As the Biden administration continues to combat the COVID-19 pandemic, there is also an important opportunity to address long-standing gaps in our responses to other public health threats — like viral hepatitis.
For many of us working to eliminate viral hepatitis, the struggles our nation has faced to contain and control COVID-19 have been a painful yet predictable reminder of the fragility of our public health and health care system. Recent trends of increasing viral hepatitis rates present valuable lessons learned and clear opportunities for the Biden administration to strengthen our public health response to viral diseases.
The latest U.S. Centers for Disease Control and Prevention and Department of Health and Human Services data shows that viral hepatitis rates have increased over the last several years. Major outbreaks of hepatitis A, which is vaccine-preventable, have been reported in 35 states over the last 5 years, resulting in over 22,000 hospitalizations and hundreds of fatalities. HHS has warned of an 11 percent increase in new hepatitis B cases since 2014, half of them among unvaccinated adults in their 30s and 40s, alongside an estimated 50,000 people newly infected with hepatitis C in 2018 alone. Transmission of viral hepatitis — most cases of which are either preventable or treatable — has been particularly high among people who use drugs and people experiencing homelessness. Disturbingly, significant disparities in disease burden and mortality continue to persist for Asian Americans and Pacific Islanders, Native Americans and Black Americans.
Unfortunately, COVID-19 has cost us valuable time in reversing viral hepatitis trends, as health department attention has been diverted, testing and vaccination programs have reduced services and syringe services programs for people who inject drugs have been forced to cut back hours. Moreover, the long-standing challenges in reducing viral hepatitis rates reflect the shortcomings in our public health and health care systems that left us insufficiently prepared to respond to COVID-19. In the case of viral hepatitis, federal funding allocated to CDC’s Division of Viral Hepatitis has remained flat at a meager $39 million annually for several years, even as new infections swept across the country.
As the administration and Congress rightly prioritize COVID-19, they must also take the opportunity to rebuild and strengthen our nation’s public health infrastructure and capacity to tackle viral hepatitis and other infectious diseases. This requires bold action in three areas: addressing the opioid overdose crisis, tackling health disparities and offering improved leadership and coordination.
The increase in new viral hepatitis infections parallels the dramatic rise in overdose deaths due to the opioid crisis. Addressing both epidemics requires urgent action as detailed in a recent letter to the Biden-Harris transition team. Action should include a commitment to expand syringe services programs, removing barriers to accessing methadone and buprenorphine for treating opioid use disorder, allowing localities to establish safer consumption spaces and marshaling funding for comprehensive harm reduction programs that can provide viral hepatitis testing, vaccination and linkage to care.
COVID-19 has also highlighted that health disparities are driving worse outcomes for the most at-risk Americans. From vulnerability and exposure to prevalence and mortality, enduring racial disparities continue driving up viral hepatitis rates in underserved communities. Viral hepatitis similarly magnifies and manifests through underlying inequities fueled by homelessness, mass incarceration, the dispossession of Native Americans and discrimination borne by immigrants. We cannot achieve the promise of viral hepatitis elimination without adopting a rigorous equity lens in policy, planning and programs.
Lastly, the administration has an opportunity to improve federal leadership and coordination to best address public health threats like viral hepatitis. In January, HHS released a credible and comprehensive National Viral Hepatitis Strategic Plan, “a framework to eliminate viral hepatitis as a public health threat in the United States.” This ambitious plan, developed in parallel to new plans for HIV and for other sexually transmitted infections, presents a rich template for the administration and Congress. But federal plans are not self-implementing, and require a combination of leadership, political will, dedicated resources and collaboration.
The polarization and politicization of COVID-19 has presented a challenge in renewing trust and restoring confidence in public health. Accountable progress towards viral hepatitis elimination goals would go far towards demonstrating effective leadership, and CDC Director Dr. Rochelle Walensky’s HIV expertise will serve her well in prioritizing viral hepatitis.
Despite setbacks and challenges, the massive mobilization around COVID-19 testing, care and vaccination brings valuable lessons on both the promise and gaps in our capacity to combat infectious disease threats. Viral hepatitis elimination poses a valuable bellwether of our collective readiness to learn and apply these lessons going forward.
Daniel Raymond is the director of policy at the National Viral Hepatitis Roundtable and has a three-decade history of working in harm reduction programs, promoting the rights and dignity of people who use drugs, and advocating for policies to protect and advance drug user health.
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