Bordeaux Declaration in Support of the Fight Against Viral Hepatitis B and C

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AFRAVIH 2018

The Francophone Alliance of Healthcare Stakeholders Against HIV and Chronic Viral Infections (AFRAVIH), meeting in Bordeaux from 4 to 7 April 2018 for its 9th international conference:

• Condemns the inadequacies of policies to fight chronic HBV and HCV
• Stresses the urgency of the global health situation involving these viral diseases
• Demands an immediate reaction from governments to boost prevention, testing and treatment to control these two diseases in order to meet the targets set by the World Health Organisation (WHO) as soon as possible.

Situation

• With nearly 1.4 million deaths per year and 328 million people infected, hepatitis B and C have now overtaken the three major endemic diseases - HIV, tuberculosis and malaria - in terms of deaths and number of people affected.
• According to the latest WHO data, only 9% of people living with HBV (0.3% in Africa) and 20% of those living with HCV (6% in Africa) know their viral status; only 8% of those diagnosed with HBV - and 7% with HCV - receive treatment.
• Four out of ten infants are vaccinated against HBV at birth, and only one in ten in Africa.

Response

• The 2030 goals set by the WHO are to diagnose 90% of people with hepatitis C or B and treat 80% of those diagnosed.
• Despite the resolutions adopted at the 2016 World Health Assembly and the 2017 World Hepatitis Summit in Sao Paulo, to date, no large-scale measures have objectively covered the extent of the need.
• Screening and treatment strategies are inadequate if not non existent.
• Access to treatment for hepatitis B and C comes under the right to access essential medicines:
  
  • Tenofovir is rarely available and accessible to treat hepatitis B, except for those with HIV/HBV coinfections.
  • The cost of HCV medication is far too high to meet the needs of eradication strategies.

Hepatitis B and C constitute a global emergency. Prevention methods, diagnostic tools and medication exist that could rapidly reverse the spread of these pandemics. We call upon the international community to make them accessible everywhere, and to all.

To achieve this, we call for:

1. Political action:

• The inclusion of the fight against hepatitis B and C in all national health policies.
• The implementation of joint national strategies for the prevention, testing and treatment of HBV, HCV and HIV.

2. Enhanced prevention policies:

This includes hepatitis B vaccination, prevention of vertical transmission, safe biological products, healthcare measures & procedures and ritual practices, risk reduction for drug users and health promotion involving the input of communities.

3. An active screening strategy:

• Hepatitis B and C screening must be offered early to all the most affected populations per country and according to international guidelines.
• Rapid diagnosis tests must be made available on a large scale.

4. Access to treatment for all:

• Short treatments which cure hepatitis C must be accessible in the form of generic drugs or at rates compatible with countries' economies.
• As with HIV, treatment for chronic hepatitis B with Tenofovir must be available at reasonable and appropriate prices.

5. Global action to fund these programmes:

• Innovative funding initiatives on a national and international level must meet the urgent need for prevention, screening and treatment.
• The fight against hepatitis B and C must be included in international funding programmes such as the Global Fund, GAVI and UNITAID.
• Generic drugs must be made more widely available.

6. More intensive research into a cure for hepatitis B:

• Health research agencies must undertake to develop solutions aimed at curing hepatitis B, in partnership with industry.
• International coalitions such as the ICE-HBV (International Coalition to Eliminate HBV) must facilitate this process.

7. Improved policies to keep citizens informed, ensure respect for persons and train professionals:

• Stepping up the fight against all forms of discrimination levelled at infected persons is an integral part of prevention, screening and treatment strategies among all vulnerable populations. For drug users, greater access to syringes and other sterile injection equipment as well as substitution methods must be provided.
• A policy to inform citizens of the risks of these diseases as well as the prevention and treatment strategies accessible to all must be developed in all countries.
• Better information and greater training in diagnostic and therapeutic treatment strategies for healthcare professionals are essential.
• Communities and all those concerned must be involved in these policies and facilitate their implementation.

Read the Bordeaux Declaration

Bordeaux Declaration authors:

Isabelle Andrieux-Meyer, Marc Bourlière, Michel Bourrelly, Gilles Brücker, François Dabis, Victor de Lédinghen, Serge Eholié, Christine Katlama, Karine Lacombe, Philippe Morlat, Stanislas Pol, Coumba Toure Kane, Gilles Wandeler

With the support of:

• Raymonde Goudou Coffie, Minister of Health and Public Hygiene, Côte d’Ivoire
• Abdoulaye Diouf Sarr, Minister of Health and Social Action, Senegal
• Nicolas Meda, Minister of Health, Burkina Faso
• Moustapha Mijiyawa, Minister of Health and Social Protection, Togo
• Alassane Seidou, Minister of Health, Benin
• Pierre Somse, Minister of Health and Population, Central African Republic

Initial Signatories:

• AFEF (Société française d’hépatologie)
• Dr Isabelle Andrieux-Meyer, Switzerland
• Prof. Françoise Barré-Sinoussi, France
• Dr Marc Bourlière, France
• Dr Michel Bourrelly, France
• Prof. Gilles Brücker, France
• Dr Philip Bruggmann, Stratégie Hépatite Suisse, Switzerland
• CanHepC, Canada
• Mr Stewart Cole, Institut Pasteur, France
• Prof. François Dabis, France
• Prof. Victor de Lédinghen, France
• Prof. Jean-François Delfraissy, Comité Consultatif National d’Ethique, France
• Mr Abdoulaye Diouf Sarr, Minister of Health and Social Action, Senegal
• Prof. Matthias Egger, National Research Council of the Swiss National Science Foundation, Switzerland
• Prof. Serge Eholié, RESAPSI, Côte d’Ivoire
• Dr Raymonde Goudou Coffie, Minister of Health and Public Hygiene, Côte d’Ivoire
• Dr Alassane Seidou, Minister of Health, Benin
• Prof. Christine Katlama, France
• Mme Lucile Guénégou, Collectif Hépatites Virales (CHV), France
• Prof. Hakima Himmich, Coaliton PLUS, Morocco
• Mr Kenneth Kabagambe, National Organisation for People Living with Hepatitis B, Uganda
• Prof. Nicolas Kodjoh, Point Focal Hépatites, Ministry of Health, Benin
• Prof. Karine Lacombe, France
• Dr Maud Lemoine, United Kingdom
• Prof. Nicolas Meda, Minister of Health, Burkina Faso
• Médecins du Monde, France
• Mr Othoman Mellouk, International Treatment Preparedness Coalition, Morocco
• Prof. Moustapha Mijiyawa, Minister of Health and Social Protection, Togo
• Dr Jean-Marie Milleliri, Groupement d’Intérêt Publique Santé Education, France
• Prof. Jean-Paul Moatti, Institut de recherche pour le développement, France
• Prof. Philippe Morlat, Société Nationale Française de Médecine interne, France
• Prof. Beat Mülhaupt, Swiss Society of Gastroenterology and Hepatology, Switzerland
• Prof. Cheikh Tidiane Ndour, DLSI, Senegal
• Mr Theobald Owusu-Ansah, Hepatitis Foundation of Ghana, Ghana
• Mr Bernard Pécoul, DNDi, Switzerland
• Mr Vincent Pelletier, Coalition PLUS, France
• Prof. Peter Piot, United Kingdom
• Dr Louis Pizarro, Solthis, France
• Prof. Stanislas Pol, France
• Dr Anton Pozniak, United Kingdom
• Dr Jürgen Rockstroh, Germany
• Ms Selly Sickout, SOS Hépatites Fédération, France
• Dr Pierre Somse, Minister of Health and Population, Central African Republic
• Prof. Samba Sow, Minister of Health, Mali
• Dr Aliou Sylla, Coalition PLUS Africa, Mali
• Prof. Safiatou Thiam, CNLS, Senegal
• Prof. Coumba Toure Kane, Senegal
• Prof. Yazdan Yazdanpanah, France
• Prof. Djimon Marcel Zannou, Centre de référence pour la recherche et la prise en charge de l’infection à VIH, Benin
• Dr Gilles Wandeler, Switzerland
• Dr Fabien Zoulim, France

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