Russia is among the countries that most successfully fight viral hepatitis

20 countries account for more than 75% of the global burden of viral hepatitis. Russia is in 10th place on this list. The authoritative journal Lancet provided information on progress in the fight against the disease in these countries. Russia is among the countries making the most significant progress, along with Bangladesh, India, Indonesia and Japan. According to Lancet estimates, in Russia the obstacles to eliminating hepatitis are the high cost of treatment and lack of public awareness of the disease. Experts with whom Kommersant spoke agree that the attention of the Russian President to the problem of hepatitis helped move it “from the point where it had been for quite a long time.”

The Lancet Commission on Gastroenterology and Hepatology reported on progress towards eliminating viral hepatitis in the 20 countries with the highest burden of this disease group (disability-adjusted life years lost). These are China, India, Indonesia, Egypt, Pakistan, USA, Nigeria, Japan, Thailand, Russia, Bangladesh, Myanmar, Ethiopia, Mexico, Brazil, Vietnam, South Korea, Philippines, DR Congo, Ukraine. The commission’s report highlights that these countries account for more than 75% of the global burden of viral hepatitis. Scientists indicate that progress “in the policy of eliminating viral hepatitis” has been achieved in 14 of the mentioned states. At the same time, Russia, together with Bangladesh, India, Indonesia and Japan, demonstrates the most significant successes. Improvements, according to experts, are largely due to the publication of national hepatitis control plans, government-funded screening programs and government subsidies for antiviral treatment.

In Russia, according to modeled data (the commission relied on official statistics and information from the Ministry of Health of the Russian Federation), the prevalence of hepatitis B virus (HBV) in 2022 was 1.1%, and the prevalence of hepatitis C virus (HCV) in 2020 was estimated at 2.9 %. The incidence of acute and chronic viral hepatitis has been declining steadily over the past five years, but varies greatly by region, the report found. The Commission draws attention to the following: coverage of three doses of the HBV vaccine in children under 1 year of age exceeded 95%, but in some regions it is declining due to parental refusal to vaccinate; The total number of Russian residents vaccinated against HBV at the end of 2020 was 107.3 million people (73%).

The commission’s report states that the state screening program covers all blood donors, pregnant women (in the first and third trimesters), medical personnel, patients with chronic diseases and other groups. Until 2020, more than 17 million people (about 12% of the population) were tested for HBV and HCV each year. At the same time, in Russia, according to the commission, the obstacles to eliminating hepatitis are the high cost of treatment (especially in the case of HCV) and insufficient awareness of the population about the problem. Let us note that, according to estimates of the interregional organization “Together against Hepatitis”, in Russia the number of cases of chronic viral hepatitis C ranges from 2.2 million to 4.9 million, but no more than 2–3% of patients receive treatment annually.

In general, experts point out, over the past three years, the world has experienced serious disruptions in the functioning of health care systems, impeding progress in the fight against viral hepatitis. They highlight that four of the 20 countries are affected by conflict: “The impact of the geopolitical crisis between Russia and Ukraine is recognized around the world, but unrest in Ethiopia and Myanmar also poses serious challenges to health systems. In addition, all countries have had to deal with the COVID-19 pandemic, which has disrupted short-term hepatitis elimination plans, as well as hepatitis B vaccination programs and hepatitis C screening and treatment programs.”

Co-chairman of “Together against Hepatitis” Nikita Kovalenko confirms that in the last two years in Russia the situation with the treatment of hepatitis has changed “fundamentally”: “The head of state drew attention to hepatitis, and the problem has finally moved from the point where it had been for quite a long time.” .

Last week, we note, Vladimir Putin once again set the task of reducing the incidence of hepatitis C to a minimum by 2030. The president announced the need to develop appropriate solutions back in 2021 during his address to the Federal Assembly. In November 2022, by order of the Government of the Russian Federation, a plan to combat hepatitis was adopted. Since 2023, treatment of hepatitis C has been included in the basic program of state guarantees, and in the program of state guarantees in 2024, treatment coverage standards have already been introduced – that is, regions are not only obliged to treat hepatitis C within the framework of compulsory medical insurance, but also to ensure a certain coverage of therapy. In March 2023, the Circle of Good Foundation committed itself to providing therapy to all children under 12 years of age with hepatitis C. In 2024, within the framework of the Unified State Automated Information System, a unified register of hepatitis patients should be launched in all regions.

“Any day now we are waiting for amendments to Order 404 of the Ministry of Health, which regulates medical examination of the adult population,” continues Nikita Kovalenko. “But, probably, the most significant change can be considered the allocation of funds for the fight against hepatitis from the federal budget. Currently, amendments to the Health Care Development program are under anti-corruption review, approving the mechanism for using this money. It is assumed that these will be subsidies for co-financing of regional programs, that is, in addition to federal money, funds should be allocated from the regional budget.”

According to Mr. Kovalenko, the measures taken by the state have made Russia a leader “at least in the post-Soviet space.” However, he agrees with the conclusions of the international commission about the lack of information. “Unfortunately, doctors who are not involved in the treatment of hepatitis often misguide patients, spreading outdated myths that hepatitis C has no cure, that treatment cannot be obtained for free, that they only treat patients with HIV and cirrhosis, and that the treatment itself is accompanied by side effects,” says Nikita Kovalenko.— Our hotline has been operating for the eighth year; we are developing and distributing information materials for both patients and doctors. But if in matters of improving the organization of medical care we feel the support and understanding of the Ministry of Health, then in matters of informing such support, unfortunately, there is no such support.”

Deputy Chairman of the State Duma Committee on Health Protection Alexei Kurinny (Communist Party of the Russian Federation) agrees with the positive assessment of the international commission. However, it is too early to talk about “real achievements,” the deputy believes: “The register has not yet been created, the criteria for treatment coverage, and the results that we want to achieve have not been determined. The tasks have been set, funds have been allocated for them – now they need to be solved.”

“In recent years, the Russian Federation has achieved some success in the fight against viral hepatitis, especially hepatitis C,” said Vladimir Chulanov, chief infectious disease specialist at the Russian Ministry of Health. “The steps currently being taken allow us to expect that in the next 5-6 years the problem of chronic viral hepatitis in Russia will be minimized, which will ensure the preservation of the health and lives of thousands of our citizens.”

Natalia Kostarnova