Second World Indigenous Peoples’ Conference on Viral Hepatitis: Anchorage Consensus Statement 2017

2017 is the 10th Anniversary of the Declaration of the Rights of Indigenous Peoples. Delegates at the 2nd World Indigenous Peoples’ Conference on Viral Hepatitis, held in Anchorage, Alaska from 8-9 August, seized the opportunity to develop a powerful consensus statement which calls on nation-states and governments to commit to eliminating viral hepatitis among Indigenous Peoples and Tribal Communities WORLDWIDE by 2030.

Anchorage Consensus Statement 2017

As delegates at the 2nd World Indigenous Peoples’ Conference on Viral Hepatitis held in Anchorage, Alaska, who are committed to effective action on viral hepatitis in indigenous and tribal communities, we declare the following:

We SEEK the ELIMINATION of avoidable mortality from people living with viral hepatitis, and the ELIMINATION of viral hepatitis from Indigenous Peoples and Tribal Communities WORLDWIDE by 2030.

We REQUIRE OUR nation-states and governments to make special provision in health and funding policies to achieve elimination of viral hepatitis from Indigenous Peoples and Tribal Communities by 2030.

We RECOGNISE and SUPPORT the desire of Indigenous Peoples and Tribal Communities to determine our futures and to receive culturally effective services which reduce the impact and eliminate viral hepatitis.

As we celebrate the 10th Anniversary of the Declaration on the Rights of Indigenous Peoples, we AFFIRM our commitment to Indigenous rights and URGE nation-states and governments to facilitate further progress.

To maintain momentum, it is critical that an Indigenous-led working group be formed and supported to drive international action on eliminating Viral Hepatitis in Indigenous Peoples; recognising how Indigenous Peoples are organised, and designed to ensure those with the greatest needs are served first.

9 August 2017 – Anchorage, Alaska, USA

In developing this statement, we have taken regard to the following PRINCIPLES:

  • Diversity exists within Indigenous peoples and tribal communities;
  • Viral hepatitis is impacted by the intergenerational trauma experienced by Indigenous peoples;
  • Viral hepatitis is everybody’s responsibility, yet Indigenous peoples must lead the change;
  • Indigenous leaders, scientists, researchers, philanthropists, academics, people in industry, and Indigenous peoples’ living with viral hepatitis – working together under Indigenous peoples’ leadership;
  • Indigenous peoples’ self-determination and empowerment of Indigenous peoples and communities to control their relationship with viral hepatitis;
  • Privileging and prioritising indigenous peoples’ responses by integrating, weaving, and incorporating cultural and traditional knowledges, worldviews, and culturally resonant, strength-based practices;
  • Freedom from racism, discrimination and stigma;
  • Health equity for all Indigenous peoples;
  • Respecting and protecting Indigenous peoples’ lands, habitats and communities;
  • Creating opportunities for sharing Indigenous peoples’ expertise on health and supporting Indigenous models of hepatitis care and treatment.

The KEY PRIORITIES are to:

  • develop a template to enable indigenous peoples regionally to report on reducing avoidable death and making progress toward elimination of viral hepatitis;
  • develop national, indigenous-specific targets within strategies to ELIMINATE viral hepatitis;
  • on the path to ELIMINATION, commit to a reduction in the incidence, prevalence and burden of viral hepatitis in Indigenous populations;
  • encourage, facilitate and fund indigenous youth attendance to meetings and workshops;
  • improve access for indigenous peoples to quality healthcare across all levels of the healthcare system;
  • incorporate indigenous knowledges and customs in viral hepatitis health education (including through Indigenous educators);
  • develop and implement Indigenous models of viral hepatitis care and treatment;
  • respond to the viral hepatitis needs of indigenous peoples in prison;
  • on the path to ELIMINATION, promote harm reduction as a strategy for reducing the burden of viral hepatitis in indigenous peoples;
  • on the path to ELIMINATION, improve surveillance, data collection, reporting and monitoring of viral hepatitis in Indigenous communities;
  • encourage, facilitate and fund (indigenous controlled) research in viral hepatitis;
  • support international meetings and workshops to address viral hepatitis in indigenous peoples.

Dr G. Yunupingu’s legacy: it’s time to get rid of chronic hepatitis B in Indigenous Australia

News of the tragic death of Dr G. Yunupingu last week in Darwin at only 46 years of age has again highlighted the unacceptable gap in life expectancy between Aboriginal and Torres Strait Islanders and other Australians. Yunupingu had been living with chronic hepatitis B since early in life, and experienced complications of this condition including liver and kidney disease.

Hepatitis B infections, which can lead to liver disease and cancer, are unacceptably high in Indigenous Australians. In Northern Australia, 10-20% of the Indigenous population is infected with the virus. Eliminating the impact of this infection in Indigenous Australians would make a substantial contribution to closing the gap in life expectancy.

Hepatitis B in Indigenous Australia

Hepatitis B is the most prevalent form of viral hepatitis worldwide. It’s also the leading cause of liver cancer. Interestingly, hepatitis B used to be known as the “Australia Antigen” as it was first discovered in Australian Aboriginal people in the 1960s.

Hepatitis B is around ten times more prevalent in Indigenous communities than in the rest of Australia. Of the nearly 240,000 Australians estimated to be living with chronic hepatitis B, over 20,000 are thought to be Indigenous people. New infections with hepatitis B remain three times as common in Indigenous people as in non-Indigenous Australians.

The chance of developing chronic hepatitis B depends on an individual’s age at the time of infection. Around 90% of those who were exposed as infants develop chronic hepatitis B, but only 5% of those who were exposed as adults will develop chronic infection. Most people living with chronic hepatitis B were infected as young children – often, through mother-to-child transmission at the time of birth. This is why vaccination during infancy is particularly important.

The prevalence of chronic (long-term) hepatitis B in Indigenous Australians varies significantly between regions. It is most prevalent in remote areas of Australia, with the Northern Territory having the highest prevalence of any Australian jurisdiction. Around 1.8% of the NT population live with the disease.

The prevalence of hepatitis B and other communicable diseases such as skin infections and influenza in Indigenous communities is intensified by the social, economic, environmental and political situation in which Indigenous Australians find themselves.

Liver disease

In some people, chronic hepatitis B can cause severe liver scarring (cirrhosis) or liver cancer. Less commonly, hepatitis B can damage other parts of the body, including the kidneys and blood vessels.

Chronic liver disease contributes significantly to the Indigenous life expectancy gap. Liver cancer is the fastest-increasing cause of cancer deaths in Australia. In 2016, it was the sixth-most-common cause of cancer deaths. However, for Indigenous people it is the second-most-common cause of cancer-related death after lung cancer.

Compared to non-Indigenous Australians living in the NT, the rate of death due to liver cancer is six times greater in Indigenous Australians.

Cure is rare with liver cancer, and most Indigenous Australians die within a few months of being diagnosed. In the NT, a range of factors contribute to the unequal burden of liver cancer in Indigenous Australians, but hepatitis B is the most important cause.

Hepatitis B vaccine is one way

A safe, effective vaccine for hepatitis B has been provided for all infants in Australia since 2000 – and in the Northern Territory since 1990. As a result, new hepatitis B infections in children born since 2000, as well as those who received adolescent catch-up vaccination from 1998 onwards, have fallen markedly.

However, funded hepatitis B vaccine for Indigenous adults is available only in some states and territories. This limits access for Indigenous people who remain at much higher risk of infection. A recent study suggested a funded catch-up vaccination program for Indigenous adults could rapidly eliminate disparity in hepatitis B incidence.

Vaccination has no effect for those who already have chronic hepatitis B. It is believed over 90,000 Australians living with hepatitis B have never been diagnosed and are unaware of their infection. Only 15% of those infected are receiving treatment or monitoring for their condition.

Unlike hepatitis C, hepatitis B is not yet curable, but current treatments are very well tolerated and effective at preventing liver disease and liver cancer. The profound lack of access to treatment and care among Indigenous people contributes to the disproportionate impact of hepatitis B on this population.

Other ways to reduce infections

An example of innovative care has been operating in Dr G. Yunupingu’s home community of Galiwin’ku for over five years. Under the management of Miwatj Health, an Aboriginal community-controlled health organisation, a hepatitis specialist visits regularly three to four times per year.

The specialist brings necessary diagnostic equipment and effectively provides a “one-stop shop” for individuals living with hepatitis B in Galiwin’ku. Just as importantly, a local healthcare practitioner champions the cause of hepatitis B treatment and elimination. Those infected are contacted and encouraged to see the specialist team.

Several other regions in the world with large Indigenous populations and high hepatitis B prevalence, such as Alaska and New Zealand, have developed programs to test most of the population and identify those with hepatitis B infections. Affected individuals are offered regular follow-up and care to prevent cirrhosis and liver cancer.

When delivering such care to Indigenous communities, it’s essential to develop trust and ensure culturally appropriate approaches. Also important is partnering with communities and their health workers to develop new ways of building awareness of hepatitis B as an important health issue.

With comprehensive public health initiatives, long-term commitment to funding and policy – including significant workforce development to ensure as many people as possible are tested and appropriately followed up – the impact of hepatitis B on Indigenous communities can be eliminated.

This article was written by Benjamin Cowie, James Ward and Steven Tong and originally published in The Conversation.


Hepatitis C - PBS listing: 'Medical miracles welcome, but barriers to elimination remain'

Federal Government funding of a breakthrough antiviral medicine that can cure all forms of hepatitis C must be matched by a concerted effort to reconnect people living with the liver-destroying virus with clinical care.

Speaking on World Hepatitis Day (28 July), CEO of Hepatitis Australia Helen Tyrrell welcomed the Federal Health Minister’s announcement that the first pan-genotypic antiviral, Epclusa® would be PBS listed from 1 August. The new therapy is more than 90 per cent effective in achieving a cure within 12 weeks, regardless of hepatitis C genotype.

“Australians living with hepatitis C now have unprecedented access to curative therapies; however this is only the first step to eliminating hepatitis C as a public health threat in Australia,” Ms Tyrrell warned.

“Equipping health care professionals to feel confident engaging their patients in conversations about hepatitis C and the availability of cures must now become a focus,” she said.

“We must also communicate to those living with the condition that a life free from hepatitis C can be a reality.”

Epclusa (sofosbuvir 400 mg/velpatasvir 100 mg) is a pan-genotypic regimen for the treatment of adults with genotype 1-6 chronic hepatitis C virus infection. The therapy is used in combination with ribavirin in patients with cirrhosis.