States Must Act Against Viral Hepatitis Now to Eliminate the Ongoing Epidemic by 2030

This article was originally written by Robert Greenwald, Sonia L. Canzater, and Adrienne Simmons and published in Health Affairs on March 1, 2022.

As the United States heads into its third year in the fight against COVID-19, Americans have seen firsthand the importance of a robust and comprehensive response to public health emergencies and epidemics. The same is true for chronic viral hepatitis, a condition that impacts an estimated 3.3 million Americans. Without comprehensive plans to eliminate viral hepatitis, the US will fall short of reaching the World Health Organization’s (WHO’s) goal of fully eliminating the virus by 2030. We call on policy makers at the state level to advance comprehensive, equity-focused proposals that will adequately address and meet the WHO’s goal of eliminating viral hepatitis by 2030.

Viral hepatitis is an infection that can cause severe liver disease, liver cancer, and death, and is rightly considered a serious public health threat. Hepatitis B and C, the most prevalent types of viral hepatitis in the United States, can be spread through contact with an infected person’s blood and can cause both acute and chronic infection. All forms of viral hepatitis are largely preventable through immunization, sterile supplies for injection drug use, testing, treatment, and funding for programs that increase access to and awareness of these measures. Tackling the viral hepatitis epidemic also requires coordination among partners at the federal, state, and local levels, as well as with community-based organizations and advocacy groups, to ensure the needs of all people living with hepatitis are met.

Despite having vaccines that protect against hepatitis A and B, and highly cost-effective treatments that cure hepatitis C in 95 percent of instances, we are losing ground in the fight against viral hepatitis. New infections have spiked due to the ongoing opioid epidemic, while treatment levels for hepatitis C have disturbingly declined between 2014 and 2020, according to recently published data from the Centers for Disease Control and Prevention (CDC). Many people do not know they are living with the virus due to a lack of testing. And long-existing barriers to treatment access for people of color, people who use drugs, people who are incarcerated, and other vulnerable populations continue to exacerbate health inequity and stigma around the disease.

The time is now for state policy makers to act. While a viral hepatitis elimination roadmap exists at the federal level, individual state departments of health are left to develop their own plans to address their unique circumstances. All states that receive funding for viral hepatitis surveillance and prevention must develop comprehensive, systemic strategies to improve their capacity to prevent, diagnose, and provide linkage to care for viral hepatitis.

Hep ElimiNATION: A National Evaluation of States’ Capacity for Viral Hepatitis Elimination is the first grading system to date to assess states’ capacity to eliminate viral hepatitis. Based on a grading scale developed in consultation with more than 40 stakeholders including advocates, clinicians, government partners, and people who have lived experience with viral hepatitis, Hep ElimiNATION is an advocacy tool to bring awareness to policy makers, public health agencies, and communities about a broad range of key considerations for elimination.

Hep ElimiNATION assesses the policy landscape and programmatic strategies impacting viral hepatitis elimination in the 50 states, Washington, D.C., and Puerto Rico. Upon its release, Hep ElimiNATION has assigned six jurisdictions with an “A” grade based on their current capacity to eliminate hepatitis: California, Indiana, Louisiana, Michigan, New York, and Washington State. In the future, the platform will offer guidance and a toolkit for states’ ongoing efforts to develop viral hepatitis elimination strategies.

Several states have published elimination plans since the beginning of 2019, including New York, Michigan, Indiana, Hawaii, Louisiana, and Washington. State plans address critical issues that impact a state’s ability to tackle viral hepatitis, including legality of syringe service programs; budget allocations specifically marked for viral hepatitis elimination; training and educational programs; access to treatment for state Medicaid beneficiaries; and attention to disparities and health inequities, among other important pieces.

Beyond comprehensive elimination plans, states across the country are increasing their efforts to eliminate barriers to treatment access, particularly for Medicaid recipients who often make up the most vulnerable populations. These barriers include removing liver damage, sobriety, and prescriber requirements for treatment access. As of January 2022, 11 states have eliminated prior authorizations for hepatitis C treatment.

Further progress in jurisdictions will require Congress to make greater federal investments in viral hepatitis elimination through relevant agencies including the CDC, the Health Resources and Services Administration, Indian Health Services, and the Substance Abuse and Mental Health Services Administration. Following the models of federal commitments to end the HIV epidemic and address the overdose crisis, such resources can bolster the capacity of jurisdictions to eliminate viral hepatitis through targeted infusions of resources for evidence-based strategies, including full and equitable implementation of federal guidelines for hepatitis B vaccination and for hepatitis B and C screening.

As representatives of policy and advocacy organizations actively working to eliminate viral hepatitis, we urge state policy makers to comprehensively respond to the viral hepatitis epidemic with actions that are proportional to its scale. In conjunction with the opportunity to apply the lessons learned from the COVID-19 pandemic, we encourage jurisdictions to use Hep ElimiNATION as a guide in developing or enhancing their viral hepatitis elimination plans. We owe it to the millions of people living with hepatitis to fully fund programs that prevent, detect, and eliminate avoidable diseases.

Authors’ Note

National Viral Hepatitis Roundtable, O’Neill Institute for National and Global Health Law, and Center for Health Law and Policy Innovation are all involved in the viral hepatitis advocacy and policy space.