According to a recent report by the World Health Organization (WHO), the incidence of viral hepatitis-related mortality is rising globally. Approximately 3,500 individuals perish from the disease on a daily basis, positioning it as the second most prevalent infectious cause of death in 2022, with a mortality rate equivalent to that of tuberculosis.

The 2024 Global Hepatitis Report, unveiled during the recent World Hepatitis Summit, presents novel data from 187 countries, marking the highest number of countries ever encompassed in the report. According to the World Health Organization (WHO), the number of fatalities caused by viral hepatitis has risen from 1.1 million in 2019 to 1.3 million in 2022. On a daily basis, around 6,000 individuals get new infections.

What is viral hepatitis?

A viral infection leads to liver inflammation, which is known as viral hepatitis.
Hepatitis is a comprehensive term used to describe an illness that results in inflammation and harm to the liver. Viral hepatitis is classified into five primary groups, namely hepatitis A, B, C, D, and E. If physicians are uncertain about the etiology of an individual’s infection, they may label it as hepatitis X or non-A-E hepatitis.

The primary focus of the WHO report is on hepatitis B, which is responsible for 83 percent of newly acquired infections, and hepatitis C, which accounts for the remaining 17 percent. Usually, each of these viruses results in persistent infections that eventually cause cancer, cirrhosis, and liver failure.

The illness is also common in younger populations: people between the ages of 30 and 54 account for 50% of chronic hepatitis B and C infections, while children under the age of 18 account for 12% of cases.

What is causing the increase in mortality rates due to hepatitis?
Untreated hepatitis can lead to serious consequences, but our capacity to fight these diseases has significantly improved with early detection.

Hepatitis B is most commonly transmitted during childbirth, but there are safe and effective immunizations available to prevent it. Hepatitis C is transmitted through contact with contaminated blood, typically as a result of unsafe injection practices or, less commonly, unprotected sexual activity. Although a vaccine has not been developed yet, the World Health Organization (WHO) has estimated that over 95 percent of individuals can achieve complete recovery if they are able to obtain antiviral medicine.

However, it is where the trouble resides. The recent research emphasizes that a limited proportion of individuals affected by hepatitis B and C are being promptly recognized and provided with treatment, aligning with the objectives set by the World Health Organization.

For instance, in the WHO African area, where 63 percent of new hepatitis B infections originate, the vaccination rate for infants is barely 18 percent. On a global scale, the percentage of individuals with hepatitis C who have undergone curative therapy is only 20 percent, which falls significantly short of the targeted 80 percent.

The paper suggests that the reason for this is the differences in pricing, which prevent many lower-income countries from being able to afford antiviral treatments, including generic pharmaceuticals that are no longer protected by patents. Similarly, individuals residing in numerous nations may be compelled to bear the cost of testing and treatment services, which may be unaffordable for certain individuals.

What measures can be taken to mitigate the issue?
The report includes several recommendations that, if promptly executed, will help us regain momentum in attaining the World Health Organization’s objective of eradicating the hepatitis epidemic by 2030.

The WHO emphasizes the need to expand access to diagnostic tests, enhance preventative strategies, and accelerate research in order to discover a potential cure for hepatitis B. However, the organization warns that the current level of worldwide financing for these initiatives is inadequate.

“The report reveals a concerning situation: although there has been global advancement in preventing hepatitis infections, the number of deaths is increasing due to a lack of diagnosis and treatment for a significant number of individuals with hepatitis,” stated Dr. Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organization (WHO).

“The World Health Organization (WHO) is dedicated to assisting countries in utilizing all available resources, at affordable prices, to prevent loss of life and reverse this pattern.”

After more than ten years of work, the first clinical study for a treatment for end-stage liver disease (ESLD) that aims to turn lymph nodes into working livers has begun.

Dr. Michael Hufford, co-founder and CEO of LyGenesis, said that we have successfully administered the first dose of a clinical trial to a patient using their own lymph nodes as living bioreactors to regenerate an ectopic organ. This is a groundbreaking achievement in the field of medicine.

The treatment involves extracting hepatocytes, the primary functional cells of a donated liver, and administering them via injection into the lymph nodes. These lymph nodes, which act as filters for foreign particles, such as infection-causing viruses, play a crucial role in supporting the immune system.

After entering the lymph nodes, the liver cells will undergo growth and division, establishing connections with the circulatory system through the development of blood vessels. “Over time, the lymph node will gradually vanish, leaving behind a small-scale organ,” explained Hufford to New Scientist.

This method has previously demonstrated success with certain animals. Scientists conducted an experiment on pigs by surgically modifying their livers to replicate human liver disease. They then introduced healthy liver cells into the lymph nodes by injection. Each of the six pigs had surgery and successfully grew miniature livers. As a result, they exhibited indications of recuperation from liver failure.

The human trial aims to assess the safety, tolerability, and efficacy of this regenerative cell therapy in a maximum of 12 individuals with end-stage liver disease (ESLD), a condition characterized by irreparable liver damage.

Under these conditions, a transplantation procedure is frequently necessary, but several variables can impede its progress. Certain patients may be deemed medically unfit for surgery due to their severe illness, for instance.

Nevertheless, a significant issue lies in the extensive duration of the transplant waiting list. Currently, there is a population of approximately 10,000 individuals in the United States who are awaiting a liver transplant from a donor. However, the unfortunate reality is that these individuals may have to endure a wait of up to five years until a suitable liver becomes available. Approximately 12 percent of individuals on the list will perish annually.

It is anticipated that this novel therapy will address the issue. “If our study proves successful and we receive FDA approval, our allogeneic cell therapy has the potential to treat numerous ESLD patients with just one donated liver. This could help to address the current imbalance between the supply and demand of organs, benefiting the patients,” stated Hufford.

The initial findings of the experiment will take some time to be revealed. However, researchers will closely monitor the patients enrolled for a year to determine the ideal dosage and safety of the treatment, as well as its effectiveness in addressing the indications and symptoms of end-stage liver disease (ESLD).

Half a decade ago, the notion of a global shutdown lasting for weeks would have been inconceivable. However, the concept of mass graves in New York City, a US Republican administration implementing a seemingly universal basic income, and a small number of individuals self-administering an ineffective horse dewormer to treat a virus would also be considered.

Presently, all of it appears to be not just feasible but outdated information. Having experienced and overcome the COVID-19 epidemic, what is the next anticipated event in the ongoing pandemic?

From whence will the forthcoming pandemic originate?
If we possessed knowledge of the nature and timing of the upcoming epidemic, we would take proactive measures to address it. However, the current situation necessitates a hopeful outlook and proactive preparation for potential negative outcomes.

“Undoubtedly, there are individuals who express concerns that this could potentially induce panic,” stated Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organization (WHO), during a panel in January 2024 regarding “Disease X,”  a provisional term for the yet-to-be-identified disease that is expected to have a widespread impact on the world in the near future.

He presented a counterargument. “It is more advantageous to proactively anticipate potential events, as they have occurred frequently in our past, and make necessary preparations.” We should not confront situations without enough preparation.

What is the consensus among specialists regarding the probable nature of disease X? There are several candidates in the competition: “We compile a yearly inventory of emerging diseases,” Ghebreyesus clarified, “and MERS, Zika, Ebola, and others could potentially be included.” COVID could be referred to as the inaugural disease X.

Possible scenarios for the emergence of the forthcoming pandemic encompass a spectrum of possibilities, spanning from speculative catastrophic scenarios wherein global warming triggers the release of previously unidentified viruses from arctic ice, akin to the depiction in the Chris Pratt time travel film, to alarmingly plausible instances of disease transmission from the animal kingdom, akin to the events that transpired shortly prior to the previous pandemic.

If you have observed a consistent pattern among those choices, you are correct: due to climate change, deforestation in the Amazon and Africa, and the increasing intrusion of human settlements into the natural environment, numerous experts believe that the occurrence of the next zoonotic disease pandemic is highly likely.

According to Nathalie MacDermott, a clinical lecturer in infectious diseases at King’s College London, the current circumstances are conducive to the occurrence of epidemics.

According to her statement, the duration of the situation could range from two years to 20 years or even longer. However, she emphasized the importance of maintaining vigilance. It is imperative to maintain a state of vigilance, preparedness, and readiness to make sacrifices once more.

How can we address this issue?
In the absence of knowledge on the kind or timing of the upcoming pandemic, how can we effectively make the necessary preparations? Indeed, it is simpler than one may anticipate: “We can make arrangements for unforeseen circumstances,” stated Ghebreyesus; “there are fundamental actions that can be taken.”

He proposed the establishment of an early warning system or the enhancement of preparedness plans. “Due to the COVID pandemic, our hospitals were overwhelmed, both in terms of physical capacity and staff,” he emphasized.

The speaker further asserted that the COVID pandemic has brought to light some deficiencies within medical supply chains, perhaps leading to the closure of gaps.

Adam Kucharski, co-director of the Centre for Epidemic Preparedness and Response at the London School of Hygiene and Tropical Medicine, stated to Sky News that the UK’s NHS COVID app showed great potential for containing the spread of the pandemic.

He acknowledged that it would take difficult conversations regarding the compromises between public health and personal privacy. “However, by utilizing the digital contact tracing infrastructure present in certain Asian countries, it is possible to restrict disruption to individuals who are at a greater risk during a specific outbreak, rather than resorting to general measures.”

Frankly speaking, everything seemed highly feasible. Is it being done?

Navigating the upcoming epidemic
With minimal logistical planning and the inclusion of AI ethics courses, we should undoubtedly successfully navigate the upcoming pandemic. Is that correct?

Regrettably, that appears improbable at present. John Bell, a prominent immunologist and part of the UK’s Covid vaccination team during the epidemic, expressed in The Independent last year that despite our extensive knowledge, we are not adequately prepared for the upcoming pandemic.

He cautioned that the forthcoming epidemic has the potential to be considerably more catastrophic than its predecessor. It is imperative that we maintain a perpetual level of preparedness for forthcoming significant health crises, as failure to take action at present will result in a lack of forgiveness.

In the United States, the establishment of a novel governmental entity dedicated to global health and the prevention of pandemics may appear to be a positive progression. However, numerous commentators have highlighted that the country lacks essential infrastructure to withstand a pandemic. Notably, there is no universal healthcare system, and European readers should take a moment to understand that there is no entitlement to paid sick leave. Undoubtedly, during the COVID pandemic, about 25% of Americans had to make a decision between working while ill or forfeiting a day’s salary.

Despite experiencing significant global repercussions due to the global spread of COVID-19, the United States as an institution appears to have a notable reluctance to acquire substantial knowledge from the pandemic. Recent modeling estimates indicate that treatments such as social distancing and mask-wearing have proven to be highly effective in mitigating the transmission of the pandemic. Similarly, vaccines have demonstrated remarkable efficacy, resulting in the preservation of about 20 million lives within the initial year of their introduction. However, the country is witnessing the ongoing expansion of anti-vacxx and anti-science movements, which are permeating politics and exerting influence on legislation at both municipal and state levels.

Put simply, it appears unappealing.

The subsequent periods of lockdown
The Covid pandemic took us off guard, and there is a possibility that we may be taken off guard once more. What will the appearance of that be? A recurrence of the events of 2020, or an entirely distinct occurrence?

It is indisputable that significant changes have occurred since 2019, prior to the widespread awareness of the terms “novel coronavirus” or “Covid-19”. Irrespective of their level of effectiveness or extent of implementation, it is really accurate to say that numerous countries have already established pandemic infrastructure that was previously absent. This includes the implementation of contact-tracing applications and the provision of more flexible work arrangements for employees.

If the supply chain difficulties are rectified promptly, vaccine rollouts should be expedited. According to Devi Sridhar, the chair of global public health at the University of Edinburgh and co-chair of the US National Academy of Sciences’ committee on advancing pandemic and seasonal influenza vaccine preparedness and response in 2021, the majority of governments are actively pursuing the objective of containing the spread of a virus within a 100-day timeframe. This timeframe allows for the approval, manufacturing, and distribution of scientific interventions, such as vaccines, diagnostic tools, or treatments, to the general public. This statement was published in The Guardian during the current week.

“In the United States, the recommended duration is 130 days from the identification of a pathogen until the entire population of the United States is provided with a vaccine,” she clarified, “and 200 days until there is a sufficient global supply.”

The nature of future lockdowns may vary significantly depending on geographical location, maybe resulting in the absence of lockdown measures altogether. “Shutdowns are a drastic policy measure that numerous governments employed in 2020 as a means to address the healthcare crisis,” Sridhar stated. “We currently have the opportunity to enhance containment methods and investigate strategies to ensure the safe operation of schools and businesses through more accurate public health interventions. These interventions should focus on improving understanding of transmission (such as increasing ventilation), diagnostics (testing for infectiousness), and data collection (surveillance of community prevalence).”

The successful implementation of preparedness procedures, as advocated by public health organizations over an extended period, is contingent upon the active engagement of governments and, when applicable, the business sector. This implies that—what about the upcoming pandemic? The appearance of it is uncertain.