hepatitis Strategic Framework (NHSF) covering the period 2017–21, which closely follows the WHO global health sector strategy on viral hepatitis while accommodating for Pakistan’s limited resources and huge burden of disease.

Although Pakistan’s commitment and bold vision to eliminate HCV infection by 2030 is encouraging, the country has a long way to go. Sustained political commitment is essential for effective implementation of the NHSF. The country should also develop an extensive monitoring and evaluation system for the NHSF, ensure the safety of all health professionals, and make care easily accessible to even the most marginalised communities. These steps are important to stop the huge numbers of preventable deaths each year and to achieve universal health coverage in Pakistan.

WHO calls for action

WHO is calling on countries to step up efforts to eliminate hepatitis by 2030.With one of the world’s highest rates of hepatitis C, Pakistan is tackling this serious health issue from many angles to improve prevention, diagnosis and treatment.

Hepatitis C is a blood-borne virus that can cause liver disease that ranges from a short, mild illness to a serious, lifelong condition. WHO estimates that approximately 71 million people worldwide have chronic hepatitis C infection and around 400 000 people die every year from it, mostly from cirrhosis or liver cancer. While there is no vaccine against hepatitis C, antiviral medicines can cure more than 95% of people with the disease.

The Government of Punjab is the first province in Pakistan to address this issue by introducing a policy to ensure that 90 % of all syringes used in the health sector are auto-disable, meaning that they cannot be used more than once. In addition, it has launched a programme to improve infectious waste control that includes building 39 incinerators in health facilities.

Government of Pakistan provides free diagnosis, treatment and care to hepatitis patients in all provinces through four Hepatitis Prevention and Control programmes. Hepatitis C patients now have free access to new oral medicines, thanks to work done by the National Technical Advisory Group of hepatitis experts, which has been instrumental in bringing down the cost of drugs for hepatitis C treatment to less than 1% of the cost paid in the USA.

Pakistan tackling from many angles

Pakistan is tackling this serious health issue from many angles to improve prevention, diagnosis and treatment, with majority living in the Punjab province. While prevention is key in the fight to eliminate hepatitis, access to testing and treatment is essential to saving the lives of those people already infected.

Pakistan Ministry of Health will launch its first National Hepatitis Strategic Framework follows closely WHO’s Global health sector strategy on viral hepatitis. It outlines a clear set of targets and objectives to help Pakistan work towards the goal of eliminating hepatitis by 2030.