Accelerating Action Towards the Elimination of Viral Hepatitis

Accelerating action towards the elimination of viral hepatitis

Event Report from WHS17 Event report 14 22 32 40 2017 1: 1 November Day 2017 2: 2 November Day 2017 3: 3 November Day 3 ontents rogramme content rogramme 6 Introduction 8 12 Background Objectives P Key Summit take-aways 44 Impact 52 Annexes C THE EVENT IN NUMBERS

750+ DELEGATES FROM 106 COUNTRIES COUNTRIES IN ATTENDANCE

118 GLOBAL 900+ PIECES OF EXPERT SPEAKERS MEDIA COVERAGE

82 PROGRAMME MANAGERS FROM 65 8060 TWEETS TO COUNTRIES #HEPSUMMIT2017

300 ABSTRACT POSTERS 91.3 MIL SOCIAL DISPLAYED MEDIA IMPRESSIONS WHS17 Event report host Government ofBrazil. incollaboration withthe Hepatitis Alliance (WHA) O World HealthOrganization (WH significant event was ajoint initiative between the for production two years,In nearly thisglobally many challengesofviral hepatitis. ideas, experiences inaddressing andbestpractice the platform for abroad hepatitis to community share advance theviral hepatitis agendaandto provide a T second World Hepatitis Summit. T cametogetherglobal hepatitis at sector the World NovemberIn 2017,over 750delegates from the I rade Center P inSão he event globalmeetingto was alarge-scale, c ntrodu aulo, Brazil inorder to attend the ) andthe World tion 6 WHS17

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Background

The World Hepatitis Summit focuses on a public health approach to viral hepatitis.

It was initially convened to build on the World Health Assembly 67.6 resolution, which asked WHO Member States to develop and implement national viral hepatitis strategies and to call on WHO to examine the feasibility of eliminating hepatitis B and C with a view to setting global targets and developing a monitoring mechanism.

Such elimination efforts can only be realised when the world is united in action.

Consequently, the Summit was developed to provide a much-needed platform for over 100 Member States to learn from others in implementing their viral hepatitis action plans and to create opportunities for multi-sector audiences to share key learnings from country scale-up activities and national efforts to eliminate hepatitis.

The Summit was also designed to forge relationships between civil society and governments and to strengthen the community voice in the viral hepatitis response.

This community voice is relatively new within viral hepaitits and still needs strengthening. The Summit was therefore designed to specifically fill a gap in an area that had traditionally been saturated by scientific and medical conferences but which has lacked a platform for civil society and government to come together for the benefit of hepatitis patients.

9 WHS17 Event report lack of global action to combatlack ofglobalaction thedisease. Yet, recently, until very there hadbeenaremarkable people are chronically infected withhepatitis BorC. million peopleayear andmore than325million Worldwide, approximately viral hepatitis kills 1.34 G comparable to comparable MILLION 257 lobal MILLION PEOPLE PEOPLE 71 +22% +22% H HEPATITIS C HEPATITIS B ealth = = S 66% Hep B Hep 66% 30% C Hep E Hep 3.3% 0.8% A Hep 3.5% increase in since 2000 ec mortality mortality 1% tor S TB trategy 10 • threat by 2030: would eliminate hepatitis BandCasapublichealth T 13years.the next treatment to 80%,saving 10millionlives globallyin systems, reduce annualdeaths by 65%andincrease countries which,ifreached, willstrengthen health for actions by 2030andincludesanumberofpriority eliminating hepatitis BandCasapublichealththreat Sustainable Development. to theachievement ofthe2030Agenda for T global commitment to viral hepatitis to date. V unanimously voted to adoptthefirstever Global At the69th World HealthAssembly, governments hepatitis by 2030was madeby States. 194Member May 2016,ahistoric commitmentIn to eliminate viral It’s eminently achievable.justrequires It immediate but that doesn’t meanit’s someunattainable dream. by 2030.For sure, we are stillalongway from thisgoal governments committed to eliminating viral hepatitis that“We lastyear cannotlosesight ofthefact 194 scale upinresources isvital. andprioritisation national hepatitis plansinplace –meaning adramatic across theworld. Many countries stilldonothave isthenewfocusImplementation for governments to maketheelimination ofviral hepatitis areality. considerable politicalwill, more work isstill needed Although theadoptionofStrategy demonstrated • • • • he Strategy outlinesanumber ofkeytargets that he GHSS was the first of its kind andwill contribute he GHSSwas thefirstofits iral Hepatitis Strategy (GHSS), signalling thegreatest 80% ofpeopletreated 90% ofpeopleaware oftheirillness are safe90% ofinjections 100% ofblooddonations screened vaccination 90% ofinfants receive dose ahepatitis Bbirth

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meetings. sessions, panels, workshopsof plenary andside addressed across eachdirection itsthree days framework for theSummit, whichmethodically T • • • • • hepatitis: and five strategic critical directions to eliminate viral T within thecontext oftheGHSS. stepobvious inthefight next towards elimination momentum oftheinaugural event andprovided the T elimination ofhepatitis asapublichealththreat). StrategySector on the event’s theGlobalHealth strapline: Implementing implementation ofsuchstrategies –asindicated by point andlookedat the picked upfrom thisstarting hepatitis strategies. for States Member to developopportunity national in September2015Glasgow to provide an T leave witha ‘can do’ attitude”. Strategy into concrete andinspire peopleto actions Summit 2017isallabouthow to turn WHO of the World Hepatitis Alliance. “ action,” says Gore, Charles P hese five strategic provided directions the his globalStrategy outlinesa vision,goals, targets his focus onimplementation builtonthe he inaugural World Hepatitis Summittook place acceleration Strategic 5:Innovation direction for sustainability Strategic 4:financing direction for Strategic 3:Delivering for direction equity Strategic for 2:Interventions impact direction focused action Strategic 1:Strategic direction information for V T iral Hepatitis (GHSS): he second SummitinBrazil ast P T resident andFounder he World Hepatitis T owards the ’s global 11 “ World Hepatitis Alliance P GoreCharles with a ‘can do’ attitude. inspire peopleto leave concrete and actions global Strategy into how to turn WHO Summit 2017isallabout T ast P he World Hepatitis he World resident andFounder ’s

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WHS17 port e r nt e Ev WHS17 Event report • • • • included civil together aglobalaudience from 106countries that three daypolicy event P inSão T O • • T of Health,publichealthscientists andfunders. States, patient organisations, Ministers policy-makers, he World Hepatitis Summit2017was apublic- he Summit’s were: keyaimsandobjectives viral hepatitis” ofpreventing,aspects diagnosing andtreating “promote theinvolvement inall ofcivilsociety WHA67.6, whichurges States Member to stakeholders and/or diagnostics through engagement ofkey T T best practice plansthrough of hepatitis thesharing action T from WHO support the latest publichealthresearch andtechnical useof plansbyviral making hepatitis action T funders. to where itisneededby engaging keyglobal T engagement ofinternational media. top-tier T o discussfundingmechanismsfor medicines clause1.3of o support WHO o improve theimplementation ofexisting viral o increase thenumberofcountries developing o encourage publichealthresearch anddirect o raise theprofile ofviral hepatitis by bjec society groups, society WHO tives aulo, brought Brazil. It ’s R and its Member and itsMember esolution 12

WHS17 port e r nt e Ev WHS17 Event report : 2017 ne Side meeting Submissions presentations O ovember ay for focused action focused for Georgia in elimination Making a reality elimination Unitaid’s role in the global hepatitis C in the global hepatitis role Unitaid’s hep C elimination for as a tool Policy Opening session and partnerOpening session introductions information direction 1: Strategic Strategic HCV information: of strategic critical role The hepatitis plan on viral a national Developing case? investment an develop to How raising awareness successful develp to How response campaigns? Harnessing the learning from Harnessing the learningcampaigns? from civil society and other global initiatives D 1 N 15 lenary P Workshop KEY WHS17 Event report of thecountry’s ongoingnational initiatives and the World Hepatitis Summit2017,inrecognition Consequently, andhost Brazil was chosento partner preventing, diagnosing andtreating viral hepatitis. coordinated, national multisectoral strategies for which urged governments to develop andimplement co-sponsored anew WHO resolution (WHA67.6), in 2014,at the67th World HealthAssembly, Brazil one ofonlyfour days. Similarly,WHO disease-specific whichestablished World(WHA63.18), Hepatitis Day as by proposing thefirstever viral hepatitis resolution was instrumental inputtinghepatitis inthespotlight 2010,at the63rdIn World HealthAssembly, Brazil intensified andglobalhepatitis response. world stagefor many years andhadpushedfor an Brazil hadchampionedthe causeofhepatitis onthe ofHealthforMinister Brazil. handed over to theHonourable R O address from R T O he World Hepatitis Summitopenedwithashort “ fficer, andotherspeakersbefore thestage was pening Brazil ofHealth Minister R the road to elimination. hepatitis forward –on in itsresponse to recenttaking advances Brazil iscommitted to icardo Barros aquel P C eremony eck, eck, WHA’s ChiefExecutive icardo Barros, ” 16 on theroad to elimination.” recent advances initsresponse to hepatitis forward – posed by viral hepatitis…Brazil iscommitted to taking representatives to discusstheglobalhealthproblem researchers,of experts, managersandcivilsociety teamSummit 2017–andwelcomes thisextraordinary “Brazil ishonoured to hostthe World Hepatitis their treatment for allannouncement: Adele echoedtheMinister’s Benzaken comments on ofHealthBrazil, Dr oftheMinistry Department Director for STI,HIV/AIDSand hepatitis around theworld”. will beabigstep forward inthetreatment ofviral Hepatitis Day. Heconcluded: “I hopethat thisevent resolutions onthediseaseandcreation of World viral hepatitis, beingakeyplayer invarious WHO one ofthefirstnations to begin thefight against He endedhisspeechby that declaring Brazil was with hepatitis C. estimated 660,000Brazilians thought to beinfected Brazil would now betreating allofthe andcuring Barros usedtheSummitto formally announce that age of49in2013to universal free access in2016,Mr for free hepatitis Bvaccinations from thoseupto the Having already increased thenumberofthoseeligible 2030. host nation’s ambitiousplansto eliminate hepatitis by Barros tookMr to thepodiumto tell delegates ofthe hepatitis. consistent international leadershipinthearea ofviral V iral Hepatitis • elimination by 2030: implementing viral hepatitis initiatives to helpreach to share theirnational successes andchallengesin R and Ministerial Showing trulyglobalrepresentation, 12Ministers responsible for leadingonhealthreforms. senior leadersfrom thecentre ofgovernment –those elimination areality sessionbroughtmaking together P andtheGlobalHepatitis HIV/AIDS Department Chaired Director ofthe Hirnschall, by DrGottfried viral hepatitis. strong politicalcommitment to theelimination of profile government casestudiesthat demonstrated T received contaminated blood transfusions, reiterated having contracted theinfectionin 1982whenhe T Bachchan, alsowelcomed delegates to theevent. for Asia Hepatitis intheSouth-East R veteranBollywood and Ambassador WHO Goodwill • • • • • • • • • • • M he start ofthemeetingoffered ofhigh- aseries he start he actor, wholost75%ofhisliver to hepatitis B, rogramme (GH P) at O andR WH Greg Hunt, (by Minister video), Australia Byambasuren Lamjav, Wang Guogiang, Georgia Amiran Gamkrelidze, P National Committee), Egypt Ad Said, (Chairman Minister Kadri ofthe Dr Aceng, Minister, Uganda Saira Afzal N Christopher Fearne, Minister, Malta P Manthabiseng R Firdous Yousif, Minister, Sudan aking icardo Barros, Minister, Brazil izar Yazji, Minister, Syria

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reality 17 detail throughout theSummit. stories andcasestudieswere presented inmore of viral hepatitis withintheirregions andwhose Georgia) boldsteps intheelimination whoare taking (Brazil, Egypt, Bangladesh, Mongolia, T towards elimination. organisationsand civilsociety to accelerate action change makersingovernments, medicalprofessions P further, R government commitment to viral hepatitis still T eliminate viral hepatitis. andcommitment to leadthefight his support to o reinforce thedemonstration ofinternational he programme wasby spearheaded sixcountries rogramme, whichisdesigned to together bring key aquel P “ Hepatitis in South-East AsiaHepatitis inSouth-East R Ambassador forWHO Goodwill Amitabh Bachchan a reality for all. to makehepatitis elimination T eliminate hepatitis by 2030. world hasanewvisionto I extremelypleasedthat the he questionnow really ishow eck launchedtheNOhep T he Gambia and he Gambia V isionaries isionaries

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WHS17 port e r nt e Ev WHS17 Event report on viral hepatitis. gave delegates onglobalprogress anoverview P Sharon Hutchinson, P preparedness to respond to hepatitis. StatesWHO Member inrelation to theGHSSandtheir Hepatitis withtheaimofdetermining thestatus of P in2016toa project establishCountry implemented. order In to baselinethis, WHO initiated order to recognise what tailored investments may be extent ofthehepatitis epidemicandresponse in Strategy’s firststrategic looked direction at the T most countries –anissuethat would beaddressed fundamentally,Most financing remains anissue for stressed that obstaclesto elimination stillexist. countries now have viral hepatitis plansinplace but P years. countries developing national plansover thelastfive to viralrisein hepatitis –witha nearfive-fold made by countries across WHO regions inresponding T infected with viral hepatitis. 132 countries –equalto 87%ofthe325million P intelligencepreliminary from these WHO Country focused S he Summit’s sessionsdealingwiththeglobal he session underlined the fact that progress thefact he sessionunderlined isbeing opulation Healthat Glasgow Caledonian University, rofessor Hutchinson announced that intotal, 82 rofiles, from whichthere hadbeen responses from trategic

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his usedthelatest data and c direc tion rofessor ofEpidemiologyand tion 1:S rofiles on trategic V iral commitment andnational planning. and response asabasisfor advocacy, political to understandtheviral hepatitis epidemic StrategyHealth Sector focuses ontheneed T 18 he firststrategic from direction theGlobal towards elimination. Suchsystems willgenerate the strategic information systems to monitor progress countries thereforeis lacking: needto invest more in data to measure progress inreaching thesetargets Finally, whilst many countries are settingtargets -the an issuefor diagnosed patients inmany countries. stressed that access to optimaltherapies alsoremains these are notallcomprehensive. Similarly, she ofcountries nowthe majority have policiesontesting, Moreover, P responses. and innovative modelsfor financingtheirhepatitis were designed to offerMember States sustainable in financingsessionsontheclosingday, which

information “ Glasgow Caledonian University P P P elimination stillexist. place butobstaclesto viral hepatitis plans in 82 countries now have rofessor Hutchinson explained that whilst opulation Health rofessor ofEpidemiologyand rof. Sharon Hutchinson

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” R level casestudieswere presented by Ministerial reiterate point, anumberofcountry thisimportant can leverage muchneededpoliticalcommitment. data onviral hepatitis intoto-date usableinformation information system that analyses andtranslates up- T andwork to improveaction andoutcomes. quality data to createnecessary awareness, advocate for hepatitis responses. strategic information to inform theirown national -whodetailedhow theyusedsuch Indonesia he sessionalsodemonstrated that arobust strategic epresentatives from Zimbabwe, elimination ofviral hepatitis. P living withviral hepatitis canplay down inbreaking barriers, findingtheundiagnosed andachievingthe ofthepatient voiceUnderscoring theopeningsessionswas theimportance role andthecritical people hepatitis to generate resources andto mobiliseaction. leaders, are required to increase publicandpoliticalawareness ofviral ofthepublichealthimportance by politicaland meeting repeatedlycommunity stressedefforts,particularly advocacy that concerted with lived experience, event. whichmakesitauniqueadvocacy Summitpresenters throughout the T A national funding. plansandinsecuring demonstrated that are countries engagedwithcivilsociety more advanced bothindeveloping boththeir he World Hepatitis Summitistheonlymeetingthattogether brings bothdecisionmakersandpeople dvoc a c y rofessor Hutchinson evidenced thisusing P WHO Country V ietnam and T o 19

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WHS17 port e r nt e Ev WHS17 Event report on D created basedonstrategic information. plan usingbaselinednational prevalence data that it elimination andnow hasanambitious elimination drug use. prevalence ofhepatitis Cattributableto injecting with apopulation ofjust3.7millionbutwithahigh work withinGeorgia. Georgia isasmallcountry Control andP Gamkrelidze, from National Centre for Disease theHC In elimnation strategic T initiatives: around strategic 1andnational direction planning exchanging at bestpractices variousparallel sessions Attendees listening spent and theafternoon he eveloping

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20 for how investment inresources long-term impacts here cantherefore play acase avital role inmaking impediment to treatment. Cost-effectiveness analysis however theprice ofDAAs remains asignificant areinterventions well tolerated andeffective, the hepatitis Clife cycle. are medications targeted at specificsteps within antivirals (DAAs),of multipledirect-acting which hepatitis Chasbeendisrupted by thedevelopment delegates heard how thetreatment landscapefor the In ‘How to develop aninvestment case.’ workshop investment H and regional strategies. and streamline suchnational strategies withglobal and Greece inorder to demonstrate how to achieve examples from Uzbekistan, used country national planonviral hepatitis’ workshop, presenters the burden ofthedisease. the In ‘developing a ifprogressis critical isto bemadetowards decreasing Having acomprehensive national viral hepatitis plan ow

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Hepatitis inchildren hepatitis D Submissions presentations Side meeting 22

WHS17 port e r nt e Ev WHS17 Event report and S hepatitis interventions, medicinesand services, theessential viral needsto select that eachcountry P fromHande Harmanci WHO “ rogram openedthesecond day by explaining trategic Community Declaration Decriminalization! No Elimination without hinder access. procedures anddiscriminationthat by reforming laws, law enforcement by peoplewhousedrugs services of thefullrange ofprevention to remove to theuptake allbarriers We callonworld politicalleaders

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equity ” 2 and 3: benefit packages. be considered for inclusioninnational health andglobaltargets,country andwhichshould tothe continuum reach ofhepatitis services thatinterventions needto bedelivered along ofhigh-impact theessentialdescribes package T 24 equity, andensure quality. maximiseimpact populations andlocations, soasto achieve to reach ensure different hepatitis services identifies thebestmethodsandapproaches T he second strategic from direction theGHSS he third strategic from direction theGHSS highlighted that inDAA reductions are pricing P issue ofhepatitis Cprevention andtreatment for R P for DiseaseControl. Director oftheDivision from DrJohn hepatitis Binfectionat birth Ward, to of Health,andinterventions prevent the Ministry inN for hepatitis Bservices opportunities of HealthBrazil, DrAdele challengesand Benzaken, AIDS and inBraziltreatment by Director for services STI,HIV/ T interventions. of apublichealthapproach indelivering such stressinghealth benefitpackage, theimportance commodities that shouldbeincludedinthenational ions intervent he sessionalsofeatured presentations onscaling-up eople presentation Drugs(PWID). His Who Inject rofessor Greg Dore, Head, esearch P V rogram, Institute, Kirby lookedat the iral Hepatitis Department of the Ministry ofthe Ministry iral Hepatitis Department V

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discrimination that hinderaccess”. reforming laws, law enforcement procedures and of prevention by peoplewhousedrugsby services remove to theuptakeoffullrange allbarriers Declaration calledonworld political leaders “to endorsing thedecriminalizationofdruguse. signed by WHA, onbehalfofthehepatitis community P unachievable incountries withPWIDtransmission. access reduction harm hepatitis Celimination is that druglaw reform isessential, andthat without essential for theremoval ofdruguserestrictions, rofessor Dore concluded withaDeclaration, co- T he

WHS17 port e r nt e Ev WHS17 Event report disease andimplement treatment. healthcare professionals inorder to manageliver providers andimprovingofnon-specialist theskills recommendation ofexpanding thepooloftreating major price reductions. Healsomadethestrategic examples where thereas country hadbeensuch to improve access andofferedIndia Egypt and to makemedications more affordable inorder presentation determined that there isaclearneed Western P how to secure withafocus generics within WHO Manager, amfAR, Giten Community andP Khwairakpam, governments isamoral andethicalobligation”. with apoignant note: “political commitment from must makeaccess a priority. speechended His Baptista Leite, whoreaffirmed that governments session was openedby P topics ofaccess, ofgenerics. cost andefficacy T A he access to hepatitis medicinessessionaddressed ccess “ World HealthOrganization T Hutin Dr Yvan the peoplewhoneedit at therighttimeandfor all product, intherightplace, successful whenit’s theright Access willonlybe echnical O acific and South-East acific andAsia regions.His

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medicines olicy P olicy ” icardo roject roject T he ’s 26 this 2030elimination target isto beachievable. treatment mustbesignificantly increased globallyif presentersSession repeatedly stated that access to including theincreasing oftreatment rates to 80%. T who needit”. right place, at therighttimeandfor allthepeople only besuccessful whenit’s therightproduct, inthe ofgenerics: that price isonlyoneaspect “access will O by Dr supported – anassertion Yvan Hutin, care, dropping prices simplywon’t makeadifference that withoutgreater to diagnosis andbetter linkages Giten andDrAndrewBoth agreed Khwairakpam Hill as $50. purchased for $70-and, withinayear, could beaslow studies have shown that hepatitis Cmedicinecanbe andwhose ofgenerics about thecost andefficacy R T he globalstrategy ambitioustargets, carries his was followed by DrAndrew Hill,Senior esearch Fellow, Liverpool University, whospoke fficer, WHO “ P ofP Member R obligation. a moral andethical from governments is P ortugal icardo BaptistaLeite olitical commitment , whoconcluded thesessionby stressing arliament ” T V echnical isiting hepatits A combinations. generic important tofor these speeduptheprocess ofpre-qualification WHO he concluded that to date, nocombination drughas received WHO prequalification for SOF. Nevertheless, stated that somecompanies producing have generics from GileadandBristol-Myers Squibb. DrDamascene ofHealthnegotiated donations theMinistry after patients withOriginators’ in2016and2017 products within R who gave acasestudyofthe viral hepatitis work STIs andOBBIDivision,R T Ag.Dr JeanDamascene Makuza, Director ofSexual hepatitis medicinesworkshop was presented by T medicines a O challenging patents ondrugs. frontier for European that exists around advocacy sustainable prices for DAAs andproposed anew explained that thefree hasfailedto market achieve duMonde’sMédicines DrugP R Maguet, hepatitisgeneric medicinesworkshop, Olivier theoptionsforIn countries withoutaccess to hepatits without O methods ofovercoming to access: barriers explored workshops ofmorning further A series ransmitted and Infections he optionsfor countries withaccess to generic ccess dvoc ptions ptions -PQ orUS-FDA approval andstressed theneed wanda – a country that hasbeentreatingwanda –acountry esponsible for theDrugP

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infections. towardspriorities preventing associated injection hasto beoneofthehighest injections unnecessary 50% globalburden ofhepatitis andthat eliminating from a reported seven outof11countries that carry stated that unsafehave injections beenrepeatedly DrAltaf safety pilotstudiesinUgandaandIndia. WHO Consultant for P Infection the newgeneration DAAs nationally andtheneed concluded ofregistering by stressing the importance access to DAAs inthepublichealthsystem. She ofbetween 20-40%butwithlimitedcommunity withanHC country drugsprogrammepeople whoinject withinKenya –a presenting onapilotaccess for to hepatitis Cservices O build it, theywillcome”. Abigael Lukhwaro, Advocacy C elimination isto beachieved andstated “if you areinsisted essential ifhepatitis that suchservices drugs. to She peoplewhoinject health services regarding ofdelivering highquality theimportance (P session, Margaret Hellard. Director Deputy hepatitis thedelivering services highquality In hepatits D way. inequalitiesinanexplicit andmeasurable at tackling to ensure that resourcesopportunities are directed behindhealthinequalitiesandlookedat the factors scenarios.to imagined country differentlythinking framework by applyinganequity workshop together haddelegates and working T ices serv D he delivering equitable services interactive he delivering equitableservices fficer, Monde, Médecinsdu reiterated theideain rograms). Institute. theBurnet gave apresentation eliverng eliverng , addedto thisupdate by focusing oninjection

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WHS17 port e r nt e Ev WHS17 Event report : 2017 hree Side meeting Submissions presentations T

ovember ay Service good hepatitis: delivery viral for for direction 4: financing Strategic for viral financing mechanisms Different partnership private eliminate to Public for direction 5: innovation Strategic Summit 2017 Hepatitis World Close of the practice pricinples in health delivery of civil society the role and hepatitis sustainability programmes hepatitis acceleration D 3 N 31 lenary P Workshop KEY WHS17 Event report billion onthe2010Commonwealth inorder Games to 2010 World Cup –whospent USD$4.1 andIndia Africa –whospent more thanUSD$3billiononthe significant, heoffered South upthe of comparisons in order to reach elimination. While thisfigure is required countries by 135low- andmiddle-income per year onaverage innewinvestments willbe countries. Hedetailedthat atotal ofUSD$3.5billion that financing remains asignificant issue formost Hepatitis Alliance, opened thesession-highlighting Gore,Charles Founder andP achieve thetargets for 2020and2030. to willbenecessary continuum ofhepatitis services All agreedwork. that adequate investment inthefull innovative ways for countries to finance theirhepatitis at funds asefficiently aspossibleandlooking a sustainableresponse willrequire usingavailable panelliststook(CDC), to thestageto discusshow US Centers for DiseaseControl andP John Ward, Director oftheDivision Africa andDr ofHealth,South National Department Chaired by DrAmanda Kgomotso S trategic “ World Hepatitis Alliance P GoreCharles ast P to elimination need to beabarrier Financing doesnot resident andFounder Financing for sustainability Strategic 4 direction

direc ast P tion resident, World V ilakazi N ilakazi revention 4: V iral Hepatitis, ” financing hlapo, models for financing hepatitis responses. by identifying sustainable andinnovative addresses theissueofuniversal healthcoverage T 32 he fourth strategiche fourth from direction theGHSS 4. 3. 2. 1. strategy: a strategic approach to financingaviral hepatitis stage approach for countries to takeindeveloping financing hepatitis isachievable andoffered a four- T needed. give to someperspective thefinallevel ofinvestment he presentation repeatedly demonstrated that budget. an overall increase inspendingonthehealth of Health Coverage andideallyaspart (UHC) programme withinthecontext ofUniversal may want to consider financing for ahepatitis from acombination oftheseoptions. Countries it islikelythat financingwillneed to come and external. three keysources: domestic, patient payments Financing strategies. Financing cancome from depending ontheresources available. scenarios sothat any three could beimplemented conservative, moderate andaggressive budget scenario planningusing may wishto undertake accordingly. Gore cautionedthat countries Mr andbudgetfor budgetcycle this within thenext Budget. what Determine canbeimplemented programme. programme or tojustify efficiency investment ina can beusedto helpyou makeadjustments for and acost-benefit analysis. ofanalysis,types acost-effectiveness analysis Create theinvestment case. an overall cost for elimination. targets. toobjective reach the2020and2030 WHO programme shouldbefullycosted withthe Cost theprogramme.

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he outcome ofwhichwillgive countries sustainabilty T o fullyfundahepatitis programme, T he national hepatitis T T hese analyses here are two be keyto financinghepatitis programmes andthat T Health. of Biomedical Center andtheColombian Ministry CenterBank, for DiseaseAnalysis, WHO R Development, andincludedspeakersfrom the World Dr Eduardo P González health systems approach. panel discussiononfinancing for hepatitis withina T hepatitis together thanto have hepatitis alone. arrangements –arguing that isbetter to have HIVand financing with common poolingandpurchasing Dr Lauerclosedby suggestingcountries streamline to “reach clients” rather than “fund programmes”. vital to integrate hepatitis withinhealthsystems and fragmented –insistingthat itistherefore services and that fragmented funding simplyleadsto financing. Hestated isineffective that silo working approach whendesigning hepatitis programmes and effective coverage andusingaperson-centred he proposed that thefocus shouldbeonincreasing since programmes are ameans, notanend. Instead, countries notto focus onsustaining “a programme” joined-up approach to financingandcautioned Given thistrend, DrLaueradvocated for abig-picture, concern. programmes understandablyidentify thisasa fewer resources andmore goalsandthat hepatitis how fundersare increasingly to cope prioritising with the issueofefficiency. His presentation highlighted Dr Jeremy Lauer, aneconomist from WHO for comprehensive fundingofhepatitis programmes. pressure external ongovernmentsnecessary to push role canplay here civilsociety increating the advocating for financingandstressed theimportant Gore finished Mr by of reiterating theimportance elimination”. that “financing doesnotneed to to beabarrier T he discussionreiterated that domesticfunding will by presentershis positionwas re-affirmed withina he keyrefrain throughout thepresentation was ier oftheCenter for Global T he panelwas chaired by wanda , addressed 33 nothing at all”. will spendlesseliminating hepatitis Cthandoing that ultimately,session withhisassertion “countries and concluded the elimination efforts underwriting Analysis Foundation, explained theeconomics Homie R 1% ofGDPisallocated to health. health –offering the example ofP still don’t give enoughoftheirnational budgetto Director, World emphasised that many Bank, countries ScienceandGlobalHIV/AIDSP Delivery Dr David Wilson, GlobalLead for and Decision 2020. to increasing treatment by 500peopleeachyear until lower costs through P Colombia hasprocured hepatitis Ctreatment for commitment to elimination. O that haseffectiveas anexample ofacountry intrinsically linkedto politicalwill–giving Colombia P sustainable anduniversal healthcoverage systems. disease area andnow countries mustwork to develop the world hasmoved onfrom focusing onasingle the HIV/AIDSresponse, that panellistsunderlined integration. thedifferences Highlighting between the mosteffective way to achieve thisisthrough anellists alsoagreed that sustainablefinancingis “ azavi, ManagingDirector, Center for Disease Foundation Center for DiseaseAnalysis Managing Director Homie R doing nothingat all hepatitis Cthan less eliminating Countries willspend azavi AHO andhave now committed ver thelastfew years akistan where only akistan

rogram

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WHS17 port e r nt e Ev WHS17 Event report build dialoguearound hepatitis by demonstrating a within theirown terms -urging States Member to ofFinanceengaging Ministries to them by speaking Eduardo P Gonzalez ofFinance.including theMinistry the needto ensure buy-in from different groups, and sources infundinghepatitis programmes and need to lookat acombination offinancingstrategies T services. ofintegrationand theimportance withinhealth encourage ofFinance Ministers to makeinvestments addressed by presenters, includingtheneedto T P ofHealthBrazil andDr fromBenzaken theMinistry programmes sessionwas chaired by DrAdele T programmes D he session stressed that Ministries ofHealthwill he sessionstressed that Ministries he sessionrecapitulated anumberofthemesalready he different financingmechanisms forviral hepatitis hilippe Duneton, Deputy Executivehilippe Duneton, Deputy Director, Unitaid. ifferent

ier looked at practical waysier lookedat practical of financing

mechanisms 34 prices willgodown withvolume dueto economies andbonds/loans.with price reduction R either through that self-funding;co-pay diminishes national financing for elimination canbesupported presentation that concluded withtheassertion down costs. payments andmonthly His mortgage larger savings inthelonger-term despite upfront arguing that buying, rather thanrenting, willmean and treatment costs to that ofbuyingahouse– Homie R hepatitis. hospitalised from complications associated to viral always begenerated over timeasfewer peopleare of upfront costs, significant healthcare savings will researchempirical demonstrating that regardless elimination isnotalways seenascost effective despite P clear investment caseinthefirstinstance. resenters explained that for ofFinance, Ministers

for azavi likenedtheseupfront prevention

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a sustainableplan. tools are now counties available inmaking to support solution exists, financial anumberofhighquality all panellists agreed that whilstnoone-size-fits based research suchapproaches. inmaking All Jigjidsuren ofevidence- stressed theimportance lobbying thegovernment for funding. DrChinburen groups ofcivilsociety in discussed theimportance ofHealthinMongolia. from theMinistry Jeremy Lauerof WHO andDrChinburen Jigjidsuren T countries withsmallerorders.needed to support of scalebutaglobalprocurement mechanismisstill he sessionendedwithadiscussionbetween Dr T hey

WHS17 port e r nt e Ev WHS17 Event report successes ofhepatitis Bvaccination programmes in General for Communicable Diseases, WHO them to scale,” saidDrR and approaches,interventions andimplementing elimination targets withoutinnovation inprevention “We cannotmeettheambitioushepatitis inclosingthesegaps.innovation willbeimportant urgently neededandpresenters demonstrated how diagnostic tools for bothhepatitis BandCare allstill and thedevelopment ofmore effective point-of-care innovation. cure for Afunctional hepatitis Binfection highlighted theneedto promote andembrace the innovation for acceleration session,which N Michael S trategic “ World HealthOrganization Communicable Diseases Assistant for Director-General Dr R them to scale. approaches, andimplementing prevention and interventions without innovation in hepatitis elimination targets We cannotmeettheambitious inburg, Current P en Minghui en Minghui Innovation for acceleration Strategic 5 direction

direc en Minghui Assistant Director-en Minghui resident, WHA chaired tion 5: ” . “ innovation T he great achieved. in order for the2020and2030targets to be oftheviral hepatitis response the trajectory identifies where innovation is required to shift T 36 he fifth strategiche fifth from direction theGHSS to beapproved. pipeline for hepatitis Bandseveral ofthemare likely there are around 50newdrugsintheresearch that combined eradication strategy,” hesaid, concluding between hepatitis BandHIVcommands for a was basedonHIVresearch. “ the work that created thenewDAAs for hepatitis C B research agendainFrance, explaining that alotof discussed theoutcome ofanintegrated HIV/hepatitis et delarecherche France, médicale(Inserm), then P the United States”. reduce theburden ofchronic hepatitis Cinfectionin care providers. with HC “P clinicians inlocalcommunities. DrCohen concluded an academiccentre ofexcellence care withprimary specialistteams at to hepatitis careexpert by linking how aimsto theproject innovatively scaleupaccess Cohen, ECHOP Dr Henry health coverage.” globally inthecontext ofmoving forward to universal many countries needto bereplicated andsustained rof. Christian roject ECHOisacost-effectiveroject way to treat patients

infection at scale, using existing primary V infectionat scale, usingexisting primary for T

T repo national delasanté ofInstitut a his approach could substantially cceleration roject, Uruguay, explained T his common biology • • • T 2020 and2030targets to beachieved. of viral hepatitis responses inordertrajectory for the and to recognise theneedfor innovation the to shift there areandtechnologies majorgapsinknowledge embracing innovation to drive rapid progress where finalists were chosen for their inpromotingwork and presentations at thecloseofSummit. innovation submissionswere invited to give oral posters andoral presentations, ofwhichthetop six total,In over were 300abstracts accepted for strategic intheGHSS. directions a broad publichealthfocus that aligned withthe original contributions inthefieldofhepatitis with individuals andorganisations to identify andpromote T I

he innovation finalists were: he SummitlaunchedaCall for inviting Abstracts nnovation presented onthe “Little HepBHero” –aproject Lien T ifscaledupstillfurther.India and could allow hugetreatment expansion in more than1,500patients withhepatitis Csofar these nursecoordinators to monitor thecare for initiative from to nurseshasallowed doctors outcomes at low cost inIndia. treatment model, whichimproves treatment an innovative hepatitis nursecoordinator whodiscussed Sciences (ILBS),NewDelhi, ofLiverAnila, Institute Goswami &Biliary risk ofacquiring and/ortransmittingrisk hepatitis C. tocreates cure thoseat highest opportunities marginalized populations access services demonstrated that focusing resources where to “difficult toengage” populations. Emalie Franciscodevised withinSan to reach out ,who discussedanelimination strategy being fromEmalie Huriaux P ran ofHepatitis

abstra V roject Inform andCalHep Inform roject ictoria, Australia.,ictoria, who c T his task-shifting his task-shifting ts T hese global 37 • • • community. implemented by thecommunity, for the initiative iscompletely conceptualised and their families’ healthandwell-being. understanding to helpprotect children and conversations abouthepatitis Bandbuild that aimsto helpfamilieshave important villages across Egypt. testing and hasnow to beenextended 36other highly effective inachievingalarge uptakeof patient. recommended diagnosed for actions every delivering messagesandArabic songwith employed anautomated SMSsystem for around 7,000people. Al- screening andelimination ofhepatitis Cfrom ofEgypt ,whodiscussedthe Ammal Metwally patients insuchresource-limited contexts. essential indelivering HC concludedMomoko that simplification is treatment programs. large-scale to support where healthsystems donothave thecapacity optimal care modelfor hepatitis CinCambodia Frontières,Sans Cambodia, whodiscussedthe Iwamoto oftheEpicenter,Momoko Médecins HC Amsterdam, whopresented onhome-based Freke Zurre oftheP eliminate HC ofanintegratedmen (MSM)-part approach to O V -RNA testing for menwhohave sex with thmanya in northern Egypt –avillageof thmanya innorthern T his community-based strategy was V infectionamongthispopulation. ublic Health Service of ublic HealthService T his innovative project V treatment for

WHS17 port e r nt e Ev WHS17 Event report T K ake ey S at the heart oftheresponse paysat theheart off P and thoseat greatest risk behind must reach thefurthest Efforts Harm reduction iscrucial reduction Harm hepatitis committed to theelimination ofviral Countries around theworld are Diagnosis remains achallenge and cure P barrier Financing doesn’t have to bea utting peoplelivingwithviral hepatitis - rogress isbeingmadeintreatment aways ummit

38 WHS17 Event report diagnosis. programmes to increase awareness andsubsequent infection. Countries needto improve policiesand in 5peoplelivingwithhepatitis C,were aware oftheir estimated 1in10peoplelivingwithhepatitis B, and1 diagnosis for hepatitis BandC.As of2015,an urgently needto increase uptake oftesting and T treatment target isto bereached by 2030. treatment mustbeincreased globallyifthe80% milestones represent onlyinitialsteps –access to itin2015.Butthese the 1.7millionpeoplestarting hepatitis Bin2016wasincrease amarked from lifelong treatmentadditional peoplestarting for people whowere treated in2015. hepatitis C,asignificant increase onthe1.1million 2016,1.76millionpeoplewereIn newlytreated for elimination. Sudan, Syria, UgandaandAustralia to commit to Egypt, Georgia, Lesotho, P Mongolia, Malta, representatives took to thestagefrom Brazil, China, regions. ofHealthandtheirMinisterial 12Ministers and P by P work beingundertaken case studiesandpresentations aboutthevaluable Summit offered aplatform for dozens ofnational leadership withintheviral hepatitis space. Many countries are demonstrating strong political o achieve rapid scale-up oftreatment,o achieve countries rapid scale-up olicy Makers withintheirown Makers countries and olicy Diagnosis remains achallenge viral hepatitis committed to theelimination of Countries around theworld are treatment andcure P rogress isbeing madein rogramme Managers T he 2.8million T akistan, akistan, he 40 groups, particularly thoseatgroups, greater particularly risk. that are accessibleservices to different population need to provide afullrange ofhepatitis prevention at greatest orwhoare risk mostaffected. Countries targeted poorly often andfailto reach thosewhoare where andservices, theyexist, areInterventions drug dependence andpoormental health. such aspoverty, discriminationandcriminalization, that generate factors underlying healthinequities, seldomaddress critical Existing hepatitis services populations andprisoners. children; thoselivingwithhepatitis E;indigenous hard-to-reach groups andsub-populations,including P N at all”. spend lesseliminating hepatitis Cthandoingnothing CDA Foundation, reminded attendees, “countries will key to achieving elimination andasHomieR that integration into widerhealthsystems willbe hepatitis. Across thesessions, presenters reiterated - adedicated fundfor theelimination ofviral elsewhere, anevening event launchedENDhep2030 Strategy its National the 2020and2030 WHO targets. WHA announced programmes willbefullycosted inorder to reach to thiswork inorder to ensure theirhepatitis Countries were urged to takeastrategic approach to thinkcreatively whenfinancingtheirprogrammes. fund for hepatitis andcountries willtherefore need national viral hepatitis programme. to developingnot beabarrier andimplementing a Delegates repeatedly heard that financingshould artner organisations to presentartner content around ine sidemeetingswere developed withexternal T emplate to support thisambitionand emplate to support behind andthoseat greatest risk must reach thefurthest Efforts a barrier Financing doesn’t have to be V iral Hepatitis P rogramme Financing T here isnoglobal azavi, to bereached. viral hepatitis. marginally more involved inthenational response to response to stigma anddiscriminationare only have hadlittleinvolvement intheirgovernment’s Summit, whichdemonstrated that mostcivilsociety GlobalR Civil Society Despite this, WHA’s HoldingGovernment Accountable and thosewithanational plananddedicated funding. who involve intheirhepatitis response civilsociety demonstrate astrong correlation between countries findingsfromInitial WHO people’s access to healthservices. to reform drugpoliciesthat criminalizing hinder increase access and interventions to reduction harm declaration callingonworld leadersto urgently GroupAction andCoalition P International DrugP organisations including duMonde,WHA, Médecins Fifteen services. reduction such harm civilsociety Despite theproven benefits, many countries lack remains farbehindthe WHO targets. testing, treatment, services reduction andharm equipment. injecting Yet theiraccess to prevention, infections attributed to ofunsterile thesharing ofnew to thehepatitis Cvirus, withone-quarter P eople who inject drugs are particularly exposed drugsare particularly eople whoinject response pays off ofthe hepatitis at theheart P Harm reduction iscrucial reduction Harm utting peoplelivingwithviral T his mustchangeifelimination isgoing olicy Consortium, Consortium, olicy eport was launchedat the eport ’s P Country lus launcheda rofiles T reatment

WHS17 port e r nt e Ev WHS17 Event report t c Were any significant call to actions call and/or significant any Were made? commitments and convening to it contribute did How networking knowledge debate Did it increase and stimulate or new thinking? of viral and profile awareness Did it raise hepatitis? participation inclusive? Was mpa I Based on the objectives set for the event, our event, the Based on the objectives set for impact of the immediate of the event assessment reflecting key categories five around framed was trying achieve: were to we what • • • • • 43 WHS17 Event report C alls cirrhosis) werecirrhosis) eligible for treatment). advanced liver damage(fibrosis/ only thepatients withthemost A). forrespect human rightsandevidence (seeannex onpublichealthpromotion,overwhelmingly who usedrugsandto adoptanapproach based the fullrange ofprevention by people services leaders to remove to theuptakeof allbarriers calledonworld2030, thecommunity political viral hepatitis BandC(seeannex A). Hepatitis Strategy withaspecialfocus on outlinedin interventions WHO implementation ofthecoreto support abroad andcoordinatedtaking approach directly reachdirectly theglobaltargets. campaign on World Hepatitis Day to

decriminalization! no eliminationwithout Hepatitis Community: Declaration ofthewider for hepatitisC(P treatment restrictions Health committed to lift T achieve thegoalofelimination by governments committed to thisdeclaration Hepatitis. In Declaration onViral São PauloGovernment implement atargeted to including civilsociety high levelpolicymeeting Germany isconvening a a he Brazilian Ministry of he Brazilian Ministry c tion

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reviously, c ommitments 44 annex A). and asHIV/AIDS,malaria priority governments give viral hepatitis thesame member organisations demandedthat the World Hepatitis Alliance andits256 consultation ontheirproposed strategy. T to eliminatehepatitisCby2025. sofosbuvir anddaclatasvir. treatment course for thekeymedicines per day,or$12012-week medicines foraslowUS$1.40 hey have alsolaunchedanopen

made since announced they plan WHO targets andhave committed to meetthe T the government Declaration, responseHepatitis. In to Declaration onViral São PauloCommunity for generichepatitisC that ithassecured deals (MSF): MSFannounced Frontières Sans Médecins he Government of Malta

TB (see C “ onvening and funders. publichealthscientistspolicy-makers, States,Member patient organisations, Ministers ofHealth whoformallyMinisters spoke. friends. created andinspirations from new T he bestoutcome beingconnections society groups,society WHO andits delegates from civil a globalaudience of750 WHS17 brought together participated, including12 participated, annex C) 65 countries(See acrossand governments 82 Programme Managers delegates. 97 publichealth

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WHS17 port e r nt e Ev WHS17 Event report thinking I ncreasing “ topics. and 9sidemeetingsonrelevant meetings, including17workshops 2030. initiatives to helpreach elimination by in implementing viral hepatitis their national successes andchallenges (68%). oftotalattending invites asaproportion enjoyed ahighnumberofdelegates at thecloseofSummit. invited to give formal oral presentations the top sixinnovation submissionswere implementation thelearnings. andfostering the action-oriented T he summit was very inspiring,he summitwas very across three days of presented to delegates global expertspeakers 118 senior-level, oral presentations, ofwhich were accepted for posters and responses toviralhepatitis 300 abstractsoninnovative presented casestudieson Representatives and Ministerial 12 Ministers

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awareness country policy dashboard policy country Lets EndHepC–across were launched: Innovative newplatforms Hepatitis Programme T were launched: Innovative newplatforms AFP andAl Jazeera were Mundo, T El BBC, media coverageincluding Over 900piecesof with 91.3million hashtag (#HepSummit2017) to theevent’s dedicated 8,060 tweetswere made he NationalViral T he platform hadatotal

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WHS17 port e r nt e Ev WHS17 Event report I nclusiveness “ attendance (seefigure D). public healthscientists andfundersin organisational members, policy-makers, to elimination. successful strategies andapproaches sharing ofaglobalnetwork part for allto become An opportunity organisations from WHA’sorganisations States,its Member patient groups,society WHO and Good proportion ofcivil event (seefigure B). itatrulyglobal making Great geographicspread

participation ” 48 “ “ viral hepatitis ispossible. impacting event.impacting made theSummitagreat and andcivil societiestogether experts Bringing together governments, counterparts across theglobe.counterparts to engagewithour the opportunity awareness,community giving us with limited resources amidstlow stimulus for many ofuswhowork T he Summitprovided aunique funded. organisations was fully of resource limited patient T he attendance of97.5% T he elimination of ” ” Portuguese. French, Spanishand translated inEnglish, wereAll plenaries each plenary session. each plenary were of shown at thestart living withviralhepatitis Testimonials from people 49 on eachcommittee). inclusiveness (e.g. member acivilsociety members were to promote selected content.the intellectual Committee andbroaden responsibility forexperts

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WHS17 port e r nt e Ev WHS17 Event report 1. Source: WHO 1. Brazil, from 1to 3November 2017; We, thehighlevel representatives ofgovernments whoassembledat the World Hepatitis P SummitinSão S A 6. 5. 4. 3. 2. 11. 10. 9. 8. 7. ão nnex and 1.34millionpeoplediedofviral hepatitis in2015 Note, withdeepconcern, that 325millionpeoplewere livingwithchronic hepatitis infectionsworldwide R inadequate response globallyto date; Express profound concern ofviral hepatitis aboutthepublichealth,economic and andsocialimpact viral hepatitis BandC,whichhave thehigherrates andmortality; ofmorbidity preventing, diagnosing, treating ofallforms andsurveillance ofviral hepatitis –withaspecialfocus on R treatment for Hepatitis B, whilerecognizing that Hepatitis Cisstillnotpreventable through vaccination; Note that Hepatitis AandBcanbeprevented by vaccination andthat there isacure for Hepatitis Cand treatment andcare; approach to prevention andcontrol measures aswell astheinadequate access to affordable, appropriate progress initsprevention andcontrol indeveloping countries, notablydueto thelackofanintegrated 2Consider that viral hepatitisglobalpublichealthproblem isaserious andexpress concern at thelackof Highlight theneed toHighlight mobilize adequate resources andpredictable for the viral hepatitis response, planning, target-setting andmonitoring thenational andglobal response; systemsepidemiological surveillance to better inform decisionmakers, focus andimprove national can provide publiclyaccessible information protection ofpersonaldata, whileensuring including R transmitted diseasesandthosefor diseases; cancer andothernon-communicable such asHIVandotherrelated sexually transmitted infections, andbloodborne thosefor motherto child synergies between prevention andcontrol measures for viral hepatitis, andthosefor infectiousdiseases Further recognize theneedto strengthen healthsystems andintegrated collaborative approaches and on theepidemiological andsocialcontext; that are mostaffectedwithin theircountry by viral hepatitis epidemicsandthe response shouldbebased shoulddefinethespecificpopulations to andthat populations each mostaffectedcountry andrisk, at andfor thepreventioncommunity-based services andcontrol attention ofviral hepatitis, withparticular of healthsystems strengthening inthisrespect,includingtheprovision ofandaccess to comprehensive Acknowledge countries` goalstoward achievinguniversal healthcoverage andrecognize theimportance strategyhealth sector onviral hepatitis 2016-2021; viralimplementation hepatitis prevention ofhigh-impact andcontrol measures asoutlinedintheglobal ofacomprehensive,Emphasize theimportance integrated approach andmultisectoral that includes Glasgow Declaration onHepatitis; World HealthAssembly R eaffirm the Global Health Sector Strategy Sector theGlobalHealth eaffirm on ecognize theneedfor aglobalapproach to eliminating viral hepatitis asapublic healthproblem through ecognize ofhaving strong, theimportance integrated strategic healthinformation systems, that P . GlobalHepatitis R aulo A:D D eclarations eport, 2017 eport, eclaration esolutions WHA45.17, WHA63.18, WHA67.6 and WHA69.11 andrecalling the2015

on V iral Hepatitis adopted by R

V 50 iral 1 ; H epatits esolution WHA69.22 aswell as aulo, 2. Source: WHO 15. 21. 20. 19. 18. 17. 16. 14. 13. 12. T R than the50%globaltarget by 2020andthe90%target by 2030; We willcontinue to strengthen international cooperation to achieve thegoalsofglobalhealthsector andcontexts; priorities strategy oftheglobal healthsector directions onviral hepatitis 2016-2021, adapted to national legislation, We willaccelerate asoutlinedundereachofthefive strategic actions implementation ofthepriority andtreatment; testing reduction; services harm safety; Hepatitis Bvaccination; injection prevention transmission ofHepatitis B;bloodsafety; ofmother-to-child strategy onviral hepatitis 2016-2021,adapted to national priorities, legislation andspecific contexts: We willaccelerate theimplementation ofthecore outlinedintheglobalhealth sector interventions acceleration, towards achieving thegoalofeliminating viral hepatitis asapublichealththreat by 2030; and innovation financing for for sustainability; fordelivering interventions for impact; action; equity; priorities, legislation andspecific contexts, and itsreaffirm five strategic directions: information for focused We strategy willfullyimplement theglobalhealth sector onviral Hepatitis, 2016-2021,adapted to national viral hepatitis epidemicsandtheresponse shouldbebasedontheepidemiological andsocialcontext; that shoulddefinethespecificpopulationsare most withintheir country that eachcountry affected by the context attention ofviral hepatitis, to populations withparticular mostaffected andmostrisk at mental healthandresolve to fulfillourinternational obligations and commitments in this regard, and, in We reaffirm right the of totheenjoymenteveryone ofthehighest attainablestandard of physical and towards achievingUniversal HealthCoverage; if we are to achieve globalviral hepatitis targets inaccordance withnationally setgoalsandpriorities delivery, service Acknowledge includingfor theneedfor diagnosis, early newmodelsofpeople-centered incentive inthedevelopment ofnewhealthproducts; rightseffective medicines, are andquality notingthat, animportant inter property alia,intellectual coverage doseofhepatitis Bvaccine, for birth to prevent transmission, isonly39% mother-to-child is estimated at 84%andistherefore below the90%globaltarget, andconcerned that current global situation, andexpressing concern that currently theglobalhepatitis Bvaccine coverage for infants for healthworkers asneeded, feasible andappropriate, withregard to thenational epidemiological Call ongovernments to includehepatitis Bvaccines innational immunisation programmes, including resources, complemented by international resources andtechnical assistance where needed; hepatitis response aswell astheavailability ofadequate, sustainedfinancial resources andtrained human R synergies inthiscontext; systems andpatients andalsorecognize theneedto address thissituation, includingthrough promoting innovation for Hepatitis BandCinrecent years, andnote withgreat concern theincreasing cost to health R level tocountry combat hepatitis andeliminate viral hepatitis asapublichealththreat by 2030; quality, effective, safe diagnostics, andtreatment themaffordablevaccines, andmaking services atthe especially inlow andmiddleincome countries, andto improve equitableaccess to andavailability of rade-related Aspects of the Intellectual P oftheIntellectual Aspects rade-related eaffirming also the rights alsothe of eaffirming governments tothefulluseof flexibilities inthe W ecall that national ownership andacomprehensive approach are keyelements for thesuccess oftheviral ecognize with appreciation theintroductionbasedoninvestment ofnewpharmaceutical products in . GlobalHepatitis R eport, 2017 eport, roperty R roperty 51 ights ( TRIPS) to increase access to affordable, safe, TO Agreement on

2 , lower

WHS17 port e r nt e Ev WHS17 Event report 25. 24. 23. 22. We thanktheGovernment this ofBrazil for hostingandsupporting World Hepatitis Summit. health threat. Strategyof theGlobalHealthSector on We callupon WHO to andassistance provide inorder to technical accelerate support theimplementation affordable level; at the country and availability ofquality, effective, safe diagnostics, andtreatment them vaccines, andmaking services hepatitis response, especiallyinlow andmiddleincome countries, andto promote equitableaccess to We willcontinue to improve themobilization ofadequate resources andpredictable for the viral results; programmes incollaboration with WHO andotherrelevant stakeholdersfor effective andsustainable We willdevelop andimplement asappropriate, comprehensive, fundednational hepatitis plansand exchange, asappropriate; forcapacity quality, safe, effective andaffordable vaccines and technologies through collaboration and strategy onviral hepatitis includingby enhancingsustainable, national andregional manufacturing V iral Hepatitis towards theelimination ofhepatitis asapublic 52 S 10. 9. 8. 7. 6. 5. 4. 3. 2. 1. assembled at the World Hepatitis P SummitinSão We, theviral hepatitis community, consisting ofpeoplelivingwithand/oraffected by viral hepatitis, who ão reach thegoalwe allshare whichistheelimination ofviral hepatitis by 2030. to helpyou findthe necessary resourcesadvocacy you need, achieve prices the commodity you want and our praise offine as work we are ofaninadequate withourcriticism response andthat we willprovide the P national viral hepatitis plans. R they canreadily afford. those livingwithviral hepatitis have access to thetests anddrugstheyneedeitherfor free orat aprice R hence Strategy to thegoalofelimination setoutintheGlobalHealth Sector onviral hepatitis. to finding these ‘missing millions’ and to giving thosethat needitappropriate care andtreatment and R year.1.3 millionofthemdyingevery essential to preventing newinfectionsandessential to providing access to thetreatments that willstop who are livingwithhepatitis BorCbutremain undiagnosed. Finding these ‘missing millions’ willbe R from thosediseases. whichhasbeensoeffectivemalaria in reducing mortality R to endingthisepidemic, asyou have withHIV/AIDS, R behindfirst.’furthest Development notjust Goals behind’ willbeleft no-one ‘that butthat you endeavour‘will to reach the R hepatitis. Wish to thanktheGovernment ofBrazil for hostingtheSummitandto applaudtheirleadershipinviral P theSão support Wish to whole-heartedly ledge, inreturn, that we willwork tirelessly to assistyou intheseendeavours, that we willbeasfree with equest that you involve us, thepeoplelivingwithdisease, fullyinthedesign andimplementation of equest that you usewhatever andthat you meansare stop necessary at nothingto ensure that allof equest that you since makeaddressing theyare stigma amajorimpediment anddiscrimination apriority emphasisonfindingthe almost300millionmen, equest thatwomenandchildren you putparticular equest that you that give hasbeengiven thesamepriority viral to hepatitis HIV/AIDS, exactly equest that you gobeyond SustainableDevelopment 3.3 of Goal ‘combatting’ viral hepatitis andcommit equest that you fulfil, in relation to viral hepatitis, your governments’ pledgeintheSustainable P aulo C ommunity D aulo Declaration madeby high-level representatives. eclaration aulo,Brazil, from 1to 3November 2017 53 TB andmalaria.

V iral H epatits

TB and

WHS17 port e r nt e Ev WHS17 Event report • • • • drug law enforcement inmany ways: services to reduction harm barrier isadirect which criminalize druguse, drugpossessionand, ultimately, peoplewhousedrugsthemselves [10][11].P T epidemic continues to grow among peoplewhousedrugs[9]. of violence andabusewhendisclosingstatus asdrugusers, anduniversal stigmatization. As aresult, thehepatitis C prevention andtreatment dueto pooraccess theirexclusion to healthservices, through treatment threats criteria, [8].Even doexist, peoplewhousedrugsface whereservices more services difficultiesin accessing hepatitis C below WHO indicators, drugslivingincountries with highcoverage withlessthan1%ofpeoplewhoinject ofboth programmessyringe [8].Furthermore, theregional andnational coverage variessubstantially and ismostoften has beenreported, just86(48%)have implemented opioidsubstitutiontherapy and93(52%)have needleand most peoplewhousedrugsworldwide. 2017,amongthe179countries druguse and territorieswhere In injecting Despite theevidence and WHO recommendations, comprehensive are inaccessible services reduction for harm hepatitis elimination by 2030. asoneoffive identified harm on viralreduction hepatitis core [7].It needed interventions to reachthegoalofviral StatesMember ofthe O World HealthOrganization (WH and prevalence are drugs[3][4],andtheseinterventions In 2016,the cost-effective [5][6]. amongpeople who inject therapy, hepatitis Ctreatment are interventions reduction andotherharm essential to reduce hepatitis Cincidence accessEnsuring to suchaslow-threshold interventions programmes, needleandsyringe opioidsubstitution account for 23%ofnewinfections[2]. and eliminating theepidemic,equipment isestimated ofneedles, assharing andotherinjecting to syringes improving access to prevention andtreatment for peoplewhousedrugsiscrucialto reducing hepatitis Cincidence positive, and9%are livingwithchronic hepatitis Binfection[1];From apublichealthandhumanrightsperspective, Globally itisestimated that drugs52%are amongthe15.6millionpeoplewhocurrently hepatitis inject Cantibody equipment putspeopleatofhepatitis highrisk Bandhepatitis unsterile Cinfections. druginjecting Sharing accessdrugs andtheiralmostnon-existent to prevention, diagnosis around andtreatment theworld. services concerned over thegrowing ofhepatitis Bandhepatitis Cover impact gapbetween theenormous peoplewhouse viral hepatitis, doctors, nurses, socialworkers, researchers, andpeoplewhousedrugs-are publichealthexperts, We, membersandrepresentatives oftheviral that hepatitis -acommunity includespeoplelivingwith community elimnation D his lackofaccess to hepatitis care for people whousedrugsisdeeplyrooted inanddriven by ourlaws andpolicies eclaration reinforcing stigmatization anddiscrimination. drug usefuelstereotypespolicies criminalizing andnegative assumptionsofpeople whousedrugs, ultimately hepatitis infection; medical treatments, withoutaccess to prevention andat heightened services, of reduction risk andotherharm people whousedrugsare frequently incarcerated detained, orextra-judicially leadingto often interruption of offenses (suchasdruguse, possessionandlow-level supply); many national laws imposesevere custodial anddisproportionate sentences for minor, non-violent drug anduptake; delivery the prohibition service reduction of drugparaphernalia possession impedesharm

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decrimnalzation epatits ) adopted thefirsteverStrategySector GlobalHealth (GHSS) C 54 ommunity ! : no

unitive evidence. and to adoptanapproach onpublichealthpromotion, for basedoverwhelmingly respect humanrightsand procedures anddiscriminationthat hinderaccess, includingthecriminalizationofminor, non-violent drugoffences the uptakeoffullrange ofprevention by peoplewhousedrugsby reforming services laws, law enforcement viral hepatitis order by 2030.In to achieve that goal, we callonworld politicalleadersto remove to allbarriers We, States’ Member support theviral hepatitis community, whole-heartedly commitment to thegoalofeliminating [21][22]. drug offenses, alternatives andastrengthening [9][15][16][17][18][19][20] ofhealth-oriented sanctions to criminal the experts, WHO andotherUnited Nations Agencies to recommend thedecriminalizationofminor, non-violent Growing reform recognition drugpolicy hasledseveral oftheneedfor world evidence-based leaders, publichealth violations includingviolence, disease, ofpeople’s discrimination,andtheundermining rightto health[10][11][12]. demonstratesevidence overwhelmingly that theyhave humanrights anddisproportionate driven unnecessary policies that prohibit drugsare to public healthandsafety, anddefendedpreserve portrayed asnecessary the new HIVinfections, andreduced associated harms withdruguseanddependence [14]. While ourlaws and an increase by peoplewhousedrugs–contributing ofaccess to andhealthservices decreased to reduction harm with significant publichealthbenefits[12][13]. A numberofcountries, suchasP a glassceiling –asthefear ofarrest continues to drive peopleaway from prevention andcare services. Even incountries that have integrated into reduction harm domesticpublichealthpolicies, criminalizationremains 1. 3. 2. 4. 6. 5. 7. 8. 9. 10. 11. 12. 17. 16. 15. 14. 13. 18. 22. 21. 20. 19. a multistagesystematic review. P Lancet GlobHealth2017.In Degenhardt etal. Globalprevalence druguseandsociodemographic andprevalence characteristics ofinjecting ofHIV P eng.pdf?ua=1, accessed: 11September2017). O World Health Organization (WH Hagan Hetal. ASystematic R Cochrane R 204(1):74-83. (academic.oup.com/jid/article/204/1/74/2192163/A-Systematic-R Wilson DPetal. hepatology.eu/article/S0168-8278(16)00086-6/pdf, accessed 9O NKetal. P Martin strategy2016-2021/ghss-hep/en/, accessed 9O O World Health Organization (WH accessed 9O systematic review. P Lancet GlobHealth2017.In Setal.Larney Global, regional, coverage andcountry-level to ofinterventions prevent drugs:a andmanageHIVhepatitis Camongpeoplewhoinject Global Commission onDrugP thelancet.com/pdfs/journals/lancet/PIIS0140-6736(10)60832-X.pdf, accessed 9O Wolfe Detal. (www.globalcommissionondrugs.org/wp-content/uploads/2016/03/GCDP_HepatitisC_2013_EN.pdf, accessed 9O 6736(10)60958-0.pdf, accessed 9O Wood Eetal. 6736(16)00619-X.pdf, accessed 9O Csete Jet al. P sites/default/files/media_asset/donoharm_en.pdf, accessed 9O Joint United Nations P globalcommissionondrugs.org/wp-content/uploads/2016/11/GCDP Global Commission onDrugP 20(1):22146. (www.jiasociety.org/index.php/jias/article/view/22146, accessed 9O Grebely Jetal. Elimination ofHC ;2016(www.inspq.qc.ca/pdf/publications/2133_synthese_connaissances_substances_psychoactives.pdf,Québec accessed 11September2017). F.Gagnon Synthèse novatrices desconnaissances :actions enmatière desubstances psychoactivesNational deSanté «illicites :Institut P ».Québec publications/A%20Quiet%20R T UN Women. P AGender N_Women_files/2014/12/02/Gender_and_Drugs_-_U P for Collaborative Interventions. United Nations O mediacentre/news/statements/2017/discrimination-in-health-care/en/, accessed 9O United Nations (UN).Joint United Nations statement onendingdiscriminationinhealthcare settings, Joint WHO/UN statement. 2017.(www.who.int/ (apps.who.int/iris/bitstream/10665/128048/1/9789241507431_eng.pdf?ua=1&ua=1, accessed 9O O World HealthOrganization (WH accessed 9O CommissionerHigh for HumanR United Nations HumanR ransform. R AQuiet latt Let al. programmes Needlesyringe andopioidsubstitutiontherapy for preventing HC eview andmeta-analysis. 11. 2017Sep Addiction. ctober 2017). ctober ctober 2017). ctober V T ublic healthandinternational drugpolicy. Lancet. 2016Apr 2;387(10026):1427-1480.(www.thelancet.com/pdfs/journals/lancet/PIIS0140- reatment andcare fordruguserswith HIVinfection:areview andways ofbarriers injecting forward. Lancet. 2010Jul31;376(9738):355-66.(www. ienna declaration:drugpolicies. acallfor Lancet. 2010;376(9738):310–12.(www.thelancet.com/pdfs/journals/lancet/ evidence-based PIIS0140- T he cost-effectiveness of harm reduction. Int JDrugP he cost-effectiveness ofharm reduction. DC). Implementing Comprehensive Implementing fficeCrime (UNODC). onDrugsand HIVandHC rioritization ofHC rioritization evolution: Across Drug Decriminalisation theGlobe. Bristol, 2016.(www.release.org.uk/sites/default/files/pdf/ United Kingdom; rogramme health,humanrightsandpeoplewhouse. noharm: onHIV/AIDS(UNAIDS).Do Switzerland; Geneva, 2016.(www.unaids.org/ erspective on the Impact ofDrugUse, theDrug ontheImpact erspective ights Council (UNHR eview and Meta-Analysis of Interventions toeview andMeta-Analysis P ofInterventions olicy. olicy. Advancing DrugP evolution%20-%20Decriminalisation%20Across%20the%20Globe.pdf, accessed 9O V as a public health concern among people who inject drugsbyV asapublichealthconcern 2030– amongpeoplewhoinject What willittaketo getthere? AIDSSoc. 2017Jul28; JInt ienna, Austria; 2017.(www.inpud.net/sites/default/files/IDUIT%205Apr2017%20for%20web.pdf, accessed 9O ights. Switzerland; Geneva, 2015.(www.unodc.org/documents/ungass2016//Contributions/UN/OHCHR/A_H ). Global hepatitis report, 2017. Geneva, Switzerland; 2017.Geneva, ). Globalhepatitis 2017.(http://apps.who.int/iris/bitstream/10665/255016/1/9789241565455- report, ). Global health sector strategy). Globalhealthsector onviral hepatitis Switzerland; 2016-2021.Geneva, 2016 (www.who.int/hepatitis/ ). Consolidated guidelinesonHIVprevention, diagnosis, treatment andcare for keypopulations. Switzerland; Geneva, 2014. ctober 2017). ctober ctober 2017). ctober V treatment antiviral era: inthedirect-acting aneconomic evaluation. JHepatol. 2016Jul;65(1):17-25.(www.journal-of- T egative Impact O he Negative Impact ortugal andtheCzech R ortugal C). Study on the impact oftheworld drugproblem Study ontheimpact ontheenjoymentC). ofhumanrights, R ctober 2017). ctober ress. olicy R olicy olicy_Brief.pdf, accessed 9O f T eform: anewapproach to Switzerland; decriminalization.Geneva, 2016(www. he War OnDrugsP ress. T hese policy changeshavehese policy proven successful andhave very ledto ctober 2017). ctober ctober 2017). ctober -R olicy. 2015Feb; 26Suppl1:S5-11.(www.ijdp.org/article/S0955-3959(14)00311-9/pdf, NGLISH.pdf,eport-2016-E accessedO 9 T rade, andDrugControl R revent Hepatitis C epublic, decriminalized minordrugoffenses years ago 55 eview-and-Meta-Analysis-of, accessed 9O ctober 2017). ctober ctober 2017). ctober ctober 2017). ctober ublic Health: ctober 2017). ctober transmission among people who inject drugs:findingsfromV transmission a amongpeoplewhoinject V irus Infection inP irus Infection V P T egimes. New York, United Nations; 2014.(www.hr-dp.org/ he Hidden Hepatitis Switzerland; CEpidemic;Geneva, he Hidden 2013. ctober 2017). ctober rogrammes withP ctober 2017). ctober eople Drugs. Dis. JInfect 2011Jul1; Who Inject ctober 2017). ctober ctober 2017). ctober eople Drugs:P Who Inject , HB ctober 2017). ctober V , andHC in people who inject drugs: V inpeoplewhoinject eport oftheUnited Nations eport ctober 2017). ctober C_30_65_E.pdf, ractical Guidance ractical

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WHS17 port e r nt e Ev WHS17 Event report A Colombia China Chile Canada Cameroon Cambodia Burundi FasoBurkina Bulgaria Brazil Bosnia Bhutan Benin Belgium Belarus Bangladesh Australia Armenia Argentina Angola Algeria Afghanistan nnex B:C ountries Israel Ireland Iran Indonesia India Haiti Guinea Guatemala Greece Ghana Germany Georgia Gambia France Ethiopia Egypt Denmark Cuba Croatia Côte d’Ivoire R Dem Congo ep ofCongo

represented Countries represented Mozambique Morocco Mongolia Moldova Mexico Mauritius Mauritania Malta Mali Malaysia Malawi Madagascar Macedonia Libya Lesotho Lebanon Kyrgyztan Kuwait Kenya Kazakhstan Jamaica Italy (n=106) 56

Sweden Suriname Sudan Spain Africa South Slovenia Serbia Senegal R Russian Federation R Qatar P P P P P N New Zealand Netherlands Nepal Myanmar araguay akistan ortugal eru hilippines omania wanda igeria Zimbabwe Zambia V Uzbekistan Uruguay United States UK UAE Ukraine Uganda T T T T T T Syria Switzerland ogo anzania urkey unisia imor-Leste hailand iet Nam Haiti Guinea Guatemala Greece Ghana Georgia France Ethiopia Egypt Cuba Croatia Colombia China Chile Canada Cameroon Cambodia FasoBurkina Bulgaria Brazil Belarus Angola A nnex C:G overnments Governments represented (82delegates) P P P P N Nepal Mozambique Mongolia Moldova -R Mexico Mauritius Malta Malawi R Macedonia - Libya Lesotho Kyrgyztan Kazakhstan Jamaica Indonesia India araguay akistan ortugal hilippines epublic O igeria

represented f epublic of T he Former Yugoslav (n=65) 57

Zimbabwe Zambia V Uzbekistan Ukraine Uganda T T T T Syria Switzerland Suriname Sudan Africa South Serbia Senegal R Russian Federation R Qatar anzania -United R unisia imor-Leste hailand iet Nam omania wanda

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WHS17 port e r nt e Ev WHS17 Event report 23+13+1+9+16+1+7+6 A nnex D: elegate

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58 Abstract authors(6%) Industry (7%) Multi-national agencies(1%) Public health(16%) Funding bodies(1%) Civil society(9%) Media (1%) Brazilian delegates(23%) (13%) Governments Patient organisations (23%) www.worldhepatitissummit.org videos. for presentations, posters, photos and V forLooking more? isit the World Hepatitis Summitwebsite

WHS17 port e r nt e Ev www.worldhepatitissummit.com