The 2024 African Viral Hepatitis Convention Declaration of Cape Town
We, those present and today assembled on the 18th May 2024, affirm the following:
In April 2024, the WHO updated its Global Viral Hepatitis Report and for Africa noted:
1. Almost 2/3rds or 63% of the global burden of hepatitis virus infection now occurs in Africa
2. 771 000 new hepatitis B and 172 000 new hepatitis C virus infections will occur this year in Africa
3. 272 000 will die from hepatitis B, and 35 000 from hepatitis C in 2024 alone
4. Children below the age of 5 will still not reach the <0.1% hepatitis B seroprevalence target
5. Liver cancer rates continue to rise – now the 3rd leading cancer in men
6. Only 18% of babies received a hepatitis B birth dose vaccination and PMTCT programs are minimal.
This is happening:
1. 45 years after the availability of the hepatitis B vaccine
2. With the youngest population worldwide, only 13 African countries having introduced a universal
hepatitis B birth dose vaccination policy and 2 countries targeted hepatitis B birth dose vaccination
3. Globally available and a8ordable hepatitis B treatment
4. 10 years after the availability of highly e8ective cure for hepatitis C
5. 28 countries have developed a national hepatitis strategic plan for viral hepatitis; but most are still in
draft form with only 13 o8icially published and disseminated.
6. 5 years after the African Union endorsed the Cairo Declaration on Viral Hepatitis in Africa
PEOPLE ARE STILL DYING! As a community of people living with viral hepatitis, advocates for those living with viral hepatitis, healthcare workers, academics and those who simply care, we say NO MORE!
All the tools to eliminate viral hepatitis are available and are uncomplicated interventions. In 2016, our global leaders signed up to eliminate viral hepatitis as a public health threat by 2030. Africa is among the regions lagging and will miss out in achieving the target of testing 90% people with viral hepatitis and treating 80% of diagnosed individuals. We know it can be done. When there is political will there is a way! Egypt, Rwanda, Namibia, and Mauritius, amongst others, have shown us the way and are beacons of hope, leading the way forward.
Our leaders lack the political will. Our leaders have failed us by not demonstrating that they truly care
We say No more silence!
We say No more marginalization!
We say No more barriers to implementation!
We say No more excuses!
We say No more to a lack of domestic funding!
We say No more to any care without a patient centered approach!
Viral hepatitis is a silent disease that kills – we will be silent no more!! Silence = Complicity. Silence = Death
We demand:
1. To be heard and to be seen
2. The immediate prioritization of national elimination plans (National Strategic Plans) – vaccinate – prevent - screen – treat!
3. The immediate allocation of the needed resources and domestic funding
4. No more talking – we need African action
5. The political will and commitment to institute policy and remove discrimination.
2 great African leaders once said, “It always seems impossible until it's done" (Nelson Mandela) and “It can be done, play your part”! (Mwalimu Julius Nyerere Kambarage).
Eliminating viral hepatitis is not impossible – and it can and will be done in Africa. We reaffirm ourselves to the struggle today!
“Doing things our own way”: the road ahead for liver disease research and practice in Africa
Globally, progress has been made in the fight against several liver diseases. However, geographical variations in access to the latest diagnostic, treatment, and prevention tools mean that the inequality that continues to be a major challenge in global health is also a major challenge for the various global initiatives that aim to impact Africa’s poor liver disease indices.
Although African scientists are making vital contributions to the global knowledge base on infectious diseases, sometimes leading the world, the continent’s hepatology landscape has struggled to achieve large-scale continent-wide collaborations that could be crucial in achieving research and intervention goals in Africa—goals that could influence who has good or bad outcomes from liver diseases.
In July, 2023, a study identified hepatitis B virus infection as the primary cause of hepatocellular carcinoma and cirrhosis in an African (Gambian) population. With survival rates very low—patients with hepatocellular carcinoma having a median survival of only 1·5 months and patients with cirrhosis having a median survival of 17·1 months—the authors argued that programmes supporting screening and early diagnosis and treatment of cirrhosis are urgently needed in Africa.
Manal El-Sayed, Professor of Paediatrics at Ain Shams University in Cairo, Egypt, and president of the Society on Liver Disease in Africa (SOLDA), agrees. With an estimated 82 million people in Africa living with hepatitis B virus, El-Sayed noted the urgent need to address liver diseases in the African region. She pointed out that, although Africa has a very high burden of liver disease, accessibility to testing and treatment is limited, with only a small proportion of those infected receiving diagnosis and treatment. “This underscores the critical need for intervention and improvement in health-care services for liver diseases in Africa”, she told The Lancet Gastroenterology & Hepatology.
Established in 2022, SOLDA is now recognised as a sister society by the European Association for the Study of the Liver, the American Association for Study of Liver Disease, and the Latin American Association for the Study of the Liver. SOLDA has already created a large community, with more than 1000 members from 37 African countries distributed across the continent.
Early in September, 2023, SOLDA held the sixth edition of the Conference on Liver Disease in Africa in Dar Es Salaam, Tanzania. The conference aimed to empower “health-care professionals to diagnose, prevent, treat, and achieve a cure for liver diseases for the benefit of patients in Africa”. Embodying the goals of SOLDA, it featured the dissemination of the science and practice of hepatology in Africa through educational activities, research presentations, and collaboration fostering. According to El-Sayed, SOLDA aims to promote research, facilitate consensus and practical guidance for the region, and adapt international guidelines to better suit resource-limited settings in Africa.
According to the organisers, this year’s conference saw the highest number of abstract presentations and the quality of the research presented was also the best they had ever had. “The young investigators are showing huge interest and they’re becoming much better at writing their abstracts and also translating this into research manuscripts”, El-Sayed said.
Although societies in individual African countries can support hepatology locally, El-Sayed noted that there is more to gain from being able to connect practitioners across the continent. This includes getting African investigators to lead major clinical trials and investigations done in Africa, which she said would require appropriate partnerships to build the capacities of the continent’s research institutions and researchers, especially young investigators.
Backed by the enthusiasm stemming from the conference, the way forward for SOLDA, considers El-Sayed, is to first accept the reality for the hepatology field in Africa—that it will continue to be practised with gastroenterology due to practitioners’ concerns that hepatology alone is not financially sustainable. “Everything has to be tailored according to the situation in Africa and the resources that are available. We need to do things our own way. We need to have our own clinical trials with the new medications for hepatitis, liver cancer, and others,” she said.
In spite of the advancements in hepatology that have been recorded elsewhere, including landmark studies and clinical trials on liver diseases in western countries, China, and southeast Asia, El-Sayed noted that more efforts need to be given to getting the data out and exploring different models for disease diagnosis and prevention and control programmes.
Paul Adepoju
For the study of liver disease in The Gambia see Articles Lancet Glob Health 2023; 11: e1383–92