World Hepatitis Day and Amitabh Bachchan

Saurabh Gupta | Updated on August 01, 2020

Why Bachchan’s fight against a disease that cost him three-fourths of his liver should not be forgotten

In 1982, Indian film icon Amitabh Bachchan was shooting for the Hindi film Coolie when he suffered a near fatal accident. He was rushed to the hospital, where scores of his fans gathered and volunteered to donate blood for him. Of the many who donated, there was one unaware fan who carried the Hepatitis B virus.

Cut to two decades later, Bachchan surprisingly learns that he suffers from liver cirrhosis and has lost 75 per cent of liver function. For over two decades virus from the infected blood silently scarred his liver, which led to liver cirrhosis. Bachchan had a very good reason to champion the cause to detect and treat viral Hepatitis and in 2017, he was appointed the WHO Goodwill Ambassador for Hepatitis in the South-East Asia region to increase awareness on this issue.

According to the World Health Organization (WHO), more than 325 million people worldwide are living unaware with various forms of Viral Hepatitis. A report published by the Health Ministry estimates that 40 million Indian citizens are chronically infected with Hepatitis B and 6-12 million with infected with Hepatitis C. The prevalence rate of HBV and HCV in India is estimated to be 3-4 per cent and 0.8-1 per cent respectively, which means that out of 2,500 people in my phone book around 100 would likely suffer from one of these forms of Hepatitis.

What makes it scary is that most of them are living unaware like Bachchan. The reason is that Hepatitis B has a long gestational period and before the patient gets to know about it, significant damage has already been done. The consequences are fatal. Compared to more than 33,000 deaths that have been caused by the novel coronavirus as of this week, Hepatitis B is alone estimated to have taken more than 1,10,000 lives in 2019, in India.

Governments across the world came together in 2016 to sign an agreement to eliminate Hepatitis by 2030. To align its efforts, in 2018, the Indian government launched a dedicated programme, National Viral Hepatitis Control Program (NVHCP), to prevent and control Viral Hepatitis. The programme aimed to provide free of charge screening, diagnosis, treatment and counselling services to all, and to those in high-risk groups. National, state, and district-level infrastructure and monitoring units were to be set up for this task and several key performance indicators (KPIs) were outlined.

Two years since its launch, the programme has moved the needle on some of its KPIs. While the data in public domain is limited and reported with a bit of delay, here is what we can learn about India’s fight against Hepatitis from the data available in public domain.

Vaccination to prevent Hepatitis B

Hepatitis B is preventable with vaccine and one of the key goals of the NVHCP programme was to reach 90 per cent coverage of birth dose of Hepatitis B for all deliveries by 2019-20. According to the latest data from the Health Ministry for 2019-20, it seems we stood at 71 per cent in 2019-20, up from 68 per cent in 2018-19. Another goal of the programme was to have 95 per cent coverage with three doses of Hepatitis B vaccine in infants by 2019-20. It appears that we have moved ahead as the coverage has reached 91 per cent of all infants by 2019.

Blood safety to prevent transmission of HBV and HCV

HBV and HCV can transmit through contaminated blood and hence it becomes important to ensure safety of blood products. At all licensed blood banks in India, it is mandatory to test blood for HBV, HCV, and other infections before transfusion. To make this possible, increasing the share of voluntary blood donations in total donations is considered an effective measure.

Back in 2018, NVHCP set the target to have 80 per cent of all blood donations to be voluntary by 2020. This was a reasonable goal because NACO-approved blood banks in India already had 78 per cent voluntary donations in 2017-18. However, as per the latest data from NACO, voluntary donations dropped to 76 per cent in 2018-19. While data for 2019-20 is awaited, the good news is that the percentage of blood units found infected with HBV has declined over the years.

Another angle to this is about reliability of testing methods. India mostly uses serological testing for blood transfusion testing while the NACO recommends using Neuclic-acid based RT-PCR testing — which is used by most countries in the world. With the capacity build-up and awareness during Covid-19, we might see more of this happening.

Testing for detection of Hepatitis

Testing is recognised as key to detecting the ”missing millions” that are living with Hepatitis without knowing it. The latest data available from a National Health Mission presentation, May 2019, indicates that 11.5 lakh HBV tests and 7.5 lakh HPV tests have been approved for distribution to various States. Key beneficiaries include Rajasthan, Maharashtra, Telangana, Harayana and Delhi.

Infrastructure and training

Another updated presentation for the programme created in October 2019 revealed that there has been major progress on creating the infrastructure and human resource development to tackle Hepatitis. Against the first year goal of establishing State Viral Hepatitis Management Unit (SVHMU) and steering committees in all States and UTs, the government has established SVHMU for 31 States and UTs and steering committee for 25 States and UTs. Model treatment centres were to be established in all States and UTs within the first year. By October 2019, Model treatment units were established in 22 States and UTs. Training of medical officers is completed for 18 States.

While the latest data on many indicators is still awaited, we know for sure that this programme has stirred a new focus on management of Hepatitis and the results should start to show up soon. In the years to come, we hope a lot fewer people will get an unpleasant surprise like the one Bachchan got.

The writer is Vice-President at Contify. Views are personal

Published on August 01, 2020

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