10 September, 2012
8th Australasian Viral Hepatitis Conference
Welcome everyone to Auckland, New Zealand, to the 8th Australasian Viral Hepatitis Conference. The significant attendance at this conference shows viral hepatitis as a global health issue, with Asia Pacific the most affected region.
It’s a great privilege for me to be here to open your conference, particularly for reasons you’ll understand later on.
I would like to acknowledge Ngāti Whātua kaumatua Pita Pou and Dave Hillman, and the Chairs of the conference; Professor Ed Gane and Mr John Hornell.
World Hepatitis Day was marked recently at an event with the New Zealand Hepatitis Foundation at Parliament with the theme: let’s know about it, let’s increase testing, and let’s treat hepatitis.
The prevalence of hepatitis on a global scale is staggering.
The burden of the hepatitis spectrum is immense. The sheer numbers of cases are large, the end diseases are severe and chronic and affect years of life.
The treatments can be very expensive, and for many patients the early infection stages of hepatitis disease are silent and ill-recognised.
In essence, the challenge represented by hepatitis is formidable.
One in 12 people in the world live with either Hepatitis B (HBV) or Hepatitis C (HCV) – and the life-long health risks of liver cancer or liver failure.
An estimated two million people die every year from hepatitis, while many more struggle with reduced quality of life from chronic liver disease.
Here in New Zealand, 150,000 people live with HBV or HCV – in Australia it’s estimated around 450,000 do. What’s startling – as you know - is that most of these people don’t realise they have the virus.
It’s estimated around 300 people die of hepatitis in this country each year.
That is why some of the most important work around this communicable disease is happening in our part of the world.
Including my part of the world …in the Bay of Plenty on New Zealand’s east coast.
Bay of Plenty Hepatitis Foundation Kawerau Screening
New Zealand has pioneered work with the Hepatitis B Virus.
In the mid-1980s, local researchers carried out ground breaking population screening for HBV in Kawerau in the Eastern Bay of Plenty where I was brought up and went to school.
They had noticed that many children coming into Whakatane Hospital were jaundiced.
At the same time, an “Assay” test that identified the disease had become available.
The team – which was to become the Hepatitis B Foundation – proceeded to screen 90 per cent of the population of Kawerau – looking for HBV.
They found almost 600 people with HBV in Kawerau… a town of around 8,000 people.
A number of those people have remained in long term follow up. Some of whom I know personally.
Last year Professor Ed Gane, Professor Chris Cunningham, and the Hepatitis Foundation won a New Zealand Health Research Council grant to go back to Kawerau, 28 years later, and retest the almost 600.
They’re looking for markers identifying which HBV patients are more at risk.
…Why one person with HBV gets liver cancer and another doesn’t.
This will be a significant long term study which should greatly add to our knowledge of this disease.
New Zealand was only the second country in the world, after Taiwan, to introduce a universal neonatal vaccination programme against HBV.
Vaccinating babies against Hepatitis B is one of the most important preventative tools we have.
Neonatal vaccination remains one of the most cost effective health interventions introduced, and as such it could be possible to eradicate HBV within the next 50 years.
Childhood immunisation is one of the Government’s six national health targets. Over the past four years, completed immunisation rates for two year olds have gone from 67% to 93%... with today no difference between ethnic groups. This is a significant public health achievement.
We are now bringing the focus and effort of the immunisation target down from two year olds to eight month olds to improve the timeliness and coverage of neonatal vaccinations. Currently 80% of newborns have received the appropriate vaccinations – including for the three for HBV – by eight months, and we are determined to be at 95% by this time in 2014.
Meantime we must do more to manage the tens of thousands of people with hepatitis coming down the pipeline.
Focus on Long Term Conditions
This Government continues to build on services already in place to reduce the spread of viral hepatitis.
There is the Needle and Syringe Exchange Programme and the National HBV Surveillance programme.
This latter programme is now the largest HBV surveillance programme in the world, with over 13,500 people enrolled.
Regular blood testing enables complications such as liver inflammation and cancer to be detected early.
But to be even more effective, health services need to improve early diagnosis and treatment.
We need to ensure an integrated approach to hepatitis – a similar integrated, community based approach best suited to managing most long term chronic conditions.
Increasingly in New Zealand we are seeing health resources move to better support the desire of patients to receive care closer to home, and often manage their conditions themselves.
Community and hospital clinicians are sharing expertise, information and resources to ensure patients don’t have to worry about navigating between multiple services, providers and settings.
Finances are too tight…and patients too savvy…to permit silos and uncoordinated care to remain.
Successfully managing the Hepatitis B and C viruses in the future will depend on just this sort of integration.
Too may HBV and HCV carriers don’t know they have the virus.
They don’t know that they can live longer and healthier lives with the right support and treatment for their condition.
HBV and HCV are diseases that are asymptomatic for years, so it’s important there is increased identification and diagnosis.
HBV and HCV can both be successfully managed in the community if caught early.
The Hepatitis Foundation of New Zealand, with $5m from this Government, is building on its already successful HBV surveillance programme by implementing an integrated healthcare approach to the hepatitis C virus.
They’ve begun one integrated community-based pilot in the Bay of Plenty and will soon start the second in Wellington-Hutt Valley-Wairarapa.
In the Bay of Plenty, a committed HCV nurse will work with all providers involved in health care likely to care for patients with Hepatitis C; general practice, community care agencies, hospitals and people living with HCV.
The aim is to increase public awareness, and to seek out and identify HCV patients, and then prioritise helping those people to manage their conditions with the appropriate care.
…supporting the most affected patients into secondary care, avoiding unnecessary waiting, and supporting the rest in the community with education and lifestyle advice.
The project will also seek to reduce the stigma some people experience with having hepatitis C, and ensuring there’s information available about how to avoid infection in the first place.
In the Wellington area, two HCV nurses will work with the Department of Corrections, running programmes with prisoners who’ve agreed to be involved.
Progress in technology and pharmaceuticals will also make a difference to people living with hepatitis.
The introduction of Fibroscan machines in Australia and New Zealand has provided a safe alternative to liver biopsy.
Earlier this year Medsafe approved the first generation of protease inhibitors for HCV treatment in New Zealand. Pharmac is currently evaluating a proposal to fund them.
These and other new oral antiviral drugs could increase both the effectiveness and safety of antiviral therapy and should encourage more people to start treatment.
And I’d also like to acknowledge the superb work and leadership of the Liver Transplant Unit at Auckland City Hospital. This is indeed an important national service with world class clinicians.
Your conference brings together more than 600 eminent thinkers, researchers, community leaders and practitioners from throughout Australia, New Zealand, Asia, the Pacific, Europe and North America.
It’s a great honour to host you here in New Zealand.
The solutions to the issues raised by the various forms of hepatitis will be found by advances in all the areas I have mentioned this morning - research, technology, vaccination, drugs, and targeted intervention in society and with individuals.
However there is one more essential ingredient and this is what this conference is all about.
This element is a mix of collaboration, discussion, dissemination of important information and identification through networking of the best ways ahead.
Your presence here and your scientific engagement is important work. It makes a difference in the lives of so many.
I wish you well with the 8th Australasian Viral Hepatitis Conference.