Progress Towards Hepatitis C Virus Elimination in High-income Countries

An Updated Analysis

Ivane Gamkrelidze; Jean-Michel Pawlotsky; Jeffrey V. Lazarus; Jordan J. Feld; Stefan Zeuzem; Yanjun Bao; Ana Gabriela Pires dos Santos; Yuri Sanchez Gonzalez; Homie Razavi


Liver International. 2021;41(3):456-463. 

In This Article

Abstract and Introduction


Background & Aims: Elimination of HCV by 2030, as defined by the World Health Organization (WHO), is attainable with the availability of highly efficacious therapies. This study reports progress made in the timing of HCV elimination in 45 high-income countries between 2017 and 2019.

Methods: Disease progression models of HCV infection for each country were updated with latest data on chronic HCV prevalence, and annual diagnosis and treatment levels, assumed to remain constant in the future. Modelled outcomes were analysed to determine the year in which each country would meet the WHO 2030 elimination targets.

Results: Of the 45 countries studied, 11 (Australia, Canada, France, Germany, Iceland, Italy, Japan, Spain, Sweden, Switzerland, and United Kingdom) are on track to meet WHO's elimination targets by 2030; five (Austria, Malta, Netherlands, New Zealand, and South Korea) by 2040; and two (Saudi Arabia and Taiwan) by 2050. The remaining 27 countries are not expected to achieve elimination before 2050. Compared to progress in 2017, South Korea is no longer on track to eliminate HCV by 2030, three (Canada, Germany, and Sweden) are now on track, and most countries (30) saw no change.

Conclusions: Assuming high-income countries will maintain current levels of diagnosis and treatment, only 24% are on track to eliminate HCV by 2030, and 60% are off track by at least 20 years. If current levels of diagnosis and treatment continue falling, achieving WHO's 2030 targets will be more challenging. With less than ten years remaining, screening and treatment expansion is crucial to meet WHO's HCV elimination targets.


An estimated 71.1 million people (95% uncertainty interval 62.5–79.4) were infected with hepatitis C virus (HCV) in 2015, corresponding to 1.0% (0.8%-1.1%) of the world's population.[1] In 2016, the World Health Assembly approved the Global Health Sector Strategy to eliminate viral hepatitis by 2030[2] and the World Health Organization (WHO)[3] published targets that countries must meet to achieve the elimination goals of reducing incidence of viral hepatitis by 90% (95% decline in hepatitis B and 80% decline in hepatitis C),[2] diagnosing 90% of all viral hepatitis infections, and treating 80% of the eligible population by 2030. Achieving these goals was expected to reduce mortality due to HCV infection by 65%.[3] With the introduction of highly efficacious prevention measures and curative therapies for HCV infection, these targets are attainable.[4]

Confirmation of whether a country has achieved the WHO elimination targets will require large serological surveys and a review of the results by an independent committee. In the interim, mathematical modelling can be used as a surrogate to estimate whether countries will achieve these targets.

Recently, we published a study that reported when 45 high-income countries, accounting for 98% of the population in the world's high-income economies,[5,6] will achieve the WHO elimination targets using the available 2017 data.[7] That analysis found that one in five high-income countries was on track towards a timely HCV elimination by 2030, while two out of every three countries analysed were off track by at least 20 years. Since 2017, a number of countries removed treatment restrictions and expanded their hepatitis elimination programs. The objective of this study is to leverage the latest available data to identify which countries have progressed, fallen behind or remained unchanged in their timing of HCV elimination between 2017 and 2019, and the enabling factors for accelerating the path towards success.