Numerous obstacles stand in the way of ending the hepatitis B and C virus (HBV/HCV) epidemics in the United States. A new report from the National Academies of Sciences, Engineering and Medicine examines the challenges facing efforts to combat each disease and suggests that reducing both new infections and the overall number of people living with each virus is more of a feasible short-term goal than outright victory.

An estimated 700,000 to 1.4 million Americans have hep B, and between 2.5 million and 4.7 million people have hep C in the United States. About 20,000 people die from the diseases annually.

One obstacle in the fight against each disease is the lack of proper state surveillance systems. Only five states and two large cities have sufficient funds budgeted for comprehensive surveillance.

Another obstacle is the stigma associated with each virus, which discourages testing and seeking care. Also, an estimated two thirds of those with hep B and half of people with hep C do not know they are infected. Given that both diseases are typically asymptomatic until later stages of infection, people are unlikely to have lack of physical well-being as an impetus to get tested.

Most new hep B infections are in foreign-born U.S. residents who may have language or social barriers to accessing health care. Additionally, U.S. laws can make it difficult for immigrants to access health coverage through Medicaid or Affordable Care Act marketplace plans.

People who contract hep C in the present day tend to be poorer and less educated than the average American. Many are injection drug users. These individuals may be alienated from the U.S. health care system.

While prisons are a good place to screen for hep C, the high cost of treatment for the virus is straining prison budgets.

To read a press release about the study, click here.