Download Civil Society Organizations Endorse the Brazilian Prorposal for a

11 May, 2009
Mr. Naresh Dayal
Secretary Minister of Health and Family Welfare
Government of India
Nirman Bhavan
New Delhi
Sub: Endorsement of the Resolution proposed by the Brazil on Viral hepatitis at the 62nd
World Health Assembly May 2009
Dear Sir,
We write to you as civil society organizations and activists vitally concerned with the
health and rights of people living with HIV/AIDS and co-infected with HCV.. Many of us are
and represent the most marginalized sections - people using drugs and/or, living with TB, HIV
and other blood borne infections.
We are writing this letter with reference to agenda item 12.17 at the 62nd World Health
Assembly relating to viral hepatitis.
According to the World Health Organisation (WHO), the world is reeling under the
burden of chronic hepatitis viral infection. Nearly two billion people worldwide are reported to
be chronically infected with hepatitis B (HBV)i[1]; several million (130-170 million) are
reported to be infected with hepatitis C (HCV)ii[2].
In India too, viral hepatitis is emerging as a major public health problem exhibiting a high
and continued incidence for hepatitis A and Eiii[3]. Although there is no national and regional
surveillance on hepatitis, certain studies report the presence of intermediate HBV endemicity,
with 2%-4% carrier frequency.iv[4] Hepatitis E (HEV) is responsible for most of these cases and
30%-70% cases of acute sporadic hepatitis are caused by HEVv[5].
WHO estimates 12 million people in India to be chronically infected with HCVvi[6]. It is
the leading cause of chronic liver disease in India; the prevalence has ranged from 10.8% to as
high as 48.5% among patients with chronic liver diseases.vii[7]. Unlike hepatitis A and B, there
is no preventive vaccine for HCV and the diagnosis, management and treatment for HCV
infection poses additional challenges.viii[8] HCV primarily affects people injecting drugs.
According to one study, over 92% of adults who inject drugs in India are infected with
HCVix[9]. The north eastern states of Mizoram, Manipur, and Nagaland report a staggering
prevalence of HCVx[10]. One of the studies on IDUs with HIV in northeastern India reported
HCV prevalence at 79.1% (n=400) xi[11]; while another reported HCV prevalence at 90.4%
(n=250)xii[12]. In these states, HIV coupled with hepatitis co-infection is main cause of
mortalityxiii[13]. These statistics, undoubtedly call for increasing attention to viral hepatitis
especially HCV. It is our experience that many people living with HIV in the north eastern states
are dying because they are unable to access the expensive treatment for HCV which are patented
in India.
We understand that Brazil has proposed a resolution for debate during agenda item
12.17 on viral hepatitis at the forthcoming 62nd World Health Assembly scheduled from 18
May to 27 May 2009. The resolution calls for establishing national hepatitis programs (with
surveillance, treatment systems and reaching populations affected by HCV), enhancing
prevention and control with WHO guidance, civil society and NGO involvement, assigning
international and national resources, recognizing TRIPS flexibility to enhance access to
therapeutic goods and observing World hepatitis Day on May 19 to mark the struggle against
viral hepatitis.
As health activists we are deeply concerned with the absence of resources to address the
health problems posed by viral hepatitis including lack of access to expensive and unaffordable
diagnostics and treatment. We believe that the proposed resolution on viral hepatitis signals the
beginning of global attention towards a much neglected health problem. We are hopeful that it
will spur member states as well as the WHO to take concerted measures and craft a response to
viral hepatitis, especially HCV, and protect and promote the right to health of those living with
hepatitis.
We ask you to support the Resolution proposed by Brazil on viral hepatitis at the
forthcoming World Health Assembly in Geneva.
As civil society, we assure you of our full support in tackling this silent health crisis.
Given the opportunity, we would be happy to personally brief you and/or officials attending the
forthcoming World Health Assembly on the above mentioned issue.
In solidarity
Hopers Foundation, Chennai
Indian Harm Reduction Network
Indian Network for People Living with HIV/AIDS
Lawyers Collective HIV/AIDS Unit
Manipur Network of People Living with HIV/AIDS
Social Awareness Service Organisation, Imphal
Sankalp Rehabilitation Trust, Mumbai
Sharan, Delhi
i[1] WHO fact sheet on Hepatitis B – Available at
http://www.who.int/mediacentre/factsheets/fs204/en/index.html (2009)
ii[2] Viral hepatitis – “Report by the secretariat”, A62/22 (2009)
iii[3] Acharya S.K., etal “Viral hepatitis in India” Dept of Gastroenterology AIMS - Natl Med J
India, 2006 Jul-Aug; 19(4):203-17 Dept of Gastroenterology AIMS
iv[4] ibid
v[5] P.Kar “Viral hepatitis - is it still a challenge in Indian subcontinent?” - Indian J Med Res
125, May 2007, Available at http://medind.nic.in/iby/t07/i5/ibyt07i5p608.pdf
vi[6] Hepatitis C: 2002 - “WHO Epidemic and Pandemic Alert and Response, 2002”. Available
at: http://www.who.int/csr/disease/hepatitis/whocdscsrlyo2003/en/index4.html
vii[7] Mukhopadhya A “Hepatitis C in India” - J. Biosci (2008). 33 465–473
viii[8] WHO “Hepatitis C – An introduction”- Available at
http://www.who.int/csr/disease/hepatitis/whocdscsrlyo2003/en/index5.html (2003)
ix[9] Aceijas C, Rhodes T. “Global estimates of prevalence of HCV infection among injecting
drug users” - Int J. of Drug Policy 2007, 18(5):352-358
x[10] P.K.Chellenge, etal “Risk of HCV among IDUs in Mizoram” - Indian J Med Res 128, Nov
2008, pp-640-646
xi[11] Borkakoty B, et al. “Co-infection of HIV, HCV, HBV and the associated risk behaviors
among injection drug users in two northeastern states of India” - Abstract MOPEC044
xii[12] Devi KS, etal “Seroprevalence of hepatitis B and hepatitis C virus among hepatic
disorders and injecting drug users in Manipur” - Indian J Med Microbiology 2004, 22(2):136137
xiii[13] Swati Gupta etal “Hepatitis B and C virus co-infections in human immunodeficiency
virus positive North Indian Patients” - World J Gastroenterol 2006 November 14; 12(42): 68796883