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Bill, supported by Stanford doctor, guards against hepatitis

A Stanford Medicine doctor helped write and support legislation to enable free hepatitis B and C screenings for those who request it.

Samuel So, MD, founder and executive director of the Asian Liver Center at Stanford Medicine, started his career as a liver transplant surgeon.

"A lot of patients who needed liver transplants were dying from hepatitis B- and C-related liver cancer or cirrhosis," said So, a professor of surgery who holds the Lui Hac Minh Professorship. And it's especially problematic in people of color.

Viral hepatitis is preventable and can be diagnosed and treated early. So has dedicated much of his work to demonstrating this to policymakers and advocating for policy changes that could help diminish, or even eliminate, the need for liver transplants through early screening.

To that end, he worked with legislators to write and support a new bill -- California's AB 789 -- to close disparities in diagnosis and treatment for hepatitis, especially for communities of color. Gov. Gavin Newsom signed the bill into law on Oct. 4.

The law mandates clinics and any facilities that provide primary care services to offer adult patients voluntary hepatitis B and C screening tests. The bill also requires health care providers to connect patients who test positive with resources to help them manage the disease. 

I spoke with So about the bill and why he considers it imperative in standard health care. This conversation has been lightly condensed and edited for clarity.

Why is this bill important?

It is meant to close the gap in screening and in linkage to care and treatment, particularly for people of color. I think this legislation will save tens of thousands of lives in California and potentially save us hundreds of millions of dollars in liver disease and cancer treatment and transplant costs.

How big of a problem are hepatitis B and C in California? 

They cause huge public health problems. We have about 600,000 adults -- 2% of the adult population -- living with hepatitis B or C. More people die in California from viral hepatitis than in any other state, and it accounts for more than one-third of the liver transplants in California.

In the past, health care providers have told patients with hepatitis B, "You don't have any symptoms, you are just a carrier," and didn't provide them with regular  monitoring -- or when necessary, treatment -- for liver cancer and liver inflammation.

Most people who have hepatitis don't have symptoms until they develop advanced liver cancer or cirrhosis. The good thing is that we now have highly effective medicines (as simple as a pill a day) to cure hepatitis C and to suppress the hepatitis B virus.  We can also stop hepatitis from passing from one generation to the other. A hepatitis B vaccine is the only vaccine you give the newborn right after birth.  

It's a big problem worldwide, too. About 300 million people globally have hepatitis B, and 60 million have hepatitis C, compared to 40 million with HIV. The World Health Organization estimated that 1.1 million people died of hepatitis B and C-related liver cancer or cirrhosis in 2019.

What puts communities of color at higher risk for hepatitis B and C? 

Hepatitis B disproportionately affects Asians. Many were infected before a vaccine was available, very often through mother-to-child transmission. By the time they reach 30 or 40, they can develop liver cancer or cirrhosis. It is a major problem, and it largely affects a lot of foreign-born people who were not vaccinated as infants.

Hepatitis C is a big problem for anyone who has used intravenous drugs. Injecting drugs, even once, puts you at risk, which then puts you at risk of eventually developing liver cancer or cirrhosis.

What's next?

We've been working with the California Department of Health, and they will be sending out notices to all the clinics in California about this new law. State officials, the Asian Liver Center and health care providers will monitor, through big databases, to see whether there has been improvement in screening as well as improvement in linkage to care and treatment over the next few years. 

I feel great about the passage of this bill. But you know how it is -- now I worry about the next steps, the implementation. The World Health Organization has a very ambitious goal towards elimination of hepatitis B and C by 2030 in the United States and the world.

Photo by Sherry Young

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