Prince Danjuma Ada, the past president of the World Hepatitis Alliance and of the Aspen New Voices Fellowship, in this interview with Sade Oguntola, he says that preventing hepatitis in newborns is just as important as ensuring access to hepatitis testing and treatment for stem cases of liver cancer in Africa, Nigeria, and beyond.
You were diagnosed with hepatitis B in 2004, so what is your personal perspective about the disease?
I had a needle prick injury in 2004 while working in the hospital, after which I tested positive for hepatitis B. Imagine someone with a background in microbiology and virology who works in the hospital’s laboratory but has very little understanding of what hepatitis means. That is to tell you about the low level of awareness about hepatitis globally, even among health care professionals, who are people who should know better. Then, two years later, I lost my mother to liver complications from hepatitis C. That was the icing on the cake. I told myself I needed to do something to increase awareness about hepatitis and to ensure others do not pass through the same pains. So, that was when I started the charity.
Even now, awareness of hepatitis is low. There is a lot of misconception and misinformation about hepatitis. It is a disease that is killing many people, people are not aware, our governments are not doing anything about it in terms of providing access to care and it’s important for the public to pick up health seeking behaviours and get tested in order to stop the progression of the disease liver cirrhosis and liver cancer.
What do Nigerians need to know about hepatitis B?
Hepatitis B is the leading cause of liver cancer, and the majority of people with hepatitis B don’t even know. A few weeks ago, data released by the World Health Organisation said that over 270,000 people die in Africa from hepatitis B and C-related liver diseases including cancer every year. So it’s a silent killer. Hepatitis B and C are now the second most infectious killer disease after tuberculosis and COVID-19. The challenge is that one in seven people with hepatitis B and one in five people with hepatitis C have been diagnosed. So, the majority of people with this disease that causes liver cancer are not aware. Just like COVID-19 attacks the lungs, hepatitis affects the liver. That is why people should be concerned because it attacks the liver, the largest organ, and the engine inside the body. If the engine of the body is gone, an individual definitely won’t survive.
It’s really unfortunate that many people with hepatitis don’t know about it and are taking alcohol and herbal preparations, which are also bad for the liver. So, the majority of people are diagnosed too late, when it has already gotten to advanced liver disease or liver cancer. The best way to know if you have hepatitis is to get tested. Early detection saves lives.
What challenges have you faced since being diagnosed with hepatitis B?
The first challenge was when I was first diagnosed because there was a lot of stigma. It is people being shamed for having hepatitis. The first challenge was disclosing my status to the partner I was to marry, who is currently my wife. I was able to summon the courage to share it with her. She was negative, and she got vaccinated. The fear of the possibility of transmitting the virus to patients while working in the clinical diagnostic department is also a challenge. These were things that were always consciously in my head and that sometimes affected my confidence level. Now, for the fear of transmitting, as a health professional, assuming there was a cure, I wouldn’t have that fear.
Then the other challenges have been about the cost of treatment. Unfortunately, the tests to determine the legibility of treatment, including treatment for hepatitis B, are very expensive. But I’m happy I was able to overcome many of these challenges.
What can we do to make hepatitis—an ‘invisible disease’ that is the leading cause of liver cancer—more visible?
It starts with media enlightenment on hepatitis to educate the public, including healthcare professionals, to put a face to the numbers of people with hepatitis and increase awareness. It is not only about the letters of the alphabet (A, B, C, D, and E). Hepatitis is about the liver; it is about people having liver cancer. According to the WHO, hepatitis kills 1.3 million people every year. And even though the cost of treatment has come down, it is not readily available.
Hepatitis B can be prevented through an effective vaccine, but the vaccine is not available for babies, especially in hospitals in rural areas and for populations that are at high risk. So, hepatitis must be in the limelight, like HIV, TB, and malaria. Even in hospitals, you can barely see any information displayed about hepatitis, and yet people are dying from liver cancer, liver cirrhosis, and liver complications that are attributable to hepatitis. This is unacceptable. Hepatitis is preventable, and its vaccine is cheap. For hepatitis C, the cure is less than N100, 000. And the treatment for hepatitis B is less than N5, 000 per month. So why should people still die from a disease that is treatable and curable? This is unacceptable, particularly because the Nigerian government signed a 2016 agreement in Geneva that they were going to eliminate hepatitis. So, it’s really a cause for concern.
What about mother-to-child transmission of hepatitis B?
There is very little information and awareness about mother-to-child transmission of hepatitis B. It is the same in many countries in the developed world. It is not common knowledge that about 15% to 20% of babies that get infected with hepatitis from birth will end up developing liver cancer and may die at a very productive age. An infected mother can transmit the virus to her baby at birth, during delivery, or within the household. The condition of hepatitis B becomes worse at an early age when one is infected from childhood.
The World Health Organisation has recommended that all pregnant women should be tested for hepatitis B in antenatal care and that all babies be vaccinated with the hepatitis B vaccine within 24 hours of delivery, especially babies that are born to women that have hepatitis. They have an increased risk of getting hepatitis. Hepatitis can be transmitted from mother to child during pregnancy, but the chances are very limited compared to during birth and then during early childhood. But how many governments are doing that? This needs to be corrected. We need to ensure that the government at all levels takes up hepatitis B testing in the antenatal period so as to stop mother-to-child transmission of hepatitis B and then improve the birth-dose vaccination.
What are the risks of transmitting hepatitis to a baby during childbirth?
The risk is very high, especially from vaginal delivery, because the baby is exposed to the blood from the mother. If there is a cut through the nose or mucus membrane, the baby could get infected. That is why the WHO recommended that pregnant women with hepatitis receive prophylaxis treatment and their babies be vaccinated within 24 hours of birth to prevent or minimise the risk. The prophylaxis treatment is given at 28 weeks of pregnancy, up to 3 to 4 months after delivery.
When the woman delivers, WHO recommends that the babies receive the birth dose vaccine within 24 hours or as early as possible, too. But the majority of hospitals don’t give the vaccine until after one or two weeks. Some places don’t even do the vaccination at all. Babies that are delivered by the weekend or after closing hours are also not vaccinated because the vaccine would have been returned to the fridge for proper storage. This is unacceptable because 15 to 20% of babies that get infected at birth are likely to die from liver cirrhosis or cancer. They will never achieve their goals in life.
It might interest you to know that this vaccine costs less than 30 cents, but where is it? So, women should also call and say that they need a free hepatitis test during pregnancy. It is a fundamental human right. Without testing during antenatal care, it is impossible to know if a woman is positive for hepatitis B or not. African countries can eliminate mother-to-child transmission of hepatitis B by integrating free hepatitis B testing into maternal and child health and by promoting the birth dose. Also, the nurses that give the general health talks during antenatal should provide general awareness about hepatitis.
Why should African governments implement new WHO guidelines on treatment?
A few weeks ago, the WHO, in a release, said Africa is home to 63 to 65% of all the hepatitis B cases in the world. In Sub-Saharan Africa, over 770,000 people are living with it, and 270,000 people die from hepatitis-related complications in Africa annually. And 77, 000 new infections happen annually, which is unacceptable. In Africa, the death rate and morbidity from hepatitis B are on the increase. So one of the ways governments can implement the guidelines is that they should improve testing and treatment.
The treatment is affordable; it costs 28 dollars for a year, but it’s not available. Middlemen in pharmaceutical companies are taking advantage of this and selling the medicines to treat hepatitis for more than 28 dollars a year; for hepatitis C, it is $60 for 3 months. This is the approved cost. In Nigeria, these drugs are going for between 100 and 200 dollars. The government should intervene to prevent middlemen from buying these medicines at that subsidised rate and then inflating prices before selling them to people. This will prevent people from dying from this preventable, curable disease. Hepatitis is also preventable through vaccination. All health care workers are supposed to get this vaccine free of charge to protect them from getting infected. The vaccine is affordable, but it is not available because governments lack the commitment and the will to invest in hepatitis. However, for every dollar any government invests in hepatitis care, they gain back two to three dollars as a return on that investment because they have prevented people from dying from liver cancer. People are dying at the prime of their lives from liver cancer in Africa. Why would you invest in education for young people who are infected from childhood and may not even live to fulfil their dreams due to liver cancer because they were not protected from the infection or lack access to hepatitis treatment? So it is a win-win for the government to invest in hepatitis care. It strengthens the immunisation system, the maternal and child systems, and the capacity of healthcare workers. Also, the more we test people, the more people are placed on treatment, and we avert deaths from liver cancer. It is possible to eliminate hepatitis if everyone commits.
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