1. 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

2. 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.

3. 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?

4. 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.

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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.

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

12. 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

13. 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

14. 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.

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

16. Welcome to Washington, DC
Introduce Rich Wolitski – Then Jono