Hepatitis is the test of Africa’s health sovereignty

Today, Africa CDC releases the Operational Toolkit for the Prevention, Diagnosis and Management of Hepatitis B. It is a deliberately practical document. Treatment algorithms. Liver fibrosis assessment. Clinical decision support for a nurse in a district facility where the nearest specialist is hundreds of kilometres away.

Developed with leading African hepatitis experts, it translates World Health Organization recommendations into guidance a health worker can apply in daily practice.

We built it because the gap on this continent sits between what we know and what we do.

Consider what we already know. Around 64 million Africans live with chronic hepatitis B. Our region accounts for 63 per cent of new hepatitis B infections worldwide. The virus killed an estimated 272,000 people here in 2022. Fewer than five in every hundred people infected have been screened. Fewer than one in a hundred receive treatment. A vaccine given within 24 hours of birth prevents almost all transmission from mother to child, and 18 per cent of African newborns receive it. Hepatitis C can be cured in more than 95 per cent of cases with a short course of treatment.

Every one of those deaths was avoidable using tools invented decades ago. That is an implementation failure. Implementation failure is a political choice.

Why this matters now

Development assistance is falling. Outbreaks are more frequent. Geopolitics is less predictable than at any point in a generation. Africa’s Health Security and Sovereignty agenda exists because the continent can no longer plan its health systems around the assumption that someone else will fund them.

Health sovereignty does not mean isolation. It signals a new model of partnership in which African nations lead with clarity and confidence, finance what they can finance, produce what they can produce, and set their own priorities.

Viral hepatitis is the cleanest test of whether that agenda works. The vaccine costs cents. The medicines are off patent.

The diagnostics are simple. Existing maternal health, HIV and tuberculosis platforms can deliver the services. If Africa cannot organise itself around interventions this affordable and this proven, the harder tests ahead will defeat us.

In February 2020, African Union Heads of State and Government adopted the Cairo Declaration on Viral Hepatitis in Africa, committing to expand prevention, testing and treatment. Six years on, the record shows what commitment produces when it is funded, and what it produces when it is not.

Africa is already proving the case

Egypt screened more than 50 million of its citizens through the 100 Million Healthy Lives campaign and became the first country in the world to reach World Health Organization gold tier status on the path towards hepatitis C elimination. Its support for treatment in Ghana aims to reach 50,000 patients. One African country is accelerating elimination in another. That is health sovereignty in practice.

Rwanda has screened more than seven million people, made hepatitis C treatment free nationwide, decentralised services and authorised trained nurses to manage uncomplicated cases in primary health facilities.

Uganda allocates approximately US$3 million a year in domestic resources for free hepatitis B testing, treatment and viral load monitoring. Nigeria’s Project 365, Senegal’s national elimination strategy, Ghana’s expansion of free treatment and Cameroon’s innovative financing arrangements represent four further routes to the same destination.
The pattern across all of them is identical. Political leadership first, domestic money second, partnership third.

Nearly all African Union Member States have introduced hepatitis B vaccination into routine childhood immunisation. The African Union has adopted the Africa Plan Towards the Elimination of Vertical Transmission of HIV, Syphilis and Hepatitis B by 2030, which treats three infections as one problem to be solved through the same antenatal visit.

Since 2022, with the support of the Korea International Cooperation Agency, our Continental Viral Hepatitis Prevention and Control Programme has established a continental group of experts, completed the first assessment of national hepatitis programmes and supported 32 Member States to learn directly from Egypt’s experience.

What I am asking for

Investing in viral hepatitis elimination strengthens far more than health outcomes. It protects workforce productivity, reduces long-term health expenditure, strengthens economic resilience and advances sustainable development. Accelerating elimination requires the capabilities at the heart of Africa’s Health Security and Sovereignty agenda: resilient primary health care, integrated surveillance and laboratory networks, predictable domestic financing, digital transformation, regional cooperation, local manufacturing and pooled procurement. Member States and partners should act in five areas:

1. Increase domestic financing and innovative funding. Expand prevention, testing and treatment while reducing reliance on external aid. Solidarity levies, health security bonds, diaspora bonds, taxes on tobacco and alcohol, and catalytic private capital can complement public financing.

2. Strengthen local manufacturing and pooled procurement. Vaccines, diagnostics and antiviral medicines produced by qualified African manufacturers need reliable markets. The African Medicines Agency and the African Pooled Procurement Mechanism can improve access, affordability and supply security.

3. Integrate hepatitis services into primary health care and digital systems. Every newborn should receive the hepatitis B birth dose on time; every pregnant woman should be screened; and every person diagnosed should be linked to care and treatment. Digital birth notification and patient records can help close the gaps.

4. Deepen regional cooperation and partnerships. Member States should share expertise, scale proven interventions and sustain momentum towards the 2030 elimination targets.

5. Promote public awareness and community engagement. Civil society, professional societies and affected communities must be partners in reducing stigma, increasing demand for testing and improving vaccine uptake.

The measure of success

We will know this is working from ordinary things. A newborn vaccinated before the family leaves the ward. A pregnant woman told her hepatitis status at her first antenatal visit. A nurse in a rural clinic who knows which patient needs treatment and which needs monitoring. A person diagnosed and treated before cirrhosis or liver cancer. A diagnostic test manufactured on this continent, procured with this continent’s money, in the hands of a health worker paid by this continent’s treasury.

None of that requires a scientific breakthrough. All of it requires a decision

We do not make these decisions alone. Development partners, professional societies, civil society organisations and affected communities have all invested in this agenda, and their contribution has made continental progress possible. Partnership on these terms strengthens African leadership rather than substituting for it.

Egypt, Rwanda and Uganda have shown what determined action achieves. Their progress should now become the continental standard.

Dr Jean Kaseya is Director General, Africa Centres for Disease Control and Prevention (Africa CDC).