Third New Zealand Viral Hepatitis Conference 2010
Past Failures and New Solutions in Hepatitis B and C control in New Zealand and the Asia Pacific region

War Memorial Complex, Whakatane

Hon Tariana Turia, Associate Minister of Health

Friday 5 March 2010; 10am

Tuatahi me mihi atu ki te mana whenua. Tena koutou o Mataatua waka. Tena hoki koutou o nga mata waka kua whakarauika nei i raro i te karanga o te ra
Tena koutou i runga i te rangimarie. Tena koutou i runga i nga maharatanga mo ratou kua wheturangitia.
No reira, tena tatou katoa

I want to thank the Hepatitis Foundation of New Zealand for the honour of being invited to open this third New Zealand Viral Hepatitis Conference.

I acknowledge the local people of this rohe, and I thank them for their generosity in hosting us here in Whakatane.

I extend a particular welcome to our international guests:
• Professor Mitchell Shiffman from the United States;
• Professor Andrew Lloyd from Australia;
• Dr Morris Sherman from Canada and
• Dr James Fung from Hong Kong.

There is a feeling of déjà vu about being here in Whakatane, to talk about viral hepatitis in Aotearoa.

Because it was here in 1972, that a humble lab technician teamed up with the local paediatrician to ask questions around what they were seeing as unusually high rates of hepatitis B amongst Eastern Bay of Plenty children.

At the time, the record shows, officials were sceptical but Dr Sandor Milne and Dr Chris Moyes persevered, setting their sights on screening the entire town of Kawerau.

Their efforts resulted in the revelation of rates of hepatitis B which were among the highest in the world.

They were referred to as a thorn in the side of the bureaucracy; as zealots; as out of line.

But they never gave up, and it is from the hard work of Sandor Milne and many others, that in the 1980s the Hepatitis Research Unit was born – and subsequently the Foundation.

And so as we embark on this conference, it is appropriate to look amongst those gathered here, and to acknowledge those champions and heroes who have urged us to do better.

We can do better – and we must.

Hepatitis B and C viruses are major causes of severe illness and death.

The World Health Organisation estimates 57% of cases of liver cirrhosis and 78% of cases of primary liver cancer result from Hepatitis B and C infection.

Springing off data like that, WHO is now concluding that what is needed is global action on prevention and control of viral hepatitis. It would appear to me an idea whose time has well and truly come.

In Aotearoa, our focus in the area of Hepatitis B has been on preventing infection in children. Lead maternity carers screen pregnant women to help prevent the infection being passed to the child; and infant vaccination against hep B was introduced back in the 80s.

So is the challenge that we can do better still relevant?

There are about 120,000 good reasons why it is.

In New Zealand it is currently estimated there are around 70,000 chronic hepatitis B carriers and about 50,000 people with hepatitis C. Most are unaware of their status and are likely to have lifelong infection. Furthermore they are at increased risk of developing serious health complications. Hepatitis C, it is suggested, is now the leading cause of liver transplants.

And this is where the particular challenge of viral hepatitis is most felt.

In articles describing Hepatitis B and C, you will invariably come across references to the killer by stealth; or the sleeping dragon.

While both Hepatitis B and C viruses are notifiable conditions under the Health Act, it is only cases of acute infection which require to be notified to the Medical Officer of Health.

Alongside with the lack of awareness that comes from being asymptomatic; people with hepatitis may experience stigma and discrimination which compounds the problems of living with the virus.

So the call to do better is an important one.

We must continue to raise awareness, leading to increased testing and diagnosis.

We must debate ways of improving surveillance, although I note that the National Screening Advisory Committee has recommended that the Ministry should strengthen the current hepatitis B surveillance programme before considering a new screening programme.

We must be vigilant in ensuring a safe supply of blood and blood products, and minimising the transmission through non-transfusion routes.

And can I just at this point acknowledge a very special coming of age for the New Zealand National Needle Exchange programme.

We must not forget that what happened in the 80s with the coming together of IV Drug Users; people living with AIDS; the Prostitutes Collective; community advocates like the late Sister Paula Brett-Kelly; public health specialists like Dr Michael Baker; and the Department of Health was quite unique.

It was a wonderful coming together of minds – the technical advances and medical understandings being grounded and owned by the communities that were most affected.

The needle exchange programme was the first of its kind in the world when a small base got going in Auckland, staffed mostly by volunteers.

Today, 21 years on, there is a network of 18 dedicated exchanges, more than 175 pharmacies and many other outlets including sexual health centres and even a mobile van on the West Coast of the South Island.

A study released by the needle exchange network last year indicated that approximately one out of two injecting drug users had been exposed to the virus, so the need for a reduction in the reuse or sharing of injecting equipment remains a key priority.

At this point, I want to pay tribute to Dr Cheryl Brunton - the 2009 Public Health Champion of the Year – for her courage in keeping the issues associated with hepatitis C on the agenda.

Cheryl has been instrumental in her work with Auckland and Christchurch Hepatitis C support groups, in conducting serosurveys, and encouraging research into bloodborne viruses amongst injecting drug users; and those in prison.

It has not made her terribly popular and it was shocking to hear she had been abused for her work, including even a bullet in her letterbox. But she never wavered in her determination to do everything she can to improve the health of those affected.

I want to just finish with some comments about research.

It is fantastic that the Hepatitis Foundation offers research grants to advance our understanding of the control and management of viral hepatitis through epidemiological studies, bio-medical research and health systems research.

We are all aware of the huge contribution that people like Sandor Milne made in this field.

In fact some have attributed the timing of the Hepatitis B immunisation for children on the national schedule as being well ahead of its time as due to the consistent lobbying from Dr Milne on this issue.

I didn't always agree with him, particularly about the ongoing storage and use of samples. Maori wouldn't have agreed to releasing body samples without permission. Taking blood samples for research purposes requires ethics committee approval.

This highlights the importance of studies and research happening with the full consent of those who participate. This doesn't take away from the focus of such work but it does highlight that our passion to do these things must meet ethical standards and recognise cultural preferences.

We can do better in so many ways.

We must continue to take up the challenge that the champions in this sector have issued.

We must think creatively about raising awareness in our efforts to advance prevention and treatment options.

What is needed is a comprehensive package of measures which counter discrimination, reduce vulnerability, treat the conditions, and prevent the spread of disease.

But while we are doing this, we must remember to recognise the outstanding individuals and achievements that have occurred, including the funding decisions by Pharmac which resulted in new treatment options and a widening of access.

There are some exciting initiatives occurring, such as the shared care treatment pilot programme at Waikato Hospital and Waikeria Prison and the free hepatitis C community clinic in Christchurch that mainly targets those people who inject drugs and may not access healthcare due to the stigma they perceive.

And while we are working in all these settings, we must always remember the key lies in working with whanau as well, so that they are able to determine the best options for their future.

Thank you again for allowing me to be part of this important conference, and I wish your conference well.

ENDS

© Scoop Media