History of World Hepatitis Day

‘The existence of international days predates the establishment of the United Nations, but the UN has embraced them as a powerful advocacy tool. The United Nations observes designated days, weeks, years, and decades, each with a theme, or topic. By creating special observances, the United Nations promotes international awareness and action on these issues. Each international day offers many actors the opportunity to organize activities related to the theme of the day. Organizations and offices of the United Nations system, and most importantly, governments, civil society, the public and private sectors, schools, universities and, more generally, citizens, make an international day a springboard for awareness-raising actions’ (From the website of the United Nations). THE IMPORTANCE OF DEDICATED DAYS IN MEDICAL SCIENCE In the realm of public health and medical science, the designation of specific days for raising awareness about diseases and health conditions has become a powerful tool for education and mobilization. These days serve several critical purposes: They amplify awareness, foster dialogue between stakeholders, promote preventive measures and generate collective action against public health threats. Celebrations such as World TB Day, World Diabetes Day and World AIDS Day have played pivotal roles in elevating global consciousness about some of the most pressing health challenges of our times. By focusing global attention on a particular health issue, these days enable governments, healthcare organisations, non-profits and communities to collaborate on educational campaigns, free or low-cost screenings, vaccination drives and advocacy efforts. They serve to demystify diseases, remove stigma and empower individuals with knowledge about prevention and treatment. World Hepatitis Day, celebrated every year on July 28, is one such occasion that underscores the importance of fighting a disease that silently affects millions globally. Its observance reflects the impactful tradition of using ‘days’ in medical science to unite efforts against health crises, thereby driving public health interventions that can save the lives. BURDEN OF VIRAL HEPATITIS WORLDWIDE The global burden of hepatitis remains significant, with millions of people affected by these infections. According to the World Health Organization (WHO), an estimated 1.4 million new cases of Hepatitis A, which spreads via the faecal-oral route, occur each year.[1] Hepatitis B is a major global health problem, with approximately 296 million people living with chronic hepatitis B infection worldwide.[2] In 2019, an estimated 1.5 million new infections were reported, and hepatitis B-related liver disease resulted in 820,000 deaths that same year.[2] Similarly, it is estimated that around 58 million people globally are living with chronic hepatitis C infection.[3] In 2020, the WHO reported about 1.5 million new infections and approximately 290,000 deaths from hepatitis C-related liver disease.[3] The global prevalence of hepatitis D is estimated to be around 12 million people while Hepatitis E, associated with contaminated water supplies, is estimated to cause 20 million infections annually, primarily in developing countries with inadequate sanitation.[4,5] The diverse transmission routes, clinical outcomes and public health implications of hepatitis A, B, C, D and E highlight the need for comprehensive strategies that include vaccination, education, improved sanitation and access to treatment. Continued efforts to raise the awareness and implement effective prevention and control measures are essential to reduce the impact of hepatitis on global health. DR BARUCH BLUMBERG – THE MAN WHO INSPIRED Baruch Samuel Blumberg (28 July 1925–5 April 2011), known as Barry Blumberg, was an American physician and geneticist who co-received the 1976 Nobel Prize in Physiology or Medicine for his groundbreaking work on the hepatitis B virus while working as an investigator at the NIH and at the Fox Chase Cancer Centre. His discovery of the Hepatitis B virus, development of diagnostic tests the much-needed hepatitis B vaccine significantly reducing cancer deaths worldwide – a legacy underscored by Jonathan Chernoff, the then scientific director at the Fox Chase Cancer Centre, who stated, ‘Barry prevented more cancer deaths than any person who’s ever lived’. Acknowledging Blumberg’s importance in the history of modern medicine, Daniel Goldin, former NASA administrator said, ‘Our planet is an improved place as a result of Barry’s few short days in residence’. In recognition of his profound impact, the Library of Congress and NASA established the Baruch S. Blumberg NASA/Library of Congress Chair in Astrobiology in 2011, celebrating his dedication to interdisciplinary research. Oxford University also honoured his contributions by establishing the Baruch Blumberg Professorship in Virology. Blumberg’s work not only advanced medical science but also transformed the health of millions, leaving an indelible mark on the world. Dr. Blumberg’s contributions extended far beyond the laboratory. From 14 January 1986 to 12 April 1986, Dr Blumberg served as the Raman Professor at the Indian Institute of Science in Bangalore, Karnataka. During this time, he travelled extensively across India, engaging with colleagues on hepatitis and other diseases. To Blumberg, the experience was enlightening, revealing significant interest in hepatitis and its consequences, including primary liver cancer. Dr. Blumberg also reviewed hepatitis research, treatment and prevention programs in India, meeting government officials and discussed related issues with the then Indian Prime Minister Rajiv Gandhi on 20 January 1986. On 31 March 1987, a report titled ‘Comments on the Prevention of Hepatitis B Infection in India’ was sent to Mr. Gandhi by Dr Blumberg, as well as to various officials and scientists encountered during his stay in India. The report discussed a vaccination program for HBV and broader public health issues, such as clean water supply, waste disposal, donor blood testing and the indigenous manufacture of diagnostic reagents and medical equipment. Blumberg emphasised the importance of education and recommended establishing high-standard Schools of Public Health at the university level in association with leading Indian academic institutions. Acknowledgement of the report was received, indicating it may have influenced subsequent decisions regarding hepatitis prevention programs. In India, Dr. Blumberg’s efforts and recommendations and the subsequent efforts of organizations like the Kalinga Gastroenterology Foundation (KGF) spearheaded by Professor Shivaram prasad Singh have led to significant strides in hepatitis prevention. In 2002, the Hepatitis B Project was initiated in India with the support of the Global Fund for Vaccines and Immunisation, accelerating vaccination efforts across the country. Voluntary programmes were also launched to promote vaccination in various regions. WORLD HEPATITIS DAY: THE ORIGINS In the 1990s, the situation regarding viral hepatitis, globally, as well as in India, was quite dismal. During this period, vaccination for Hepatitis B in India was costly, and there was virtually no awareness regarding the disease and its prevention. The number of pharmaceutical companies producing vaccines was also limited. Consequently, two significant challenges emerged: Providing affordable vaccinations for children and obtaining the necessary permissions. To start with, a few schools were targeted, their administrations were contacted, educational pamphlets were distributed and consent was solicited from parents for vaccinating their children. Cost was a crucial factor, but this issue was addressed with personal contributions and support from a few well-wishers. No pharmaceutical companies helped to fund such programmes. The initiative led by Professor Singh began with St. Joseph’s Convent at Cuttack, Odisha and it was very successful. However, considerable negative criticism arose from some people in the vaccine industry who feared that offering vaccines at such low prices would hurt their profits. Another challenge involved the dosing of the vaccine for children. The decision was made to administer half the vaccine dosage to children under 10 years of age, based on the understanding that this approach would not significantly affect efficacy. This decision drew adverse criticism from the various quarters. The pharmaceutical companies that wanted to provide some support to us faced pressure, especially from some paediatricians who even threatened legal action. Attempts were also made to discredit the entire vaccination campaign, as gastroenterologists were not supposed to engage in vaccination efforts, which were claimed as the sole domain of paediatricians. It goes without saying that for hepatologists in India, it should have been of paramount importance to contribute to viral hepatitis prevention efforts and educate the public on the importance of vaccination. However, the indifference of hepatologists, gastroenterologists and physicians towards this sphere of preventive medicine posed a huge hindrance in the efforts to curb the epidemic of viral hepatitis. There was this pressing question that cropped up: Have hepatologists abdicated their duty to the people they serve?[6] It became evident that a dedicated day was needed to raise awareness about Hepatitis B and its prevention. Without such a focused initiative, the critical issue would lack the necessary impetus for change. Which would be the apt day to observe this? This question naturally arose. The solution, too, came very easily. It was decided that the birthday of Blumberg would be the best day to observe the ‘Hepatitis B Eradication Day’. GETTING THE HANDS DIRTY In an era when the internet was not widely accessible, even sending an E-mail was a costly and challenging endeavour in those days. Somehow arrangements were made to reach out to Dr Blumberg. Dr. Koneti Rao, who was working at the NIH, Bethesda was contacted via E-mail. Dr. Rao subsequently contacted the Fox Chase Cancer Centre, where Prof. Blumberg was working at the time. However, for various reasons, progress was very slow. In early May 2001, Dr. Singh suffered a serious road traffic accident that left him bedridden and immobile for almost 3 months, with a traction fixed to his bed. This period turned out to be a blessing in disguise, as being confined allowed ample time for preparing for the upcoming event. During this period, the idea of involving school children began to take shape, recognising that schools could serve as effective channels for communicating important health messages to the community. To lay the groundwork, a small hepatitis symposium was organised prior to the main event. A national poster competition was also initiated, attracting numerous entries from across the country. The awards from this competition were scheduled to be distributed on the day of the main event, further engaging the community and generating excitement. By involving children, Dr Singh and his foundation was able to gain the much-needed publicity that helped spread awareness about hepatitis. The first ‘Hepatitis B Eradication Day’ was held on 28 July 2001, at Hotel Akbari Continental in Cuttack, Odisha [Figure 1].[7] Unfortunately, funding was lacking, and all expenses were covered out of pocket. A few journalists, doctors and children participated, coming from the various parts of Odisha despite severe flooding in the region at the time. Media coverage was minimal, but the event nonetheless marked a significant starting point.Figure 1: Inaugural lamp lighting on 1st Hepatitis B Eradication Day on 28 July 2001Following this initial gathering, planning continued with a dedicated small team. The eminent artist of Odisha, late Siba Panigrahi significantly contributed to the art competitions which were themed on ‘Art for Health Awareness’ [Figure 2]. Contributions from individuals like Mr. Tuhin Kanta Ghosh, the Secretary of KGF and Dr. Niranjan Rout, Former Professor and Head of Onco-pathology at Acharya Harihar regional Cancer Centre, Cuttack and Mrs Sudha Singh, a KGF trustee were also invaluable. Looking ahead, it was decided that the next year’s event would be held in Bhubaneswar. By utilising the souvenir as a fundraising tool, some funds were generated. The meeting in Bhubaneswar in 2002 took place at Hotel Crown, where for the first time, the KGF Samman award was instituted to promote awareness about hepatitis B and the vaccine.Figure 2: Hepatitis Awareness Poster Drawing Competition. (a) National Award-winning entry from Chandigarh schoolboy. (b) Children participating in Sit and draw competitionDuring this second ‘World Hepatitis B Eradication Day’, a group called the ‘Hepatitis B Eradication Mission’ was established. The then Health Minister of Odisha, Mr. Devi Mishra, attended the meeting as the Chief Guest. The first KGF Samman award was presented to Ms. Amin, a freelance journalist and women’s rights activist who had courageously facilitated a vaccination programme for Muslim girls from lower socioeconomic backgrounds at the Urdu Girls’ High School in Cuttack, overcoming significant challenges [Figure 3]. This inspiring story was later featured in Femina India.[8]Figure 3: Social activist and journalist Farhat Amin receiving “KGF Sammana” award from Odisha Health Minister DP Mishra on 28 July 2002Despite reaching out to the Central Government, support was not forthcoming. Officials cited pressing issues such as anaemia and malnutrition as priorities. Efforts to engage liver societies worldwide also fell short of expectations; while the African Association for the Study of Liver Diseases (AFASLD) and the Hepatitis B Foundation placed request letters on their websites, this did not lead to substantial headway. GETTING GLOBAL RECOGNITION In September 2006 (7–11 September), the meeting of the International Association for the Study of Liver and the AFASLD was held in Cairo, Egypt. Professor Singh attended the meeting to promote the idea of a united day dedicated to Hepatitis B prevention and eradication but noted a lack of interest among the attendees from all over the world on this issue. It became clear that different regions were observing ‘Hepatitis Days’ on various dates, and it was imperative that a unified global effort among gastroenterology and hepatology societies through collaboration was launched worldwide. However, in India in 2005, for the first time, Professor Singh’s efforts seemed to be rewarded when both the Indian National Association for Study of the Liver (INASL) and the Indian Society of Gastroenterology (ISG) endorsed the idea of observing World Hepatitis B Eradication Day on July 28. After endorsement by INASL and ISG, gastroenterologists and hepatologists started observing this day in different cities across India. In addition to observing this day, the foundation also started targeting schools and colleges and the general population by organising educational street plays, road shows and theatrical performances to highlight the importance of hepatitis B vaccination [Figure 4]. The foundation also instituted awards including KGF Sammana and Blumberg Oration to honour and felicitate individuals and organisations working in the field of hepatitis awareness and research [Figure 4]. Symposia, workshops and press meets were also organised for healthcare workers, medical students and media persons. This involved people from all walks of life and gave the movement a fillip.Figure 4: Hepatitis Awareness Programs. (a) Participants of Hepatitis Awareness (b) a Hepatitis B Awareness Hepatitis B Awareness Prof. children street about Hepatitis in the World Hepatitis which had been observing World Hepatitis Day on out to Professor The in was that the day with the World Health which meets in May every would the for global In Professor Singh was to a meeting of the in at the world press and a to the World Health which was to In this from the WHO and Professor the Secretary of the Association for Study of the Liver were [Figure Professor Singh was with the Hepatitis B – a of on the strategies and vaccination programmes related to hepatitis B across the Prof. Singh with to Hepatitis and World Hepatitis Day May it seemed that the had been to significant with the Professor Singh decided to their to the necessary change. The initiative in the On May the World Health a recognising the need for coverage for The stated, that July 28, or such other day or days as be designated as World Hepatitis Day to provide an opportunity for education and understanding of viral hepatitis as a global public health problem, and to the of preventive and control measures of this disease in This was a July 28 had been by Professor Singh and and every meeting had with the that one day this day be all over the This was a of the recognition of the need for global action against viral hepatitis, a disease that affects million people worldwide. 2011, a has been each year to this day and highlight the need to Hepatitis B worldwide 1: of World Hepatitis marked a the then addressed the American regarding the importance of Hepatitis B from the However, in India, where the disease burden was significantly than in the United attention from a GLOBAL the by the World Health major liver societies across the world endorsed July 28 as the World Hepatitis The based in Odisha, out as a in observing this day annually, hepatitis awareness India. The WHO began observing World Hepatitis Day in recognising the global prevalence of viral hepatitis and of the efforts by a few dedicated gastroenterologists and hepatologists who the pressing need for and on this day have played a in people about testing and treatment. The observance has to numerous countries and communities worldwide. This day has become a powerful in global action towards the of viral hepatitis by – A by the launched on World Hepatitis Day have to action and vaccination lower treatment and in research. The attention and among governments, healthcare and hepatitis a global It us every year that is – However, only through and In Dr Blumberg sent his to Professor that started in India and that are being out worldwide have made a very important that and colleagues and all of us who have been in the control of hepatitis B infection and the prevention of primary cancer of the liver a of The World Hepatitis Day has a towards the awareness of the globally and can even attention to the programs that have in the on the of the vaccination program are of significant life These are very is year and it is for and to have this event on World Hepatitis Day has become the for global efforts to raise the awareness about viral hepatitis and its prevention. as a initiative with the support of a few the day as a for communities and worldwide. The impact of these efforts to be in India, where hepatitis awareness, vaccination and treatment programmes have the observance it a powerful impetus for global collaboration in the against viral hepatitis and the need for continued progress in this public health The observance of the day on the birthday of Dr. Blumberg also as a of the impact a physician can have on and the powerful that medical research is and it can the of our modern A about Dr. Blumberg. In his Nobel Prize which is for on the website of the Nobel Dr. Blumberg 2002 the Hepatitis B Project was initiated in India with the support of the Global Fund for Vaccines and and, the vaccination program is There are also programs to vaccination. became of these several years when Professor S. Singh, Head of the of Gastroenterology at in Cuttack, India to that July 28, would be the for their Hepatitis B Eradication Day in their In 2006 it was extended to other parts of These were from a Nobel from a of modern medicine, from a person who dedicated his life to across the world in where and have become the of the day. Professor Blumberg, in his with Professor Singh had to the World Hepatitis Day program organised by him and KGF in Unfortunately, that was support and of interest There are no of