Australia Projected to Fail Hepatitis Goals With $2.6 Billion Potential Cost

The financial stakes of inaction are steep. According to a report commissioned by Hepatitis Australia, which utilized data from the Doherty Institute and the Kirby Institute, the projected $2.6 billion cost is split between two primary viral threats. Hepatitis B accounts for $1.17 billion in potential costs—including $964 million in immediate expenses and $202 million in lost workforce participation and premature death. Hepatitis C adds another $1.43 billion, consisting of $1.39 billion in immediate costs and $40 million in downstream expenses.

The $2.6 Billion Gap in Elimination Targets

Australia is not expected to meet eight of its 10 targets for hepatitis B, nor five of its seven targets for hepatitis C. While the country is on track to ensure 95% of children receive three vaccinations against hepatitis B and maintain a surface antigen rate of 0.1% or lower in children under five, other critical areas are lagging.

• Hepatitis B: Preventing mother-to-child transmission, identifying undiagnosed cases, reducing healthcare stigma, and lowering attributable mortality.
• Hepatitis C: Curing at least 85% of cases, reducing mortality by 65%, and improving the quality of life for 95% of affected people.

Despite these gaps, there is a strong economic incentive to pivot.

The Sharp Decline in Hepatitis C Treatment

The struggle to hit 2030 goals is compounded by a significant drop in treatment initiation. Between March 2016 and December 2022, approximately 100,684 people living with hepatitis C started treatment, following the introduction of antiviral medication to the PBS in 2016. However, treatment rates have plummeted since that peak.

Dr Alisa Pedrana, a public health expert at The Burnet Institute and editor of the annual report, explained that the initial high uptake was driven by healthcare providers helping people get diagnosed and ready for care. That momentum has since stalled. By the end of 2022, an estimated 74,400 Australians were still living with hepatitis C.

Pedrana identifies a critical bottleneck: only 50% of people diagnosed in the program are actually starting treatment. She notes that those remaining are often the most vulnerable, facing complex comorbidities, homelessness, or a history of incarceration, which can make hepatitis C treatment a lower priority than other urgent health or social needs.

Stigma and the Need for Implementation Action Plans

Beyond the clinical hurdles, social barriers are hindering progress. Both the Hepatitis Australia report and the joint report from the Burnet and Kirby Institutes highlight stigma and discrimination in community and healthcare settings as primary obstacles to testing and treatment.

“The evidence is clear. Acting now to meet our targets will save lives and avoid billions in future costs. Governments must take the next step. The longer we wait, the greater the cost.”

Lucy Clynes, CEO of Hepatitis Australia

Global Context: Europe’s Parallel Struggle

Australia’s challenges mirror a broader international trend. In Europe, the European Centre for Disease Prevention and Control (ECDC) reports that the region is also set to miss the 2030 target. While children’s hepatitis B prevalence is near zero, an estimated five million people in the EU/EEA still live with chronic hepatitis B or C, leading to nearly 60,000 deaths annually from linked liver disease.

Europe faces similar gaps in harm reduction. Only seven countries in the EU/EEA have met the WHO target for distributing sterile injection equipment to people who inject drugs. This suggests that the failure to reach elimination targets is not an isolated Australian issue, but a systemic failure to reach priority populations—including sex workers, people in custodial settings, and those with lived experience of injecting drug use—across different jurisdictions.