Mediclinic Morningside specialist campaigns for viral hepatitis vaccinations

Rates of hepatitis B-related liver cancer in sub-Saharan Africa are some of the highest in the world. The condition is most often transmitted from mother to child and can be prevented by vaccinations at birth.

Mediclinic Morningside gastroenterologist Professor Chris Kassianides is a campaigner for awareness of hepatitis B and the need for funding. He is also founder of the Gastroenterology and Hepatology Association of Sub-Saharan Africa (GHASSA), which recently hosted the African Viral Hepatitis Convention.

Understanding viral hepatitis

Several viruses can cause hepatitis, but the two most common ones in Africa are hepatitis B and hepatitis C, says Professor Kassianides. “Hepatitis B is sexually transmitted and is also spread through intravenous drug abuse. But in Africa there’s a big reservoir of women transmitting hepatitis B during birth – which is why it’s important to get these children vaccinated.”

A key thing to know is that hepatitis C can be cured, whereas chronic hepatitis B cannot. However, much like HIV, daily antiviral medicines are available that prevent hepatitis B from causing damage. Both C and B contribute to liver cancer development, but B is the most prevalent, Professor Kassianides adds.

While not all patients with hepatitis develop cancer, a significant number do. “The virus lies dormant in the liver, but then starts inflaming the liver, which causes the organ to harden. So, patients can develop cirrhosis of the liver, and even if they don’t develop cancer, they can die from liver failure.”

The need for viral hepatitis advocacy

In 2006, Professor Kassianides founded the Gastroenterology Foundation of Sub-Saharan Africa, which has raised around R60 million to date, mainly funding postgraduate education for gastroenterologists and hepatologists. As an offshoot of this foundation, GHASSA was formed in 2017, becoming the first African association to incorporate gastroenterology and hepatology specialties, focusing on gut and liver-related conditions. 

The African Hepatitis Convention, hosted by GHASSA in Cape Town in May 2024, was the first viral hepatitis convention in Africa to be hosted by an African organisation. “We invited 80 world authorities and opinion leaders to take part,” says Professor Kassianides.

Delegates discussed the medical aspects of the condition, but a major focus was on advocacy – looking at how to raise awareness of hepatitis B given the fact that Africa has one of the world’s highest incidence rates of liver cancer.

“It affects people in their 30s, and once they get this cancer, their survival time is eight weeks,” Professor Kassianides says. “It’s wiping out our workforce, because 60% of Africa's population is their 30s.” Liver cancer is mainly caused by the hepatitis B virus, which is transmitted from mother to foetus – preventable by administering a hepatitis B vaccine at birth.

Vaccinating newborns

“Hepatitis B vaccination protocols do exist in South and sub-Saharan Africa, but they generally only begin eight weeks after birth,” Professor Kassianides explains. However, to prevent the infant from contracting the virus, the vaccine needs to be given within 24 hours of birth – a message that GHASSA urgently wants to communicate.  

“Even if countries are legislating vaccines correctly, they’re not being rolled out for various reasons – mostly because of logistics. About 40-50% of births in sub-Saharan Africa occur outside hospitals.”

For this reason, hepatitis B remains a silent killer, with most people who carry the virus remaining unaware of this until they develop liver cancer. While the convention did a good job of highlighting this issue, it also showed that more advocacy and funding is needed to keep raising awareness.

Boosting advocacy

Professor Kassianides says it’s crucial to get support from both government and non-government groups by working directly with the African Union, which the convention intends to do. However, this is a challenging task.

“We need African businesspeople to take an interest in this problem, because it will ultimately affect their workforce,” he explains. “Adam Molai, a major industrialist from Zimbabwe, attended the convention and has formed a network called Hepbridge – a bridge to hepatitis. That network is set to raise US$25 million (±R451 million) annually to have every child in Africa vaccinated with this vaccine.”

It is too costly and difficult to screen infected mothers, which is why every single child born in Africa must be vaccinated, Professor Kassianides explains. “This push from African businesspeople is an important breakthrough. Hepbridge will make the vaccine available and monitor uptake, ensuring success.”

It's important to reach out directly to mothers to increase their awareness about hepatitis B in the same way that people in Africa have been educated about HIV. According to Professor Kassianides, hepatitis B causes more deaths than HIV, but there’s much less awareness about it.

“The main goal that came out of the convention was to raise money through African businesspeople, so we can ensure every child gets vaccinated. Another important point was to identify individuals who have the virus and make treatment – which is inexpensive – available to them.”

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