Last year, government representatives from 194 countries pledged to end viral hepatitis by 2030. Now, it appears that only nine nations in that coalition are taking steps to work toward that goal, according to figures revealed at this year’s World Hepatitis Summit, AFP reports

The three-day summit in São Paulo, Brazil, held last week by the World Health Organization (WHO), welcomed representatives from more than 80 countries, as well as nearly 200 experts to discuss modern diagnosis and treatment of hepatitis C virus (HCV) and hepatitis B virus (HBV).

At the meeting, WHO organizers announced that Egypt, Georgia, Germany, Iceland, Japan, The Netherlands, Australia, Qatar and Brazil are the only places so far that have actually taken steps to eradicate viral liver disease in their countries.

In order to meet last year’s goal and end viral hepatitis by 2030, WHO recommends that participating nations begin promoting widespread testing strategies in their countries, while dramatically opening up access to preventive vaccines and hepatitis treatments. Humanitarian organization Médecins Sans Frontières (Doctors Without Borders) also recommended at the meeting that governments begin challenging pharmaceutical patents for HCV and HBV treatment when it’s unavailable by issuing compulsory licenses for the cures.

That said, according to the announcement a record 3 million people around the world have received hepatitis C treatment over the last two years (a major improvement, considering HCV cures were largely ineffective just four years ago), and an estimated 2.8 million received hepatitis B treatment in 2016. However, international experts warn that there are nearly 325 million additional confirmed cases of hepatitis worldwide and that 1.3 million people still die every year of complications from liver disease.