A strategic approach to addressing Hepatitis in Humanitarian Crises

The Global Hepatitis Report 2024: Action for Access in Low- and Middle-Income Countries highlights Egypt’s achievement of gold tier status for eliminating hepatitis C, alongside the notable progress made in other focus countries, such as Morocco, Pakistan and Yemen in improving access to medicines and health products, strategic planning for disease elimination and local manufacturing of medicines.

However, despite these successes in the Eastern Mediterranean Region, significant challenges remain. According to the report, in 2022, around 15 million individuals were affected by hepatitis B and 11.7 million by hepatitis C in the Region, which also has the highest hepatitis C prevalence globally.

Discussions about hepatitis in the regional context, and the globe at large, often centre on times of stability. To fully understand the hepatitis situation in the region, however, we need to adopt a broader perspective that includes humanitarian and emergency settings. Lest we forget, our region is home to several crises induced either by ongoing or evolving conflicts as well as climate change-instigated disasters. These crises accelerate the spread of infectious diseases due to factors such as overcrowded settings, disrupted health services, inaccessible areas, and unsanitary and unhygienic conditions. Hepatitis is one such disease that is spreading in these contexts.

Several recent examples have been reported. Doctors without Borders have issued warnings on the spread of hepatitis E in refugee camps in eastern Chad, where over 550,000 Sudanese refugees are hosted. The World Health Organisation spoke last week on 100,000 cases suspected of contracting hepatitis A. Hepatitis B and C are neglected diseases among the Syrian refugee population, according to research reports.

And in Pakistan, hepatitis outbreaks are now more frequent with the occurrence of floods and is a growing concern according to Gavi, the Vaccine Alliance.

To address hepatitis effectively at the regional level, we must consider the unique challenges brought about by emergencies: scarce resources, dwindling funding, health worker shortages and conditions exacerbating disease spread due to lack of infection prevention and control measures.

There is consensus among stakeholders on the need to enhance infectious disease interventions in conflict and humanitarian settings through research-informed findings. This is a concern we share with the global health community, and we believe hepatitis is among the diseases that require such investigation.

Specifically for this highly infectious disease, we should consider “implementation research” studies in favor of traditional research to provide recommendations on how to effectively implement relevant interventions.

This is an emerging type of research that is showing promise in studying how health programs and interventions work in real-life situations, focusing on the best ways to apply and improve health strategies in practicality.

Implementation research could bridge the gap between science and practice. Currently, hepatitis C treatment and other hepatitis vaccines are available at low prices, yet their accessibility remains limited for the public. Implementation research is especially promising given that it can address this gap and tackle complex implementation issues by considering economic, social, policy, and other barriers and offering tested implementation alternatives. In fact, this research can serve regional implementation-relevant recommendations outlined in The Global Hepatitis Report 2024 on decentralising hepatitis services, developing screening strategies for targeting at-risk groups, overcoming practical barriers to affordable testing and treatment, and strengthening the role of civil society in the viral hepatitis response.

These priorities could be translated into success through implementation research, a strategic and practical approach that will transform the regional hepatitis situation by providing valuable insights into cost-effective and sustainable methods for actualizing emergency-tailored screening, surveillance, diagnostics and treatment.

A conversation on hepatitis in the region must consider humanitarian settings, while also initiating practical solutions for implementation to create desired change.

Mohannad Al Nsour is the executive director of the Eastern Mediterranean Public Health Network (EMPHNET).