Toronto Declaration: Strategies to control and eliminate viral hepatitis globally

Toronto DeclarationTuesday 6 January 2015

Avoidable deaths due to viral hepatitis

Over 400 million people are chronically infected with hepatitis B virus (HBV) and hepatitis C virus (HCV) and thousands of new infections occur every day. Chronic viral hepatitis puts individuals at risk of developing progressive liver disease leading to cirrhosis, liver cancer and ultimately death from liver failure. Collectively these two infections cause an estimated 1.3 million deaths worldwide every year. The enormous global public health burden caused by this ongoing epidemic is largely preventable.

Remarkable progress

The last two decades have witnessed unprecedented scientific and therapeutic advances in the field of viral hepatitis. We now possess the tools to control the epidemic. A highly effective vaccine has made HBV a preventable disease. Well-tolerated, potent medications effectively and safely suppress HBV replication improving clinical outcomes in those already chronically infected. However, although HBV can be controlled with long-term maintenance treatment, true cure remains elusive. HCV is the first persistent viral infection to be cured with medical therapy. Viral eradication leads to improvements in all clinical outcomes, including liverrelated and all-cause mortality. A protective HCV vaccine is not yet available; however short treatments with recently developed potent antiviral agents lead to cure in the vast majority of treated individuals. These powerful tools create a scenario in which control and even global eradication of both infections is now a feasible goal.

Call for coordinated action

Despite this remarkable progress, major challenges remain. Preventable transmission continues, the majority of infected individuals remain undiagnosed, and only a tiny minority currently receives treatment. In low income countries diagnostic testing for HBV DNA and ad HCV RNA is not generally available, hampering effective monitoring and treatment. Without coordinated action, the recent therapeutic advances will have little effect on the global burden of disease. Individual countries have developed effective national action plans and the World Health Organization recently developed a Framework for Global Action based on 4 specific axes of intervention ranging from raising awareness to increasing access to care and treatment. Building on this solid foundation, The First International Hepatitis Cure and Eradication Meeting presents the ideal forum for proposing an integrated plan to address hepatitis B and C globally with concrete objectives, tangible goals and measurable outcomes. Therefore, in full support of the WHO Global Hepatitis Programme and the World Health Assembly Resolutions on Viral Hepatitis, we, as a group of international experts across multiple disciplines, now call for coordinated action by governments, industry, affected individuals, and healthcare providers to address the many challenges that continue to impede global control and ultimate eradication of viral hepatitis. The present declaration outlines specific public health policies and interventions with tangible but achievable goals that we hope will help guide WHO and national governments as they continue to develop strategies to address viral hepatitis locally, nationally and on a global scale. The Global Viral Hepatitis Summit (International Symposium on Viral Hepatitis and Liver Disease (ISVHLD)) will be held in Toronto in 2018 and as such, we have set this as a target for implementation of the Toronto Declaration.

More information

For the full version of the Toronto Declaration with National Action Plan targets for Hepatitis B and Hepatitis C, click here.

If you support the Toronto Declaration and want to underscribe the declaration, click here.