TORONTO DECLARATION: STRATEGIES TO CONTROL AND ELIMINATE VIRAL HEPATITIS GLOBALLY

AVOIDABLE DEATHS DUE TO VIRAL HEPATITIS
Over 400 million people are chronically infected with hepatitis B virus (HBV) and hepatitis C virus (HCV) and thousands of new infections occur every day. Chronic viral hepatitis puts individuals at risk of developing progressive liver disease leading to cirrhosis, liver cancer and ultimately death from liver failure. Collectively these two infections cause an estimated 1.3 million deaths worldwide every year. The enormous global public health burden caused by this ongoing epidemic is largely preventable.

REMARKABLE PROGRESS
The last two decades have witnessed unprecedented scientific and therapeutic advances in the field of viral hepatitis. We now possess the tools to control the epidemic. A highly effective vaccine has made HBV a preventable disease. Well-tolerated, potent medications effectively and safely suppress HBV replication improving clinical outcomes in those already chronically infected. However, although HBV can be controlled with long-term maintenance treatment, true cure remains elusive. HCV is the first persistent viral infection to be cured with medical therapy. Viral eradication leads to improvements in all clinical outcomes, including liver-related and all-cause mortality A protective HCV vaccine is not yet available; however short treatments with recently developed potent antiviral agents lead to cure in the vast majority of treated individuals. These powerful tools create a scenario in which control and even global eradication of both infections is now a feasible goal.

CALL FOR COORDINATED ACTION
Despite this remarkable progress, major challenges remain. Preventable transmission continues, the majority of infected individuals remain undiagnosed, and only a tiny minority currently receives treatment. In low income countries diagnostic testing for HBV DNA and ad HCV RNA is not generally available, hampering effective monitoring and treatment. Without coordinated action, the recent therapeutic advances will have little effect on the global burden of disease. Individual countries have developed effective national action plans and the World Health Organization recently developed a Framework for Global Action based on 4 specific axes of intervention ranging from raising awareness to increasing access to care and treatment. Building on this solid foundation, The First International Hepatitis Cure and Eradication Meeting presents the ideal forum for proposing an integrated plan to address hepatitis B and C globally with concrete objectives, tangible goals and measurable outcomes. Therefore, in full support of the WHO Global Hepatitis Programme and the World Health Assembly Resolutions on Viral Hepatitis, we, as a group of international experts across multiple disciplines, now call for coordinated action by governments, industry, affected individuals, and healthcare providers to address the many challenges that continue to impede global control and ultimate eradication of viral hepatitis. The present declaration outlines specific public health policies and interventions with tangible but achievable goals that we hope will help guide WHO and national governments as they continue to develop strategies to address viral hepatitis locally, nationally and on a global scale. The Global Viral Hepatitis Summit (International Symposium on Viral Hepatitis and Liver Disease (ISVHLD)) will be held in Toronto in 2018 and as such, we have set this as a target for implementation of the Toronto Declaration.

CURRENT SIGNATORIES:

Jordan Feld, MD, MPH University of Toronto, Canada
Stephen Locarnini, MBBS, PhD Victorian Infectious Diseases Reference Labs, Melbourne, Australia
Harry Janssen, MD, PhD University of Toronto, Canada
Charles Boucher, MD, PhD Erasmus Medical Center, Rotterdam, The Netherlands
Henry Chan, MD The Chinese University of Hong Kong, China
Pietro Lampertico, MD, PhD University of Milan, Italy
Stanley Lemon, MD University of North Carolina, Chapel Hill, USA
Jürgen Rockstroh, MD University of Bonn, Germany
Lai Wei, MD University of Peking, China
David Thomas, MD, MPH Johns Hopkins University, USA
Mark Sulkowski, MD Johns Hopkins University, USA
John Ward, MD Division of Viral Hepatitis, Centre for Disease Control and Prevention, USA
Mark Thursz, MD Imperial College London, United Kingdom
Gregory Dore, MD Kirby Institute, University of New South Wales, Australia
Jason Grebely, PhD Kirby Institute, University of New South Wales, Australia
Heiner Wedemeyer, MD, PhD Hannover Medical School, Germany
Geoffrey Dusheiko, MD Royal Free Hospital, United Kingdom