At NHS England, our hepatitis C elimination programme has been a model for international efforts to eliminate the virus. The programme has identified and treated tens of thousands of people living with hepatitis C, preventing them from going on to develop life-threatening liver disease and cancers.

As we recognise World Hepatitis Day, today marks an opportunity to evolve our approach and establish a comprehensive viral hepatitis elimination programme that includes hepatitis B as well as hepatitis C.

Our journey so far

England has made remarkable progress in addressing viral hepatitis, stemming from an increased national focus with the advent of new curative antiviral medicines in 2015, to the groundbreaking deal with three pharmaceutical supplier partners to provide unlimited access to these treatments in 2019.

Our hepatitis C elimination programme has been internationally recognised, with around 100,000 people treated since 2015 and a 57% reduction in prevalence between 2015 and 2023. Thanks to the collaborative nature of the programme, we’ve achieved a 40% reduction in hepatitis C-related mortality.

However, while celebrating these successes for hepatitis C, we are currently off trajectory for meeting the World Health Organisation (WHO)’s 2030 elimination targets for hepatitis B.

The hepatitis B challenge

Like hepatitis C, hepatitis B causes a dangerous infection in the liver that can lead to cirrhosis and cancer. The hepatitis B virus can be suppressed through inexpensive and effective treatments, preventing long-term complications. There is also a vaccine, which is effective in preventing babies born to mothers living with hepatitis B from acquiring the virus, as well as in other at-risk groups where the virus may be transmitted through sexual or blood-to-blood contact.

UKHSA estimates that approximately 268,000 people are living with chronic hepatitis B in England, with half remaining undiagnosed. This represents a public health issue hiding in plain sight, particularly affecting migrant communities, people facing homelessness and other marginalised populations. And despite the presence of an effective vaccine schedule for hepatitis B, which is typically provided during infancy, this does not resolve the existing cases within this country.

The scale of undiagnosed hepatitis B became apparent through our emergency department opt-out testing programme. Since April 2022, this innovative programme has conducted almost 3 million hepatitis B tests across 75 sites, newly diagnosing more than 6,000 people with hepatitis B. Critically, a significant proportion of those tested had no previous record of hepatitis B testing, highlighting the programme’s success in meeting an unmet healthcare need.

However, this success in finding cases has highlighted a need to build our support for those living with hepatitis B and to prevent further transmission, meeting the 10 Year Health Plan’s objective of moving from sickness to prevention.

Our comprehensive response

Our renewed viral hepatitis elimination programme brings a shift in our approach. Rather than viewing hepatitis B and C as separate challenges, we’re establishing integrated viral hepatitis networks that can leverage the expertise, infrastructure, and partnerships developed through our hepatitis C work while addressing the unique challenges of hepatitis B.

We’re launching a series of time-limited working groups focusing on secondary care capacity, primary care delivery, pharmacy and medicines pathways, vaccination programmes and peer support, and patient navigation. These groups will review current practice, identify improvement opportunities, and develop both immediate interventions and longer-term strategic solutions, with an ambition to enable changes from this year onwards.

The working groups will pay particular attention to addressing barriers to accessing care. We’re committed to ensuring that our interventions break down stigma and reach those experiencing homelessness, people in contact with the criminal justice system, and other marginalised communities who bear a disproportionate burden of viral hepatitis.

Innovation and integration

Our approach builds on proven interventions from hepatitis C elimination whilst addressing hepatitis B’s unique challenges. In line with the 10 Year Health Plan’s ambitions to shift delivery from hospitals to communities, we will develop community-based care pathways that bring services closer to patients. This will include exploring enhanced roles for primary care, pharmacy-based services, and innovative peer support programmes.

We also intend to address the critical need for improved data systems led by the NHS, enhancing our shift towards digital care. We will upgrade our current hepatitis C treatment registry to a comprehensive viral hepatitis patient management system, with plans to develop monitoring and surveillance through the NHS app.

Looking forward

By developing an integrated approach to viral hepatitis, I’m confident in our ability to transform hepatitis B care in England. Our hepatitis C elimination programme already demonstrates what’s possible when we combine clinical expertise, innovative delivery models and sustained commitment, and we can bring the same strategy towards hepatitis B.

The evidence from our emergency department testing programme shows we can find the undiagnosed. With the additional tool of an effective vaccine, which will play a similar role to the curative treatments we have for hepatitis C, we can prevent transmission within the population. Now we must build the comprehensive care pathways that ensure everyone diagnosed receives timely, effective treatment – an aim we will deliver with the full and active engagement of patient organisations and charities such as HepB Companion, the Hepatitis C Trust and the British Liver Trust.

Our expanded viral hepatitis elimination programme represents a commitment to health equity and a recognition that no one should face preventable liver disease, cirrhosis, or cancer due to inadequate healthcare access. It is our intention to eliminate both hepatitis B and C as public health threats in advance of the WHO target, positioning England as a global leader in viral hepatitis elimination.