The writer
Africa CDC (Centres for Disease Control and Prevention) releases the Operational Toolkit for the Prevention, Diagnosis and Management of Hepatitis B. It is a deliberately practical document. Treatment algorithms. Liver fibrosis assessment. Clinical decision support for a nurse in a district facility where the nearest specialist is hundreds of kilometres away.
Developed by our Hepatitis B Group of Experts with the Centre for Operational Research on Hepatitis B, HEPSANET and the Society for the Study of Liver Disease in Africa, it translates World Health Organization (WHO) recommendations into guidance a health worker can apply in daily practice.
This is built because the gap on the continent sits between what we know and what we do.
Consider what we already know. Around 64 million Africans live with chronic hepatitis B. Our region accounts for 63 per cent of new hepatitis B infections worldwide. The virus killed an estimated 272,000 people here in 2022. Fewer than five in every hundred people infected have been screened. Fewer than one in a hundred receives treatment.
A vaccine given within 24 hours of birth prevents almost all transmission from mother to child, and 18 per cent of African newborns receive it. Hepatitis C can be cured in more than 95 per cent of cases with a short course of treatment.
Every one of those deaths was avoidable using tools invented decades ago. That is an implementation failure. Implementation failure is a political choice.
Why This Matters Now
 Development assistance is falling. Outbreaks are more frequent. Geopolitics is less predictable than at any point in a generation. Africa’s Health Security and Sovereignty agenda exists because the continent can no longer plan its health systems around the assumption that someone else will fund them.
Health sovereignty does not mean isolation. It signals a new model of partnership in which African nations lead with clarity and confidence, finance what they can finance, produce what they can produce, and set their own priorities.
Viral hepatitis is the cleanest test of whether that agenda works. The vaccine costs cents. The medicines are off patent. The diagnostics are simple. Existing maternal health, HIV and tuberculosis platforms can deliver the services. If Africa cannot organise itself around interventions this affordable and this proven, the harder tests ahead will defeat us.
In February 2020, African Union Heads of State and Government adopted the Cairo Declaration on Viral Hepatitis in Africa, committing to expand prevention, testing and treatment. Six years on, the record shows what commitment produces when it is funded, and what it produces when it is not.
Africa Is Already Proving The Case
 Egypt screened more than 50 million of its citizens through the 100 Million Healthy Lives campaign and became the first country in the world to reach World Health Organization gold tier status on the path towards hepatitis C elimination. Its support for treatment in Ghana aims to reach 50,000 patients. One African country is accelerating elimination in another. That is health sovereignty in practice.
Rwanda has screened more than seven million people, made hepatitis C treatment free nationwide, decentralised services and authorised trained nurses to manage uncomplicated cases in primary health facilities.
Uganda allocates approximately US$3 million a year in domestic resources for free hepatitis B testing, treatment and viral load monitoring. Nigeria’s Project 365, Senegal’s national elimination strategy, Ghana’s expansion of free treatment and Cameroon’s innovative financing arrangements represent four further routes to the same destination.
The pattern across all of them is identical. Political leadership first, domestic money second, partnership third.
Nearly all African Union Member States have introduced hepatitis B vaccination into routine childhood immunisation. The African Union has adopted the Africa Plan Towards the Elimination of Vertical Transmission of HIV, Syphilis and Hepatitis B by 2030, which treats three infections as one problem to be solved through the same antenatal visit.
Since 2022, with the support of the Korea International Cooperation Agency, our Continental Viral Hepatitis Prevention and Control Programme has established a continental group of experts, completed the first assessment of national hepatitis programmes and supported 32 Member States to learn directly from Egypt’s experience.
What I Am Asking For
 Member States: put the birth dose in every delivery room, and hepatitis screening in every antenatal package. The first 24 hours of life are the highest-return window in African public health. It requires a measurable national target, a supply chain that reaches health posts, accurate birth notification, and a health worker authorised to vaccinate at the point of delivery. It also requires reaching the millions of children born outside formal facilities, through community health workers, midwives and outreach teams.
Ministers of finance: build the financing before the next crisis, not during it. Solidarity levies, health security bonds, diaspora bonds, taxes on tobacco and alcohol, and catalytic private capital all belong in the conversation. UNITAID has been funded for two decades largely through a levy on airline tickets. African governments can design African versions of the same idea. Predictable domestic financing buys something no grant can offer, which is the ability to retain health workers, maintain supplies and plan beyond the fiscal year.
Regulators, procurement bodies and partners: buy African where African manufacturers qualify. South Africa produces generic tenofovir, and Biovac is producing millions of doses of hexavalent hepatitis B-containing vaccine, with Aspen completing a technology transfer with the Serum Institute. Egypt is expanding regional production of hepatitis therapeutics. Egypt, Kenya and Nigeria are strengthening local production of rapid diagnostic tests.
This capacity survives only if it has customers. The African Medicines Agency and the African Pooled Procurement Mechanism exist to turn 55 fragmented markets into one that manufacturers can plan around.
Digital systems make all of this accountable. Digitalised birth notification identifies the newborn that missed the birth dose while the intervention still works. Digital records ensure that a person diagnosed on Monday is still in care six months later. Africa CDC is supporting Member States to align partner investment behind country-led digital roadmaps rather than the reverse.
The Measure Of Success
 We will know this is working from ordinary things. A newborn vaccinated before the family leaves the ward. A pregnant woman told her hepatitis status at her first antenatal visit. A nurse in a rural clinic who knows which patient needs treatment and which needs monitoring. A person diagnosed and treated before cirrhosis or liver cancer. A diagnostic test manufactured on this continent, procured with this continent’s money, in the hands of a health worker paid by this continent’s treasury.
None of that requires a scientific breakthrough. All of it requires a decision.
We do not make these decisions alone. KOICA, the World Health Organization, UNICEF, professional societies, civil society organisations and affected communities have all invested in this agenda, and their contribution has made continental progress possible. Partnership on these terms strengthens African leadership rather than substituting for it.
Egypt, Rwanda and Uganda have shown what determined action achieves. Their progress should now become the continental standard.
By Dr Jean Kaseya, Director General, Africa Centres for Disease Control and Prevention (Africa CDC)