Hepatitis prevention, control, and elimination program in Mongolia

Naranbaatar Dashdorj n.dashdorj@onomfoundation.org
Naranjargal Dashdorj dashdorj@onomfoundation.org

Abstract

Defined as the MISSION 2020, the main objectives of the Hepatitis Prevention, Control, and Elimination (HPCE) Program in Mongolia are straightforward yet very ambitious:

  • To eliminate cancer-causing hepatitis C virus in Mongolia by 2020 
  • To reduce mortalities related to liver cirrhosis and liver cancer by 50% in Mongolia by 2020

Prevention, early diagnosis and treatment of infected patients are three pillars of infectious disease control. Viral hepatitis is not only an infectious disease, but also it is the main cause of deadly liver cirrhosis and liver cancer. In 2010, liver cancer was the third leading cause of cancer mortalities globally. It was also reported that hepatitis B (HBV) and C (HCV) together killed 1.285 million people in 2010, which is more than number of mortalities due to malaria or tuberculosis.

Mongolia has the world’s highest rate of liver cancer mortality—nearly eight times the global average. Prevalence of chronic viral hepatitis B, C, and D (HDV) in Mongolia is at an endemic level and constitutes the main cause for Mongolia’s world-leading liver cancer mortality rate, which has been steadily increasing over the last decade. At the moment, liver cirrhosis and liver cancer mortalities account for 15% of all annual mortalities in Mongolia, and it is projected to increase in the future. In short, the viral hepatitis endemic is wreaking havoc in Mongolian society, and it hits very close to home. Our uncles died of liver cancer at young ages of 51 and 57 and our parents have chronic viral hepatitis infections. One of our best friends, a college classmate has HBV and HDV superinfection, leading to an accelerated liver damage that will probably prompt him to get liver transplantation soon. 

Such heartbreaking tragedies in our personal lives and in Mongolian society compel us to do whatever we can to help to mitigate the endemic of viral hepatitis. Deficiencies in the Mongolian healthcare system for prevention, early diagnosis and control of chronic conditions compound the endemic. If we can help to prevent even one person from having a liver cancer via improved prevention, early diagnosis, and treatment for viral hepatitis, it means the world to us. It is not only meaningful to us, it’s personal. With this determination, we are implementing the HPCE Program by bringing breakthrough innovations and technologies, industry cooperations, and novel implementation approaches together to achieve the MISSION 2020 of eliminating a major cancer-causing infectious disease in a country for the first time in world history and reducing disproportionate, sustained burden of liver cirrhosis and liver cancer mortalities significantly in a country with the highest rate of liver cancer mortality in the world. Impact of the HPCE Program will be extraordinary on the ground in Mongolia. In fact, according to the treatment dynamics model, over 27,000 lives will be saved from dying of liver cirrhosis and liver cancer by 2030 in the process of eliminating HCV. Finally, the HPCE Program will serve as a model for other countries in their fight against viral hepatitis.

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