Nearly 412 Bulgarians die annually from hepatitis C, while therapy is delayed by months

Every year, over 1.1 million people worldwide die from hepatitis B and C. In Bulgaria alone, we lose approximately 412 lives annually to hepatitis C—more than one person per day. This was stated by Prof. Dr. Krasimir Antonov during a discussion dedicated to the future of viral hepatitis treatment in our country. The event was organized by the Bulgarian Society of Gastroenterology and the HepActive association, with the support of the Bulgarian Medical Association (BMA).

Despite access to modern treatment fully covered by the NHIF, the delay between diagnosis and the start of therapy remains alarming—between 49 and 135 days for protocol approval, according to a study by HepActive. “For years, we have been warning that the current administrative system does not help diagnosed individuals reach therapy effectively and quickly. It is necessary to simplify the application procedure and shorten the period for reviewing protocols; otherwise, the plan to eliminate hepatitis B and C in Bulgaria will continue to exist only on paper,” warned Silvana Lesidrenska, chairperson of the association and a patient with chronic hepatitis B.

Assoc. Prof. Dr. Radin Tsonev, a hepatologist at Acibadem City Clinic UMBAL Tokuda, commented: “Epidemiology clearly shows that we have a decline in hepatitis B vaccination coverage—from 90% to under 70% due to anti-vax campaigns following COVID-19. This puts an entire generation of children at risk.” He emphasized that the chronically ill are predominantly people over 40, intravenous drug users, and patients with comorbidities.

According to Dr. Nikolay Branzalov, Chairman of the BMA, the success of the Second National Program for the Prevention and Control of Viral Hepatitis depends entirely on its actual implementation. “The truth is that no matter what is written in the current and subsequent programs, if there is no drive for execution, we cannot expect progress in our goal of eliminating viral hepatitis in Bulgaria.”

He pointed out that despite free treatment in our country, we are witnessing a disturbing gap in two areas: “First, between the number of actually diagnosed patients and the expectations at the population level to achieve elimination. And second—the striking discrepancy between the number of those diagnosed and those who actually receive treatment.”

Data indicates that in 2024, only 752 people with hepatitis C were treated in Bulgaria, while over 9,000 annually are needed to reach the goals set by the WHO for eliminating hepatitis by 2030. Regarding hepatitis B, approximately 2,500 patients are being treated, while at least 28,000 newly discovered cases are required.

The discussion also included Assoc. Prof. Dr. Angel Kunchev, Chief State Health Inspector, who presented current data on the prevalence of viral hepatitis in the country. Assoc. Prof. Kunchev remained optimistic, noting on one hand that a breakthrough was made with the previous prevention and control program, which predetermines the success of the Second one. He added that without political will and resources, the program cannot be successful.

Nevertheless, Assoc. Prof. Kunchev expressed his concern regarding the prevalence and incidence of hepatitis C, which have increased drastically over the last four years. “We are clearly ineffective in terms of prevention, early case detection, and limiting its transmission. If we continue at this pace, we will become the leaders in Europe in terms of hepatitis C incidence and prevalence,” he added.

Silvana Lesidrenska added that there is an urgent need to abolish the mandatory liver biopsy for hepatitis B treatment, which has not been practiced in any European country for years.

As the deadline set by the World Health Organization for eliminating hepatitis by 2030 approaches, Bulgaria still lags seriously behind in achieving key goals such as early diagnosis, timely access to treatment, and effective screening. Participants in the discussion were unanimous that the Second National Program will only be effective if implemented with a clear action plan, political will, and commitment from all stakeholders.

In this context, participants also emphasized the need for strategic changes in the upcoming National Program for the Prevention and Control of Viral Hepatitis (2026–2030). Among the proposed measures are conducting a national serological study, maintaining current target groups, and expanding the scope of screening among the general population—including all individuals over 30 years of age (instead of the previous age limit of 40–65). The goal is more effective identification of risk groups and the timely inclusion of more patients in treatment.

“We have the resources, the experts, and the necessary international framework—the only thing missing is the synchronized will for change. We hope this forum is the beginning of a more intensive and real dialogue about the future of hepatitis patients in Bulgaria,” concluded Prof. Dr. Krasimir Antonov.