Hepatitis in Africa: A Silent Epidemic

On July 28, World Hepatitis Day, it is essential to shine a light on these silent epidemics, whose health impact in Africa remains largely underestimated. Far from being marginal, hepatitis B and C are major public-health issues: they are the second leading infectious cause of death worldwide, just after tuberculosis. Every year, millions of people are affected, often without knowing it.

According to the World Health Organization (WHO), deaths linked to viral hepatitis continue to rise globally, increasing from 1.1 million in 2019 to 1.3 million in 2022 , or more than 3,500 deaths per day. Of these deaths, 83% are attributed to hepatitis B and 17% to hepatitis C, an alarm signal that calls for urgent and coordinated mobilization.

Hepatitis Underdiagnosis: A Major Public-Health Challenge in Africa

Although widespread, hepatitis B and C remain massively underdiagnosed in Africa, limiting care and worsening the silent progression of these diseases. According to the WHO, fewer than 10% of carriers in Africa are diagnosed. This burden translates into around 125,000 deaths per year from complications such as liver cancer and cirrhosis, representing 26% of the global disease burden linked to these illnesses.

In Morocco, the situation is equally concerning. An estimated 370,000 people carry the hepatitis B or C virus. Hepatitis C prevalence is estimated at 0.5% of the population, or around 125,000 people with chronic infection. Yet a recent Roche study indicates that up to 60% of people surveyed would not be inclined to get tested.

This pattern is similar elsewhere in Africa, where the situation is just as worrying. In Benin, for example, according to data from the National Blood Transfusion Agency (ANTS), around 1.4 million Beninese people have hepatitis A, B or C, meaning that one citizen in seven is living with the disease without knowing it.

In Togo, the Togolese league against hepatitis reports that hepatitis B prevalence ranges between 13% and 16%, while hepatitis C prevalence ranges between 8% and 10%, figures that are very high compared with the African average, estimated between 5.8% and 8% of the general population, with significant disparities by country and region.

The Root Causes of Underdiagnosis and Hepatitis Progression in Africa

This alarming situation is explained by a set of interconnected factors that hinder the fight against hepatitis B and C across the continent. Among the major causes is first a glaring lack of awareness. Populations have limited knowledge of transmission modes, the risks involved and the crucial importance of early screening. In Morocco, as in many African countries, this lack of awareness limits demand for testing and delays care.

In addition, risky practices, often linked to shortcomings in prevention resources, whether access to vaccines, oversight of risky medical practices or hygiene, help maintain active viral transmission.

Another major obstacle is the persistent social stigma associated with hepatitis. Fear of discrimination, isolation or judgment leads many people to hide their status, avoid screening, or delay or abandon treatment. This fear feeds a vicious circle: the disease progresses silently, increasing morbidity and mortality, while remaining invisible to public policy and the wider public.

The consequences are dramatic: in 2022, more than 307,000 deaths due to viral hepatitis were recorded in Africa, including 272,000 linked to hepatitis B and 35,000 to hepatitis C. This heavy toll reflects not only the prevalence of infections, but also massive underdiagnosis, limited access to care and silent progression toward severe liver diseases such as cirrhosis and liver cancer.

Finally, this combination of stigma, insufficient prevention and unequal access to care slows the effective integration of hepatitis control into national and local health policies. Limited access to screening centers, a shortage of targeted information campaigns and insufficient overall awareness make this battle even harder, with a heavy impact on public health in Africa.

Priority Areas for Fighting Hepatitis in Africa

Raising Public Awareness:

In Morocco, despite notable progress under the National Strategic Plan to Combat Viral Hepatitis and investment in innovative health infrastructure, hepatitis C screening remains dramatically low: before 2018, fewer than 5% of at-risk populations had been tested.

This screening deficit means that most infected people are unaware of their status, delaying access to treatment and increasing the risks of transmission and serious complications. In response, integrating awareness and prevention into the national political agenda is becoming a priority. Such a commitment would improve access to care, streamline care pathways and significantly reduce costs for the health system, particularly in the most remote areas.

Strengthening Prevention:

As repetitive as it may sound, prevention remains one of the most essential levers in the fight against hepatitis B and C. Neonatal vaccination against hepatitis B, when administered within 24 hours of birth, could prevent up to 710,000 deaths in birth cohorts between 2020 and 2030, including nearly 78% in the WHO African Region alone.

Yet in 2021, only 17% of African newborns had received this crucial birth dose, underscoring a worrying delay and the urgent need to strengthen vaccination campaigns. Beyond vaccination, prevention also requires early screening, reducing risky behaviors (needle sharing, unprotected sex) and active awareness efforts against stigma, all essential conditions for ensuring better access to treatment and containing the epidemic.

Strengthening Access to Modern Antiviral Treatments:

Facilitating access to direct-acting antivirals for hepatitis C and effective treatments for hepatitis B is essential to reduce the disease burden. Despite the availability of modern treatments capable of curing or effectively controlling these infections, access remains highly unequal across the continent, especially in rural and remote areas. Obstacles are multiple: high medicine costs, insufficient health infrastructure, lack of training for health professionals and difficulty integrating these treatments into national health systems.

Egypt, a pioneer in the fight against hepatitis C through its national treatment program, has treated several million people with more than 90% success. Universal access to innovative medicines is supported by substantial public funding and international partnerships, drastically reducing viral burden in the population.

Fighting Stigma:

Fear of social rejection remains one of the main barriers to hepatitis screening and care. To address it, it is crucial to normalize public discussion of the disease by multiplying accessible, targeted and culturally adapted awareness campaigns.

In Morocco, community initiatives such as those led by ALCS, focused on peer awareness and training health professionals, have demonstrated their effectiveness by breaking certain taboos and increasing use of screening centers.

On a larger scale, deploying national education programs would make it possible to sustainably reduce stigma while facilitating adherence to care pathways and mobilizing affected populations.

In Niger, several anti-stigma campaigns have been launched to break down the social barriers that prevent citizens from accessing prevention, screening and treatment for viral hepatitis. Minister Garba Hakimi stated: "this includes, in particular, intensifying action, increasing resource mobilization for sustainable care financing, and strengthening strong advocacy for a more equitable, inclusive and results-oriented health policy."

Conclusion:

Faced with an epidemic that is as deadly as it is silent, inaction is no longer an option. While progress exists, it remains insufficient given the scale of the challenge. The fight against hepatitis cannot succeed without a comprehensive approach combining prevention, mass screening, action against stigma and equitable access to treatment.

At a time when African health systems are being called upon to transform, the question is no longer whether we can act, but how to accelerate and sustain national and regional responses.

Are we ready to give hepatitis the place it deserves on the continent’s political, health and budgetary agenda?