The National Coordinator of the Civil Society Network on Hepatitis in Nigeria, Dr. Nseabasi Ekanem has raised the alarm over the large number of Nigerians that succumb to hepatitis virus, blaming it on lack of awareness and exorbitant treatment costs.

Also, Ekanem has urged governments at all levels and relevant stakeholders to make hepatitis care accessible to all through the incorporation of its treatment and care into the National Health Insurance Scheme (NHIS) to forestall out-of-pocket treatment.

Ekanem, who spoke on Sunday during 2024 World Hepatitis Day, also stressed the government’s responsibility in leading the fight against hepatitis. This comes as the global target of eliminating viral hepatitis by 2030 is drawing close. Stakeholders have joined their voices, urging the Federal Government to intensify efforts in combating the disease.

“We are calling on the government to ensure that the whole cascade of care for viral hepatitis, from diagnosis, treatment, even at the point where maybe a liver transplant is necessary, all of these should be captured in the NHIS.

“Unfortunately, a lot of these are not covered in the insurance scheme and there’s need for the government to ensure that we have all of this covered so that patients can be able to access care.

I really must say emphatically that hepatitis affects the poor disproportionately compared to the rich. “Most of our hepatitis patients are on the lower edge level when it comes to socioeconomic status, which means that most of them do not even have money to pay out-ofpocket.

So the government must ensure that the NHIS covers the diagnosis because the diagnosis for hepatitis is expensive. “The government needs to stand tall, and work with its agencies, and with civil society. What I’m trying to say is that HIV, malaria, and the rest, have funding, but hepatitis does not have funding.

So, I think that the government should take this one as its responsibility,” he stressed. The World Health Organisation (WHO), estimates that 24 million Nigerians living with viral hepatitis B or C are undiagnosed and that Nigeria accounts for 8.3 per cent and 4.5 per cent of the global burden of chronic hepatitis B virus and hepatitis C virus respectively. Assessing the national response, Ekanem said not up to 10 per cent of people who are living with the virus know about the disease.

“Right now, we want the government and international partners to focus attention on making a significant financial commitment to viral hepatitis elimination. Just one of the drugs costs almost about N60,000; so it’s important that the diagnosis is covered, and the treatment is covered under insurance.

“Unfortunately, funding for hepatitis in Nigeria is paltry. Unlike HIV, tuberculosis (TB), and malaria which kill less people compared to hepatitis, they receive funding from the Global Fund and other sources like the President’s Emergency Programme for the Relief of HIV and AIDS, PEPFAR, but hepatitis doesn’t.” “The government needs to own this one up so that we can ensure that the next generation will be free from viral hepatitis.

We are calling on the private sector and pharmaceutical companies to come together but it is the government that will bring all of them together to stamp out viral hepatitis in Nigeria.” Ekanem stated. Noting that hepatitis patients still have to buy their medication out of pocket, Ekanem expressed

Funding for hepatitis in Nigeria is paltry

worry that in view of the current economic situation, most patients do not have access to medication because they can’t even afford it. “In terms of assessment, we’ve not done well, and it’s a clarion call for all of us to go back to the drawing board and see how we can invest, particularly the government and international development partners, because we have not done well.

Treatment is still very difficult to access, diagnosis is difficult to access, and even vaccination will help to prevent the next generation from getting this virus. These things are not available. “That means when patients start that medication, they need to continue to take it.

Dropping out of medication is worse than not even taking, so the government must allow the insurance system to support the whole cascade of care, even up until the point where there’s liver transplant. “With the new guideline of WHO, more people, up to 50 per cent of patients need to be on treatment.

The question is, if many people who are supposed to be treated don’t even have access to treatment when the new guideline is implemented and more people need to be on treatment, how would they be able to go on treatment? Decrying the country’s highest burden in Africa, he said the reason is because newborns are exposed to the virus.

“Our prevention of mother-tochild transmission (PMTCT) approach is not widespread. For you to be able to reduce the burden of the virus, you must be able to ensure that every newborn child has access to birth dose vaccination within the first 12 to 24 hours of birth. “Unfortunately, that is not much available in certain settings.

We know that the government of Nigeria, working with Gavi and other partners, has initiated the birth dose vaccination, but availability at the last mile is still a challenge, and that is what we need to address so that every newborn child can have access to the vaccine.

“We also need to ensure that every pregnant woman during an antenatal visit has access to hepatitis B screening. Once we know the status of a woman, we can take steps by giving her safe antiviral medication to ensure that we reduce the viral burden within her system so that the child does not even contract the virus during the gestational period.

“And after birth, we can also ensure that the child has access to the vaccine to ensure that the child doesn’t come down with the virus. If we can improve our PMTCT approach, we can drastically reduce the burden of the virus in Nigeria.” Ekanem said viral hepatitis is highly asymptomatic, which means that most patients tend to feel very well, and very fine.

“They don’t see the symptoms because the liver, which is the target organ that hepatitis deals with, can regenerate itself. So even when the liver is almost damaged, it still functions as though it is in optimum health. So we often tell patients not to wait. We tell individuals not to wait until they start to see the symptoms.”