Hepatitis: Let's Break It Down

World Hepatitis Day is observed on 28 July — the birthday of Dr. Baruch Blumberg, who first described the Australia antigen in 1965 (later confirmed as the hepatitis B surface antigen in 1967) and went on to co-develop the first vaccine against HBV. The WHO's 2026 theme, "Hepatitis: Let's Break It Down," calls for dismantling the financial, social, and systemic barriers preventing millions from accessing prevention, diagnosis, treatment, and care.^1,2

The tools to eliminate viral hepatitis exist. An effective HBV vaccine has been available since the 1980s. Direct-acting antivirals cure HCV in 8–12 weeks with >95% success rates. And yet — approximately 89.7% of people with hepatitis B and 78.6% of those with hepatitis C remain undiagnosed.¹³ That gap does not require new science to close. It requires breaking down the barriers that sit between patients and the care they need.

Before we go further — let's see where you actually stand.

🌍The Numbers That Should Bother Everyone

Between 1990 and 2019, global HBV prevalence fell by 31.4% — vaccination working. But HBV mortality fell by only 26.7%, and in some regions it is rising.¹ For HCV, paradoxically, mortality increased by 10% over the same period — despite curative treatment (sofosbuvir) receiving regulatory approval in late 2013.¹ In Africa, Western Africa alone recorded 33,603 HBV-related deaths in 2021; projections show a 42.5% increase in HBV deaths in Eastern Africa by 2030 without course correction.³

The Asia-Pacific region, carrying more than half of the global chronic hepatitis burden, saw HBV prevalence decline from 4.69% to 4.30% between 2015 and 2020 — but only 13% of chronic HBV infections were diagnosed, and treatment rates among those diagnosed were just 25%.¹⁰

"The 2008 economic crisis had lasting negative impacts on hepatitis outcomes in Southern Europe. Healthcare investment, once withdrawn, does not easily recover — and the hepatitis burden it leaves behind is permanent."⁹

📉The Care Cascade — Click Each Step

The hepatitis care cascade runs from infection to cure. The largest single gap is right at the beginning — diagnosis. Click each step below to see what's happening there.^13,16

🃏Myth or Reality? Flip the Cards

Five statements clinicians say every week. Tap each card to find out if it holds up.

🔬Explore the HBV Serology Panel

Click each marker to understand what it means — and what happens if you stop before ordering it.¹⁴

📋You Receive This Report. What Now?

Three real failure scenarios. Expand each one, look at the report, decide what you'd do — then reveal the answer.

🧱Breaking Down the Barriers: What the Theme Actually Means

The WHO's 2026 theme is not metaphorical. There are identifiable, categorisable barriers preventing elimination — and they have documented solutions.⁴

Financial barriers: cost of DAAs, molecular testing, clinic visits, and transport; lack of insurance; insufficient birth-dose vaccination funding in LMICs. Generic DAAs have transformed the picture in some settings — Egypt treated over 4 million HCV patients between 2014 and 2020 using affordable generics.¹⁸ But access remains deeply unequal.

Stigma and social barriers: Hepatitis B and C carry stigma disproportionate to their transmission risk — linked in public perception to injection drug use and sexual behaviour. This leads to delayed testing, non-disclosure, and avoidance of healthcare. Transgender populations have pooled HCV prevalence of 9% and HBV prevalence of 11% globally — significantly higher than the general population — yet face consistent discrimination in healthcare settings that deters engagement.⁵

Systemic barriers: Fragmented care, no national hepatitis strategy in many countries, specialist-only models, complex multi-step cascades. Decentralised, primary-care-integrated service delivery, task-shifting to non-specialists, and point-of-care molecular testing have shown concrete results in addressing these.⁴ The Xpert HCV Viral Load Fingerstick test (Cepheid) — results in approximately one hour from a fingerstick sample — increases treatment initiation in marginalised populations precisely because same-day diagnosis eliminates the return-visit dropout.⁴

Health inequities: Migrants from conflict-affected regions face structural, financial, and societal barriers including fear of arrest and xenophobia.⁴ People who inject drugs account for a significant proportion of new HCV infections globally, yet face criminalisation and exclusion from healthcare services. Needle and syringe exchange programmes and opioid substitution therapy are proven prevention tools — coverage remains inadequate.¹⁸

💉Prevention: What Works and What's Being Left Undone

HBV vaccination is one of the most effective public health interventions in existence. Universal childhood vaccination programmes have dramatically reduced HBV prevalence where coverage is high.²¹ Yet global birth-dose coverage — the dose that must be given within 24 hours of delivery to prevent mother-to-child transmission — reached only 43% in 2019, with rates below 10% in many African countries.^2,16

Infants infected perinatally have approximately a 90% chance of developing chronic HBV. Immunocompetent adults infected have a 5–10% risk.¹¹ The birth dose is not a routine vaccine — it is a narrow-window intervention that sits at the most critical moment of hepatitis B transmission. Missing it because of cold chain failures, home delivery, or underfunding is a preventable catastrophe repeated daily.

For MTCT prevention, HBsAg screening alone is insufficient. Pregnant women with HBV DNA >200,000 IU/mL at delivery remain at high MTCT risk despite vaccination and HBIG. Tenofovir prophylaxis in the third trimester reduces this risk — but it can only be offered if HBV DNA is measured.²¹ The complete antenatal protocol runs: HBsAg → HBeAg → HBV DNA → decision on antiviral prophylaxis → birth-dose within 24h + HBIG → post-vaccination serology at 9–12 months.

For HCV, there is no vaccine. Prevention is through harm reduction (NSP, OST, supervised consumption) and blood safety (universal NAT screening of donations, mandatory donor deferral).¹⁸

💊Treatment: One Has a Cure, One Doesn't — Yet

Hepatitis B: Current approved treatments — nucleos(t)ide analogues (entecavir, tenofovir TDF/TAF) and pegylated interferon-alpha — suppress HBV DNA but do not eliminate covalently closed circular DNA (cccDNA), the viral reservoir in hepatocyte nuclei. Most patients require indefinite NA therapy; discontinuation triggers virological relapse in the majority. Functional cure (sustained HBsAg loss) is the treatment goal but is achieved in fewer than 10% of NA-treated patients.¹² Research into curative combinations — capsid assembly modulators, RNA interference therapies, therapeutic vaccines — is active but as yet no functional cure is routinely available.

Hepatitis C: Pan-genotypic DAA regimens — sofosbuvir/velpatasvir and glecaprevir/pibrentasvir — achieve sustained virological response (SVR, i.e. virological cure) in >95% of patients across all genotypes with 8–12 weeks of oral therapy and excellent tolerability.¹⁸ Between 2014 and 2023, 12.7 million patients received DAA treatment globally.⁷ SVR is associated with regression of liver fibrosis, reduced HCC risk, and improved survival.

The statement worth repeating: for hepatitis C, the elimination bottleneck is not the drug — it is the diagnostic step that never happened. Every undiagnosed HCV patient is sitting at the beginning of a pathway that ends in cure.

📌Key Takeaways — What You Can Do Tomorrow