The Role of Public Health in Hepatitis Elimination ENDING THE EPIDEMICS: The Role of Public Health in Hepatitis Elimination Murray Penner, Executive Director Welcome to the 6th National Hepatitis Technical Assistance Meeting convened by NASTAD! The theme of this year’s meeting is “Ending the Epidemics: The Role of Public Health in Hepatitis Elimination” There is a lot of uncertainty in Washington, DC and around the country right now as President-Elect Trump continues to assemble his cabinet and the new Congress prepares to govern. There is also a lot of uncertainty among health departments about how to address the multiple issues related to hepatitis with little to no funding What there isn’t uncertainty about is the scale of the hepatitis epidemics in the US. – There isn’t uncertainty about what needs to be done to prevent new infections. There isn’t uncertainty about the need to test and link people to care, and there is most definitely not uncertainty that everyone living with hepatitis C deserves access to the cure. This meeting is an opportunity for all of us to come together around our the governmental public health role in eliminating hepatitis. It’s an opportunity to connect with others who have been doing this work for years – and to welcome our colleagues who are new to this work. The NASTAD staff and I are excited that you are here and are as committed as ever to support your work when you return home. National Hepatitis Technical Assistance Meeting December 5-7, 2016

Mission and Vision NASTAD’s mission is to end the intersecting epidemics of HIV, viral hepatitis, and related conditions by strengthening domestic and global governmental public health through advocacy, capacity building, and social justice. NASTAD's vision is a world free of HIV and viral hepatitis. Earlier this year NASTAD’s Board of Directors updated our mission. We believe this more accurately reflects all of our work and specifically highlights the critical role of governmental public health – the importance of intersecting and related epidemics and the power of advocacy, capacity building and social justice.

Meeting Overview NASTAD first convened this meeting in 2008 as a venue for health department staff working on hepatitis to share successful strategies, hear from federal partners and network with one another and invited partners The 2016 National Hepatitis Technical Assistance Meeting Highlights central role of governmental public health Prioritizes the prevention, care and treatment needs of people who inject drugs Seeks to reframe our response to hepatitis C as a health equity and social justice issue Re-energizes participants to continue their amazing work How many health department staff have been in their current position less than 1 year? How many have been in there current position for 2-5 years? How many have been in their current position for 5-9 years? How many have been in their current position for more than 10 years? 20 years?

Looking Back As we come to a close of the Obama Administration, it’s important to review some of the progress experienced under his leadership.

The Obama Administration In 2008, NASTAD called on the Administration to: Recognize Viral Hepatitis as an Urgent Public Health Issue – Partially DONE Appoint an Individual in the Department of Health and Human Services to Coordinate Intra-Agency Response to Viral Hepatitis - DONE Develop a National Plan for Prevention and Control of HBV and HCV - DONE Fund National Viral Hepatitis Public Awareness Campaign – PARTIALLY DONE Fund a National Chronic Viral Hepatitis Surveillance System – NOT DONE In 2008 – NASTAD (and our advocacy partners) called on the president-elect to make hepatitis a priority in his Administration. Here are the specific “asks” we made to the Obama Administration in 2008

The Obama Administration In 2008, NASTAD called on the Administration to: Fund an HBV and HCV Testing and Linkage to Care Program – DONE then UNDONE Fund an Adult HAV and HBV Vaccination Program – DONE then UNDONE Fund Care and Treatment Programs for HBV and HCV Mono-Infected - ACA Fund Care and Treatment for HBV and HCV for HIV Co-Infected – RW/ACA Fund HBV and HCV Research – PARTIALLY DONE Lift the Ban on Federal Funding for Syringe Exchange – DONE then UNDONE then PARTIALLY DONE <after reviewing all points> This Administration and our federal partners who are with us today have done a tremendous amount of work on health care, the populations most impacted by hepatitis, and specific hepatitis initiatives Has it been enough? I think we can all agree that there is much more to do – but we are in a much different place than when we first met at this meeting 8 years ago

The Future – 2017 and Beyond President-Elect Trump No history/unknown position on viral hepatitis Called for repeal and replace of ACA Vice President-Elect Pence Indiana HCV/HIV outbreak experience Strong opponent of Planned Parenthood Secretary of HHS Nominee Dr. Tom Price Strong opponent of ACA, author of alternative legislation Congress Majority called for repeal and replace of ACA Limited history/commitment to viral hepatitis Anticipate continued bipartisan support for addressing the opioid epidemic As we continue to learn more about the Trump Administration’s cabinet and policy priorities and the new Congress – here are a few things that we know related to health care and hepatitis

The Future – 2017 and Beyond We know that there continues to be bi-partisan support for addressing the opioid epidemic – and the work of our partners at CDC on the HIV/HCV vulnerability index will help to “connect the dots” between the opioid epidemic and infectious disease risk This is particularly powerful as this index identifies counties at risk for an HIV and/or HCV outbreak in many rural areas – including Congressional districts which have not necessarily had a policy history on HCV and HIV Of course we know that HCV and HIV risk is not confined to the areas indicated on this map – that they continue to also be suburban and urban epidemics as well – but in addition to being a strong public health tool – this index has the potential to be a strong advocacy tool with our advocacy with policymakers

The Future – 2017 and Beyond Recommendations to Trump Administration Establish an Office of National Hepatitis Policy Develop and implement a National Hepatitis Elimination Strategy Budget adequate funding to comprehensively address hepatitis and move toward elimination Identify emergency funding to institute national public health hepatitis treatment program In 2008 – we made specific asks to President-Elect Obama. We will also be making hepatitis related asks to President-Elect Trump. Here are some of the “top line” requests for the Trump Administration. There will be additional specific requests reminiscent of the programmatic level requests we made of the Obama Administration – but most of those “asks” will be focused on the HHS Secretary and the CDC Director Establish an Office of National Hepatitis Policy Coordination of a national hepatitis elimination strategy that: prioritizes communities at highest risk for ongoing transmission of HBV and HCV targets communities with the highest burden of chronic hepatitis and at risk for liver disease and cancer. Develop and implement a National Hepatitis Elimination Strategy Budget adequate funding to comprehensively address hepatitis and move toward elimination Screening and linkage to care National hepatitis surveillance activities Elimination of mother-to-child HBV transmission Prioritization of prevention, identification and linkage to care and treatment of PWID Support of syringe service programs Fund adult vaccination to prevent hepatitis B virus (HBV) Identify emergency funding to institute national public health hepatitis treatment program

NASTAD Chair’s Challenge Ready to End the HIV and Viral Hepatitis Epidemics Calls on U.S. health departments to accelerate the end of HIV and viral hepatitis in the U.S. Several major developments means that the next five years will present a critical turning point in determining whether hepatitis C will be controlled or eliminated in the US A highly efficacious cure Department of Health and Human Services’ (HHS) Viral Hepatitis Action Plan National Academies of Medicine report and forthcoming elimination strategy Review points- You’ll be hearing more about the Chair’s challenge as it relates to hepatitis in the next plenary, throughout the meeting and in the coming weeks and months.

NASTAD Chair’s Challenge This is not business as usual.

Ending the HCV Epidemic NASTAD is preparing a call to action for 2017 Will help to reframe the national dialogue around HCV Action for governmental public health Action for the Administration Action for federal agencies Action for Congress Action for state and local policymakers Action for advocates Action for industry partners Will also release a call to action for HBV Complimentary to National Academies Elimination Strategy

Ending the Epidemics We look forward to the Spring release of the National Strategy to Eliminate Hepatitis being written by the National Academies of Medicine We are thrilled that the Committee includes three governmental public health experts: Dan Church, Massachusetts Lucy Wilson, Maryland Randy Mayer, Iowa

Ending the Epidemics We can eliminate hepatitis. It’s going to be a heavy lift, but we’ll get there. We look forward to this meeting being an opportunity to get re-energized so we can roll up our sleeves and continue the great work you’re doing.

Thank You to Our Sponsors We couldn’t put this meeting on without support from the following sponsors

Welcome to Washington, DC Introduce Rich Wolitski – Then Jono