• Over N500,000 hepatitis C bill shocks patients as country lacks 100 liver specialists
• 50,000-plus die yearly; states lack budget lines, actionable elimination plans
• 2030 elimination goal wavering without urgent action, Okinedo warns
• Experts propose integration into HIV/AIDS framework to curb epidemic
• Aloh advocates scale-up of vaccination, free screening, awareness

As Nigeria joins the global community to mark World Hepatitis Day 2025 today, experts have sounded the alarm over a worsening crisis. Millions remain undiagnosed, treatment costs are skyrocketing, and testing rates are dangerously low.

With hepatitis B and C claiming over 50,000 lives yearly, stakeholders warn that unless urgent action is taken, Nigeria will miss its 2030 elimination goal, leaving myriads of citizens at risk of liver failure, cancer, and preventable deaths.

Viral hepatitis, an inflammation of the liver, remains a major public health concern in Nigeria. If not properly treated, it can lead to serious complications, including liver fibrosis, cirrhosis, and liver cancer. While hepatitis is often caused by viral infections, it can also result from non-infectious factors such as excessive alcohol consumption or certain medications. The disease can range from a mild, short-term illness to a severe, chronic condition that causes permanent liver damage.

About 21 million people in Nigeria are estimated to be infected with hepatitis. Of this figure, 18.2 million have the hepatitis B virus, while 2.5 million are infected with the hepatitis C virus.

According to the Centre for Disease Analysis Foundation (Polaris Observatory), 55,998 people die of the hepatitis B virus yearly in Nigeria, while hepatitis C accounts for 5,954 deaths each year.

The Nigerian National Hepatitis Elimination Profile (N-HEP) estimates that 14.3 million Nigerians live with hepatitis B. However, as of 2022, only 299,334 had been diagnosed, and less than one per cent received care between 2015 and 2022. In the case of hepatitis C, where an estimated 27,596 new infections were recorded, only 265 individuals were initiated on treatment in 2022.

The World Health Organisation (WHO) observatory reported that in 2022 alone, Nigeria recorded 46,144 deaths attributed to hepatitis B; a mortality rate of 20.7 per 100,000 people. Hepatitis C caused an additional 5,652 deaths, with a mortality rate of 2.5 per 100,000. The report also noted that over 90 per cent of people living with hepatitis C in Nigeria lacked access to essential care.

Although WHO recommends a vaccination coverage of 90 per cent, the N-HEP report showed that only 52 per cent of Nigerian newborns received the hepatitis B birth dose, while 62 per cent of infants completed the third dose in 2023: both figures falling short of the target. The report attributes the low coverage to high rates of home births, limited vaccine availability in rural areas, and inadequate public awareness.

While Nasarawa State has made significant progress, screening over 85,000 people and treating 1,300 cases using a N40 million seed fund, most other states lack hepatitis-specific budget lines and actionable elimination plans. The report also noted that Nigeria does not currently operate a national monitoring system to track hepatitis diagnosis and treatment outcomes.

Findings by The Guardian revealed that although it costs between N1,000 and N3,000 to screen for hepatitis B or C, respectively, a person who tests positive requires confirmatory testing to determine viral load, a key indicator of the risk of long-term liver damage. The cost of viral load testing in Nigeria ranges from N25,000 to N35,000.

In addition, patients require further assessments such as liver function tests, ultrasound scans, serum alpha-fetoprotein, full blood count, electrolyte panels, creatinine, and kidney function tests to assess the extent of liver damage. These tests are also necessary for preparing treatment, as hepatitis medications are long-term and may affect vital organs. The total cost of these investigations ranges from N100,000 to N150,000 per patient.

The Guardian inquiry also revealed the high cost of treatment. A one-month supply of Tenofovir, the frontline drug for hepatitis B, costs around N18,000. For hepatitis C, the financial burden is far greater: curative treatment costs approximately N500,000 for a three-month course, excluding essential diagnostics such as viral load tests and liver imaging. The treatment landscape is further constrained by a severe shortage of liver specialists—fewer than 100 nationwide—resulting in care being largely concentrated in urban tertiary hospitals, while rural communities remain underserved.

STAKEHOLDERS are calling for urgent action, including the establishment of a federal budget line for hepatitis, expansion of community awareness programmes, increased testing through multiple strategies, and making all testing and treatment services free for patients.

President of the Society for Gastroenterology and Hepatology in Nigeria, Prof. Abdulfatai Olokoba, told The Guardian that Nigeria belongs to the hyper-endemic region for hepatitis B, with a prevalence rate of about eight to 15 per cent. However, the country falls within the low endemicity region for hepatitis C, with a burden of between one and three per cent. He urged the federal government to address the increasing prevalence of viral hepatitis and liver cancer in the country, along with the associated impacts on the health and socioeconomic well-being of Nigerians.

Olokoba noted that access to care is limited, as it has become expensive to screen, diagnose, and treat viral hepatitis. He added that, because of the devaluation of the naira, the cost of test kits and drugs for treating viral hepatitis “has gone up astronomically”.

He observed that, due to the unavailability of liver transplantation services in Nigeria and the prohibitive costs associated with accessing such services abroad, the diagnosis, treatment, and management of viral hepatitis and liver cancer in Nigeria should be subsidised.

Olokoba stated that the treatment of hepatitis C in the past “used to be injection with Interferon and Ribavirin”, noting that a combination of Daclatasvir and Sofosbuvir is now being used to treat hepatitis C.

According to him, this combination drug “cost on average of about N80,000 to N90,000 for a bottle, which is for 28 days, and the patient is expected to take it for between six months and one year”, thereby bringing the cost of the drug to N540,000 for a six-month regimen and over N1 million for a one-year course per patient.

Olokoba explained that there is no cure for hepatitis B, even though “the drug is cheaper”, stressing that for hepatitis B, “an average cost of the drug, which will last for one month, is about N18,000 to N25,000 for a bottle”. He said, “If you look at that cost, you agree with me that it may be beyond the reach of the average Nigerian, especially when you consider a country with a minimum wage of N70,000. But the good thing is that apart from the cost of treatment for hepatitis C, there is a cure for hepatitis C at the moment.”

Olokoba pointed out that the treatment for hepatitis B is readily available, but it has to start with breaking vertical transmission from mother to child by identifying pregnant women who have either hepatitis B or C. He observed that antenatal screening now includes screening for HIV, hepatitis C, and hepatitis B, and that “offers the opportunity to be able to break the vertical transmission from mother to child”, while “the horizontal transmission is still there”.

He highlighted that “ignorance, stigmatisation and discrimination, cost of screening, diagnosis, and treatment” constitute barriers to hepatitis care in the country. He added that “pre-marriage screening should be seen as an opportunity to identify those who have the disease and link them to care and treatment”.

Olokoba emphasised the need for Nigeria to integrate viral hepatitis response into the HIV/AIDS management framework, which helped reduce the burden of HIV/AIDS in the country. He noted that the mode of transmission is similar across the diseases.

“In one single risk exposure, you could have transmission of HIV, hepatitis B and hepatitis C… so they have shared routes of transmission. These routes of transmission include vertical transmission from mother to child and horizontal transmission, when you have people using unsterilised objects, blood transfusion, and the use of local unsterilised instruments for circumcision. People still have scarification marks, tribal marks… You find a lot of tattooing,” he said.

Team Lead and Founder of the Hepatitis Advocacy Foundation, Prince Okinedo, expressed concern that Nigeria’s response to the hepatitis epidemic remains far from adequate. He warned that unless the country changes course, the 2030 elimination goal would remain out of reach.

According to him, despite the World Health Organisation’s push to reduce new hepatitis infections to as low as 0.1 per cent, Nigeria continues to struggle with limited access to testing, unavailability of key medications like Tenofovir, and poor integration of hepatitis services across health systems. He said the cost of treatment is a major barrier, noting that the average monthly cost of hepatitis B medication such as Tenofovir is about N18,000, while the cost of the full three-month regimen to cure hepatitis C is as high as N500,000, excluding diagnostic expenses.

He observed that many states, including Delta, still lack basic infrastructure to diagnose or treat the disease. In some cases, patients are turned away due to the unavailability of drugs in public hospitals.

Okinedo criticised the government’s passive approach to hepatitis, calling for a more aggressive strategy similar to what has been employed in HIV/AIDS control. He noted that while global discussions are now embracing a triple elimination approach: targeting HIV, hepatitis, and syphilis, Nigeria continues to isolate hepatitis in its public health efforts. This siloed response, according to him, wastes resources and reduces the chances of achieving a broader public health impact.

He proposed a shift towards subsidised services and stronger, improved funding to enable the cost-effective integration of hepatitis into existing HIV service delivery frameworks.

Lamenting the near-total absence of hepatitis funding in most state budgets, Okinedo said the disease remains largely excluded from national and sub-national health agendas. He urged the government to adopt procurement strategies used in HIV programming to ensure wider access to hepatitis drugs and treatment. He also advocated leveraging existing HIV clinics and staff to expand hepatitis services without building parallel infrastructure.

IN an interview with The Guardian, the National Coordinator of the National AIDS and STDs Control Programme, Dr Adebobola Bashorun, said that Nigeria’s prevalence rates are estimated at 8.1 per cent for hepatitis B virus and 1.1 per cent for hepatitis C virus among people aged 15 to 64 years, according to the Nigeria AIDS Indicator and Impact Survey 2018.

He stated that the socio-economic burden includes limited career opportunities for those infected, and a significant GDP loss, estimated between one to five per cent, due to loss of productivity among the 20 million people living with the disease, absenteeism from work and school, Disability-Adjusted Life Years (DALYs), and mortality.

He said, “Some people may be infected but not have overt symptoms and are known as asymptomatic carriers. This is about five to 10 per cent of those infected in adulthood. However, more than 90 per cent of those infected in childhood will develop overt disease. So when you subtract 10 per cent from the 20 million, then you can estimate that approximately 18 million of them will have symptoms and/or signs that the doctor can pick up during laboratory investigations, and these oftentimes point to liver damage.

“Sometimes the damage is outside the liver and therefore may be happening in the kidneys, resulting in Chronic Kidney Disease, in what is referred to as extrahepatic manifestations of viral hepatitis, which include conditions like depression, neuropathy, thyroiditis (Hashimoto), Type 2 Diabetes Mellitus, and arthritis.”

Bashorun listed the key drivers of hepatitis in the country to include mother-to-child transmission, sharing of needles by injecting drug users, and cultural or informal practices such as local circumcision by unskilled attendants, scarification, tattooing, tribal marks, body piercing, and sharing sharp objects, such as during pedicures, as well as low levels of awareness of preventive practices.

He highlighted other barriers to accessing hepatitis care in Nigeria to include poor health-seeking behaviour, out-of-pocket expenditure, stigma and discrimination, and cultural or traditional beliefs and practices.

Bashorun stressed that these challenges could be addressed by increasing awareness of the hepatitis epidemic, ensuring individuals utilise health insurance and the Basic Health Care Provision Fund, replacing cultural and traditional beliefs with evidence-based medicine, improving health-seeking behaviour, and ending stigma and discrimination.

He stated that hepatitis testing and vaccination are available in 75 per cent of Primary Health Care Centres, 96 per cent of secondary health facilities, and 100 per cent of tertiary health facilities in the country.

However, the Coordinator noted that the challenge is low demand for such services from people because they are not aware that it is included in the Basic Minimum Package of Health Services and can be accessed at discounted costs under the National Health Insurance and Basic Health Care Provision Fund.

Bashorun noted that the First Lady, under the auspices of the Organisation of African First Ladies for Development, recently launched “Free To Shine”, a triple elimination programme in all six geopolitical zones. It aims to screen pregnant women for HIV, syphilis, and hepatitis, and ensure treatment or prophylaxis for both mother and child to prevent mother-to-child transmission of the virus.

He said, “The use of enzyme-linked immunosorbent assay in our blood transfusion services has resulted in rare reports of transmission of the virus through blood transfusion or other tissue or organ transplant. Currently, the Federal Ministry of Health and Social Welfare has just started the Medication Assisted Treatment for People Who Inject Drugs, and this translates to this key population accepting the treatment and stopping injecting and sharing of needles and syringes, which is a known driver of hepatitis transmission across the world.”

Bashorun identified suboptimal funding as a major challenge to hepatitis elimination in the country, adding that funders have not prioritised hepatitis, while public-spirited individuals and companies haven’t understood the threat that hepatitis presents.

He highlighted the need for local resource mobilisation and market-shaping interventions to reduce the cost of hepatitis screening and treatment through bulk purchasing in the short term and local manufacturing in the long term. He also stressed the importance of preventing mother-to-child transmission, scaling up vaccination among children, and implementing catch-up vaccination for adolescents and adults to enable the country to eliminate viral hepatitis by 2030.

For her part, Consultant Physician and Gastroenterologist at Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Dr Jennifer Aloh, while acknowledging that the Nigerian government has made some progress, particularly through the integration of hepatitis B vaccines into the national immunisation schedule, stressed the need to scale up adult vaccination campaigns and provide diagnostic tools in underserved communities to detect infections early.

According to Aloh, there is an urgent need to expand free screening initiatives, improve public awareness, and ensure that those who test positive are linked to appropriate care. She added that a diagnosis without treatment or follow-up only compounds the burden of the disease. She called for increased government investment to reduce the high cost of medications and diagnostic services.

Speaking on the routes of transmission, Aloh emphasised that the virus remains highly contagious and can survive outside the human body for extended periods. She identified horizontal transmission—through the sharing of sharp objects such as razors, manicure tools, and clippers—as the most common route in Nigeria. She also noted that traditional practices such as unsterilised circumcisions, tribal markings, unsafe sex, blood transfusions without proper screening, and mother-to-child transmission contribute significantly.