World Hepatitis Day in India: A time to celebrate or lament?

An invisible pandemic threatens India’s health

Society

July 28, 2021

/ By / New Delhi

World Hepatitis Day in India: A time to celebrate or lament?

Just after China, India counts for over 40 million persons suffering from chronic Hepatitis B (Photo: MedicineNet)

As India marks yet another World Hepatitis Day, an alarming number of people continue to succumb to the virus. While Covid-19 may be new to India and the world, Hepatitis has been plaguing India since ages.

For the past 18-odd months, the attention of the entire world has been captured by the Covid-19 pandemic and perhaps rightly so and it is perhaps noteworthy how quickly the governments and the scientists have been able to respond to the crisis and rolled out comprehensive vaccinations to counter the deadly virus and its numerous variants.

But the past 18 months have also seen the governments and the healthcare industry shutting their eyes to many other diseases, more familiar than coronavirus but almost as deadly. These are quite a handful, ranging from polio and diphtheria to tuberculosis, malaria and hepatitis, one of the biggest killers around in the world today.

According to estimates by the World Health Organisation, the virus, with its five variants, has already infected nearly half a billion people around the world, almost the same as Covid-19 infections so far and claims about 1.5 million lives each year.

Field day for hepatitis in India

India is one of the key battlegrounds for hepatitis and its variants.

Just after China, India count for over 40 million persons suffering from chronic Hepatitis B, accounting for 15 pc of the global  pool of Hepatitis-B infected in the world.

Most of the patients and casualties due to the virus in India belong to the poorer sections of the society, notably the tribal population. According to Down To Earth, in 2016, Hepatitis B claimed over 600,000 lives in India, with high prevalence among the tribals. Chronic Hepatitis B accounts for 30 pc of liver cirrhosis and nearly half of liver cancers in India.

On the other hand, Hepatitis C, another deadly variant, accounts for 8.7 million infected persons in India, says Lawyer’s Collective, a non-profit organisation in India. There are fears that the actual situation may be far worse as the then Indian health minister J P Nadda admitted on the floor of the Parliament that the government had not officially recorded figures of people infected by Hepatitis C. Critics say it shows the seriousness with which the government has dealt with this killer disease.

Failures all around

The story of how India has dealt with Hepatitis can be summed up in a single word – failure. At all the fronts, right from public awareness, prevention to diagnosis and treatment, the government has failed.

Even the diagnosis of the virus is costly and requires a range of tests that include full blood count, creatininine, liver function, genotyping and fibroscan that amounts to more than ten thousand rupees which again turns out a detriment for the poor.

The absence of facilities for diagnosing the ailment is another factor that adds to the undermining of the grave situation. The disease Hepatitis C is very inconspicuous, which means it takes time to reveal its true colours, say 20 years after the person has been infected. It is equally communicable as HIV, but more dangerous because of its longevity. The patient may not be aware that he or she is infected thus, acting as a carrier for the virus and in the process infecting others.

Health experts say that while the entire focus of the administration has been on the coronavirus, hepatitis has not at all been given the kind of attention it deserves, due to its high infection as well as fatality rates.

Even though vaccines for Hepatitis B (HBV) have been available in India since 2002, its coverage has been extremely poor. In the initial years, the vaccine was solely available at select metro cities. The coverage improved only when the government introduced the HBV vaccine as part of the government-sponsored Universal Immunisation Programme, recommending three doses of hepatitis B along with the other six vaccine preventable diseases (VPDs) namely polio, diptheria, pertusis, tetanus, tuberculosis and measles. The current immunisation schedule in India includes a birth dose within 24 hours for all the institutional deliveries to prevent the perinatal transmission and other doses are administered as per a strict protocol.

However, even more than a decade later, the coverage of HBV in India is extremely poor. According to a study published in November 2019 by BMC Public Health, that cites data from latest National Family Health Survey, in 2015-16, less than half the children in India were vaccinated against HBV, despite it being part of the UIP, which is funded by the central government. The study adds that the number of vaccinated children are lower than national average in north-west, northeast as well as parts of central India.

“The primary focus is on Covid-19 vaccines, when it comes to awareness as well as delivering. There are no scheduled camps held for Hepatitis B, it is covered under the universal immunisation programmes given to children. When it comes to Hepatitis C people lack in awareness and it is still a distant concept to be studied and implemented,” says Dr. Sudip Chakraborty, superintendent at SK Roy Civil hospital, at Hailakandi in north-eastern state of Assam.

Not just in creating awareness, but the government has also failed to source vaccines for Hepatitis C, despite the country and the South Asian region being a hotbed of this variant.

“In India currently, there is neither any treatment nor vaccine for Hepatitis C. Its diagnosis is also very difficult because of the lack of facilities. Hepatitis B on the other hand is still treatable, with vaccines provided to children free of cost under the many immunisation programmes held by the government. Though, in the case of Hepatitis B vaccines are provided still due to lack of education people are not aware or government fails to make people aware. The percentage of population termed educated in India is overwhelmingly low, so hygiene and basic health etiquettes are something distant to a large number of people. This is the main reason why the number of people affected by Hepatitis, both B and C, is considerable as the spread of this virus lies in unhygienic practices,” says Dr Sumit Das, associate professor of Silchar Medical College at Silchar in Assam.

Taking into account the huge number of Hepatitis C infections in Asia, Gilead, an American pharmaceutical company,  formed alliances with 11 Indian pharmaceutical companies to manufacture Hepatitis C vaccines.

But priced at INR 20,000 a shot, the vaccines are out of the reach of most, but the richest. With extremely low affordability has come a minimal access, allowing the virus a fertile ground.

Battling hepatitis is challenging, but it is no more so than with any other serious communicable disease like tuberculosis, leprosy or polio. If India could eliminate polio and leprosy through sustained awareness and vaccination, with proper focus and funding provided by the government, the scourge of hepatitis could also be consigned to history.

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