INTERVIEW: Low awareness hampering elimination of hepatitis in Nigeria – Expert

World Hepatitis Day is commemorated each year on July 28 to enhance awareness of viral hepatitis, an inflammation of the liver that causes a range of health problems, including liver cancer.

In Nigeria, over 22 million people are infected with hepatitis B and over 4 million with hepatitis C. Yet, the awareness level of this infection is still very low.

In this interview with PREMIUM TIMES, Mike Omotosho, a public health expert and President of Hepatitis Zero Nigeria Commission talks about the many challenges facing treatment and elimination of the virus.

PT: In 2016, the WHO set targets to eliminate viral hepatitis as a public health threat by 2030, and provided a Global Health Sector Strategy (GHSS) to run from 2016–2021. Nigeria joined the league of other nations to sign this. Do you think Nigeria is on course to meet this target?

Omotosho: No, we are not but we are about to start the process. I say this because in 2016, donor partners came together and there was a strategic document developed for Nigeria. This is the Fifth year and this has not been implemented, Predominantly due to lack of funding. More importantly, the WHO goal is what has been reoriented into the Sustainable Development Goal (SDG) targets so it’s now been extended to 2030. That way we have a fresh start. When WHO look at the target, they realised that we top countries are yet to meet the strategic plan that was formulated, that’s why it came with the SDG target 3.3. But 10 years can look like a lot of time but also very short amount of time especially in public health. I am sure there is something Nigeria can do and now we are starting this way, with the powerful collaboration with hepatitis zero, National Orientation Agency and National Coordinator of the National AIDS and STDs Control Programme, I’m sure we will soon be on target towards meeting that goal but the process is just about to start. So yes, we don’t even have parameter to judge if we are on target yet but we can categorically say we are not on target. However, we have what it takes to be on target and we will walk along that path.

PT: What are the challenges towards eliminating viral hepatitis in Nigeria and or meeting the 2021 target?

Omotosho: There are several barriers as to why Nigeria cannot eliminate hepatitis by 2021. Number one is lack of awareness about the disease and to improve awareness, a lot of funding will be needed. For instance, we have less than a thousand Gastroenterologist in Nigeria so If you divide that to 200 million people that will tell you how many Nigerians we have to one gastroenterologist. The cost of treating hepatitis is also a major issue. The treatment of hepatitis cost about $90,000, even though there are fundings available through donor partners where African countries can apply for 90 per cent discount, meaning we will pay 10 per cent. That is about $9,000 but in a country where majority of the people live with the little they earn you will agree with me that $9,000 for treatment is still a lot of money. I must add that there are local treatments for hepatitis C but these drugs have not been certified by WHO or even confirmed by the National Agency for Food and Drug Administration and Control (NAFDAC)

PT: Over 22 million Nigerians are infected with hepatitis B and more than 4 million with hepatitis C, yet the awareness about this disease is still very poor. What do you think can be done to boost awareness?

Omotosho: To boost awareness as a nation, we need to come up with some creative schemes of which hepatitis zero is one. The moment you hear that, everybody understands and even a child understands that it means you want to achieve zero hepatitis. Also the countdown campaign to be launched tomorrow, World Hepatitis Day, as a reminder of 10 years to curbing hepatitis in Nigeria or globally. Partnering with requisite agencies such as NOA has been useful in improving awareness level in the country. This has given us an avenue to reach out to people at the grassroots level. There are days we go into these communities to talk about the dangers of hepatitis and where possible, how to prevent them. So if we are able to partner other agencies too, that will be very useful. Not until a lot of people get to know about it, significant progress cannot be made. I tell people that when you talk to about 10 people, eight of them will have bad story to tell you about hepatitis, like my brother died due to hepatitis etc. Now if you go to the next step and ask what hepatitis means, they will look at you because they don’t know what it means. What causes hepatitis? They do not know. How can you protect yourself against hepatitis? They do not know. But they know the word hepatitis and they know it kills. So we need to let them know beyond the name, it is a virus that destroys the liver and then moving into what can be done. From there people will be willing to know their status and then we can talk about vaccination for protection or treatment for management or cure. So I think the bulk of it rests around awareness.

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PT: A recent survey implies that Nigerian health workers have a poor knowledge about this viral disease hence the rise in infection among medical staff. What can be done to address this?

Omotosho: We have data showing that, so yes it is true. We have data of some teaching hospitals showing the prevalence rate of hepatitis amongst health workers. You know because it is highly contagious and the virus itself is more dangerous than the HIV virus. In fact in medical terms, you will say it’s 50 times more virulent which means it can actually cause harm 50 times more than another virus which is HIV in this case. So most of our health workers do not fully understand the health hazard and for some of them that understands the health hazard, they probably decide to save a live and take the risk, thereby endangering their own lives too unfortunately. I don’t want to blame government or anybody for not providing adequate protection for health care workers. But it’s all part of the problem because in most hospitals, health care workers are not working with adequate tools. There is also the lack of adequate awareness on the health workers part so indeed when we have enough funding, where the skills acquisition will start from will be capacity building for health care providers because they are usually the first line of call. It will be best to understand how they can protect themselves first because it is only when they are protected and alive they can protect others.

PT: Do you think Nigeria has the political will and a robust budget line to support the elimination of this silent killer disease that infects more than 20 million people in our country?

Omotosho: For me, it’s a yes yes for both of them. We have what it takes and we are very resilient people. If Nigeria is able to calculate its economic loses due to hepatitis and come to terms with how to prevent it, yes whatever budget is alloted to hepatitis will be very insignificant compared to the losses we have already incurred. So yes we have the political will but it has not been displayed. We also have the money but it has not been appropriated.