As the world prepares to mark World Hepatitis Day on July 28, we are reminded of both the progress made and the challenges that lie ahead in the fight against viral hepatitis. This year's theme, 'Hepatitis: Lets Break it Down' calls for urgent action to dismantle the financial, social and systemic barriers that continue to hinder hepatitis elimination and liver cancer prevention.

Viral hepatitis B and C represent significant global public health challenges, often progressing asymptomatically until advanced disease develops. These viruses are primarily transmitted through infected and unsafe blood products, contaminated medical procedures, shared injections, mother to child transmission during birth and from unprotected sex.

According to the Global Hepatitis Report 2024,304 million people were living with chronic hepatitis B and C in 2022. Each year,1.3 million people die, mostly from liver-related complications and cancer. Without rapid and sustained action, by 2030 we could see2.85 million more deaths, 9.5 million new infections and 2.1 million additional liver cancer cases.

In2022, WHO estimated that the South-East Asia Region had 61 million people living with hepatitis B and 9 million people with hepatitis C. This accounts for the second largest number of new hepatitis B infections globally after the African Region. Yet less than 5% of those with hepatitis B have been diagnosed and received treatment, and 26% of people living with hepatitis C have been diagnosed and 14% have received treatment.

The global response to viral hepatitis is falling short of the 2030 Sustainable Development Goals. However, with strong political will and investment, this can change. Universal access to hepatitis prevention, testing and treatment between 2024and 2030 could save 2.85 million lives, prevent 9.5 million new infections and avert 2.1 million cases of liver cancer.

This is a critical window of opportunity. Evidence from multiple national investment case studies shows a strong return on investment – an estimated $2-$3 in economic and health gains for every dollar spent on hepatitis elimination.

Although viral hepatitis is one of the leading causes of preventable death from communicable diseases, it continues to receive less attention globally compared to HIV or tuberculosis. This neglect is not just a policy failure, it is a missed opportunity to save millions of lives.

In Nepal, the prevalence of chronic hepatitis B and C is 0.9% and 0.38%respectively among the general population. However, the rates are higher among high-risk populations such as people living with HIV (PLHIV) and people who inject drugs (PWID). In Upper Dolpa, the prevalence of viral hepatitis B has been reported as high as 17% as per some published studies. Although national data on the actual disease burden is not available, global estimates suggest an estimated 115,179 people live with chronic hepatitis C in Nepal, yet only 18% are diagnosed and a mere 1% received treatment.

These figures highlight a critical gap between disease burden and access to treatment and care. Despite the availability of cost-effective diagnostics and curative treatments, many people remain undiagnosed or untreated due to limited-service coverage, lack of awareness and financial barriers to care.

While nine designated treatment centers for hepatitis C offer free treatment, these services remain limited. Majority of patients with chronic hepatitis B and C seek treatment at private clinics or hospitals, leading to substantial out-of-pocket expenses, often catastrophic when liver disease is at advanced stages or liver cancer has developed.

Despite these challenges, Nepal has demonstrated that progress is possible with strong political will and targeted public health interventions. In 2019, Nepal along with Bangladesh and Bhutan became the first countries in WHO South-East Asia Region to achieve hepatitis B control among children under five, thanks to robust childhood vaccination programmes.

Building on this momentum, the government's National Strategic Plan for Viral Hepatitis (2023-2030) aims to reduce new cases of chronic viral Hepatitis B and C by 90% and deaths by 65% by 2030.

Nepal's federalised health system and strong primary health care network offer a strategic opportunity to expand viral hepatitis services and progress towards achieving universal health coverage goals. Integrating viral hepatitis services into essential health services and national health insurance benefit packages would make care more accessible and affordable, especially for underserved populations.

Decentralising services to primary health centres and equipping local-level healthcare workers with basic competencies in hepatitis case management could bring life-saving care closer to those who need them most. At the same time, we must combat misinformation, stigma and discrimination with accurate public education about viral hepatitis.

Eliminating mother-to-child transmission of hepatitis B and achieving micro-elimination of hepatitis C among the high-risk groups – such as people who inject drugs (PWID), medical patients, migrants and prison populations – can accelerate national efforts to eliminate viral hepatitis. To enhance the progress, the country must prioritise these targeted interventions as part of a comprehensive elimination strategy.

On this World Hepatitis Day, I urge the government, policymakers, healthcare providers, civil society and the public to seize this opportunity to eliminate viral hepatitis. We must accelerate our collective efforts to eliminate viral hepatitis in Nepal by breaking down barriers to healthcare access, ending stigma and ensuring everyone has the opportunity for prevention, diagnosis, treatment and care.

Inaction is not an option. Together, we can save lives, prevent new infections and move towards a hepatitis-free future for Nepal.

Dr Pandav is the WHO Representative to Nepal