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Firstly, to welcome all our medical students, especially those commencing third year. On behalf of the Royal staff you are most welcome and I hope you will enjoy your clinical attachments. My Oration is primarily directed to you and to those in the early stages of their careers although hopefully there is something here for all of us.  \nMy second task of delivering a thought-provoking Oration is somewhat more challenging. I had the privilege of working under Dr Norman Campbell and I love the humorous opening remarks from his oration in 2005 when he said that the Orator has the opportunity of ‘airing views on some topic of interest to himself if not to anyone else’1. My subject is definitely close to my own heart and I hope that my remarks will be of at least passing interest to others.  \nCan a disease be eliminated?  \nMy interest in hepatitis C is well known. The trajectory of this disease mirrors my own career – it was first identified in 19892, the year I graduated from Queens. As you will hear it may be eliminated before 2030 by which time I expect to be retired - but hopefully not eliminated. My title is derived from phase one of the WHO Global Health Strategy to eliminate viral hepatitis as a major public health threat by 20303. It was published in 2016 and the UK signed up the same year. I want to consider the lessons we can learn from the hepatitis C story and through this to consider what it really means to ‘eliminate a disease’.  \nWHO had good reason for committing to an elimination strategy for viral hepatitis. In 2015, viral hepatitis was the only major infectious disease with a rising global death rate, overtaking HIV and tuberculosis (Figure 1) . This was prior to Covid-19 which I will mention later. The strategy applied to the whole hepatitis alphabet – A, B, C, D and E - but the emphasis was on hepatitis B and C which at that time accounted for 95% of the estimated 1.4 million deaths from viral hepatitis each year.  \nSeveral circumstances in 2015 suggested the time might be right for elimination. Vaccines for A and B were well established and work was evolving on hepatitis E vaccination. Strategies were in place for prevention of mother to baby transmission of hepatitis B, reductions in healthcare transmission of hepatitis B and C and harm reduction for people who inject drugs. Most importantly, new potent anti-  \nFigure 1. Estimated global number of deaths due to viral hepatitis, HIV, malaria and TB, 2000-2015  \nviral drugs for hepatitis C had just been released. You could not fault the WHO for being optimistic.  \nOf course, the WHO had an excellent track record in this respect, having eradicated smallpox4. For the pedants among you, there is a difference between elimination and eradication. Elimination means reducing the incidence of an infection to zero but requires ongoing interventions for control. Eradication means a permanent reduction to zero with no need for ongoing control.  \nLike so many infectious diseases, smallpox is known to have existed in ancient Egypt some 3000 years ago. More recent records from the past few centuries show that smallpox hada devastating mortality rate of up to 30% and it is thought to have killed 300 MILLION people in the 20th century alone.  \nMany of you will know the story of Dr Edward Jenner who noted the protection or immunity to smallpox that milkmaids developed due to their exposure to cowpox which was obviously a much less dangerous but related virus. This led Jenner to develop the first vaccine against variola in 17965.  \nIt took over 150 years but WHO launched an eradication program in 1959. A lesson we must all remember is that despite having an excellent vaccine, the program failed – it was ineffective due to lack of funding and commitment. A  \n*Consultant Hepatologist The Liver Uni","cbCaicLuHbv3LBBA","https://ap.wps.com/l/cbCaicLuHbv3LBBA","pdf",2293763,"English","# Eliminating a disease\n## Historical context and definitions\n## Hepatitis C and the WHO strategy\n## Lessons from smallpox and cautionary tales","[{\"question\":\"What are the two main tasks traditionally assigned to the Orator in the annual address?\",\"answer\":\"The Orator first welcomes medical students, especially those starting their third year clinical attachments. Second, the Oration delivers a thought-provoking address aimed at early-career professionals and others in the audience.\"},{\"question\":\"How does the speech define 'elimination' versus 'eradication' of a disease?\",\"answer\":\"Elimination reduces the incidence of an infection to zero but requires ongoing control interventions. Eradication is a permanent reduction to zero with no need for ongoing control.\"},{\"question\":\"Why does the speaker believe viral hepatitis elimination might have been feasible around 2015?\",\"answer\":\"Vaccines for hepatitis A and B were established, hepatitis E vaccination work was evolving, prevention of mother-to-baby transmission strategies existed, and harm-reduction approaches targeted injection drug use. Additionally, new potent anti-viral drugs for hepatitis C had recently been released.\"}]","Eliminating a disease - Royal Victoria Hospital Annual Oration, 4th October 2024 | PDF",1790664206,18]