WHY CAMEROON SHOULDN’T BE FINDING THE MISSING MILLIONS NOW

On the 28 of July 1925, in Brooklyn New York, a Jewish American boy by the name of Baruch Samuel Blumberg was born and he would grow to become the Medical Doctor who discovered Hepatitis B and developed its vaccine. He received the Noble Prize in Medicine for his achievements and went ahead to share the patent for his vaccine freely. In 2010, the World Health Assembly designated his birthday as World Hepatitis Day – a day set aside to bring the world together to raise awareness on viral hepatitis. 

Viral hepatitis refers to a group of viruses that infect the liver. There are a total of 5 viruses lettered from A to E with hepatitis B and C being the most dangerous because they can cause life long infection. More than a third of the world’s population has been infected by a form of viral hepatitis at some point in their lives and 325 million individuals are presently infected with Hepatitis B or C. Of these, a whopping 9 in 10 are unaware of their status. Each year viral hepatitis kills 1.4 million individuals (fathers, mothers, siblings, children) and is the cause of 2 in 3 cases of primary liver cancer. Cameroon suffers a heavy burden of viral hepatitis with 1 in 10 individuals infected with hepatitis B.

Despite this high burden, there exists an effective cure for hepatitis C and vaccine for hepatitis B. Armed with these tools, the World Health Assembly (Cameroon included), in 2016, proposed the global strategy to eliminate viral hepatitis as a public health threat by 2030. This plan specifically entails reducing new infections by 90% and reducing mortality by 65%. This was followed in 2018 by the launching of the find the missing millions campaign, a three-year global campaign to diagnose the over 90% of infected individuals who are unaware of their status. The underlying strategy of these campaigns has been: test, treat, cure. This global strategy has led to great gains in the fight against hepatitis at the global level. However, the impact at the national level in Cameroon remains fuzzy.

We should definitely find the missing millions, but only if we are ready to care for them.

Cameroon like many other African countries is scourged by the debilitating effects of viral Hepatitis. Mother to child transmission and horizontal transmission in childhood are major methods of transmission. In 2005 Hepatitis B vaccination was introduced into the Enlarged program on Immunization and to date, more than 80% of children receive the 3 dose vaccine. Regrettably, the universal birth dose vaccine has not yet been implemented in Cameroon, despite efforts having reportedly been underway since 2014. Treatment cost of hepatitis remains high and this high cost remains the major obstacle to the test, treat cure program. Internationally it is estimated that the cost of treatment of hepatitis in lower- and middle-income countries to be on average between 1.5 million XAF to 16 million XAF per year. This high cost is a barrier to treatment and leaves many diagnosed individuals unable to access treatment without getting financially ruined. In fact, the treatment of Hepatitis in Cameroon previously stood at 11 512 000 XAF before the ministry of health struck key agreements with pharmaceutical companies to drop the price by more than 80%. Today a complete course of treatment lies somewhere between 450 000 XAF and 1 440 000 XAF. Similarly, the treatment for Hepatitis B has seen multiple slashes over the past years. Unfortunately, the implementation of all these price drops has been far from smooth. Also the bulk of management costs go to diagnostic and follow up tests such as Viral load and specialist consultation fees. Other problems affecting the proper management of viral Hepatitis in Cameroon include the lack of a National Policy on Hepatitis Management as is the case with other major public health diseases, limited number of treatment centers (Seven in Four Regions) and management experts, inconsistent drug supply and frequent drug stockouts which leave many patients stranded. 

Eliminating Hepatitis by 2030 which is the objective behind the ‘Find The Missing Millions’ campaign can only be achieved in Cameroon as well as the rest of the World if some critical steps are taken. Carrying out massive test drives and sensitization campaigns are great but the ‘treat’ and ‘cure’ aspects cannot be overlooked and should be the focus. It is not about telling a patient that (s)he has Hepatitis but that the ailment can be adequately treated or cured. Otherwise, diagnosis with viral Hepatitis will continue being perceived as a life sentence. Rather than screening, emphasis should be placed on improving efficiencies in case management. Reliable channels of drug supplies need to be established to arrest the all so frequent stockouts. Competencies need to be transferred to primary care physicians to vulgarise viral Hepatitis treatment protocols. In tandem, costs of follow up tests like viral load need to be brought down and more testing centres capable of offering these tests need to be established. This all culminates in demonstrating that developing and implementing a National Policy on Viral Hepatitis Management would be a giant leap forward as well as decentralization of treatment centres and management experts. Reduction in test costs such as what has been achieved with HIV would also be a great step forward. In the war against hepatitis, it is a race against time.

While waiting for better structures to be put in place, the population can protect their health and assist the Government by going for routine voluntary testing, getting vaccinated for Hepatitis B, practising safe sex and educating themselves on how to avoid other risk factors.

We should definitely find the missing millions, but only if we are ready to care for them. Otherwise, diagnosis with viral Hepatitis will continue being perceived as a life sentence. 

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By Acho Fon Abongwa, MD And Ameaka Fatima Nkempu, PharmD

Acho and Ameaka have been organising viral Hepatitis Awareness, Advocacy, Screening & Vaccination activities since 2016. Their vision is to see a Cameroon where viral Hepatitis is not a public health challenge and to change public perception of viral Hepatitis.

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