The top 20 highest burdened countries (in disability-adjusted life years) account for more than 75% of the global burden of viral hepatitis. An effective response in these 20 countries is crucial if global elimination targets are to be achieved. In this update of the Commission on accelerating the elimination of viral hepatitis, we convene national experts from each of the top 20 highest burdened countries to provide an update on progress. Although the global burden of diseases is falling, progress towards elimination varies greatly by country. By use of a hepatitis elimination policy index conceived as part of the 2019 Commission, we measure countries' progress towards elimination. Progress in elimination policy has been made in 14 of 20 countries with the highest burden since 2018, with the most substantial gains observed in Bangladesh, India, Indonesia, Japan, and Russia. Most improvements are attributable to the publication of formalised national action plans for the elimination of viral hepatitis, provision of publicly funded screening programmes, and government subsidisation of antiviral treatments. Key themes that emerged from discussion between national commissioners from the highest burdened countries build on the original recommendations to accelerate the global elimination of viral hepatitis. These themes include the need for simplified models of care, improved access to appropriate diagnostics, financing initiatives, and rapid implementation of lessons from the COVID-19 pandemic.

中文翻译：

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消除病毒性肝炎的进展：柳叶刀胃肠病学和肝病学委员会更新

负担最重的前 20 个国家（按伤残调整生命年计算）占全球病毒性肝炎负担的 75% 以上。如果要实现全球消除目标，这 20 个国家的有效应对措施至关重要。在委员会关于加速消除病毒性肝炎的最新报告中，我们召集了来自负担最重的 20 个国家的国家专家，提供最新进展情况。尽管全球疾病负担正在下降，但消除疾病的进展因国家而异。通过使用 2019 年委员会制定的消除肝炎政策指数，我们衡量各国在消除肝炎方面取得的进展。自 2018 年以来，负担最重的 20 个国家中有 14 个国家在消除政策方面取得了进展，其中孟加拉国、印度、印度尼西亚、日本和俄罗斯取得了最大进展。大多数改进归功于消除病毒性肝炎的正式国家行动计划的发布、公共资助的筛查计划的提供以及政府对抗病毒治疗的补贴。来自负担最重的国家的国家专员之间讨论中出现的关键主题建立在加速全球消除病毒性肝炎的最初建议的基础上。这些主题包括需要简化的护理模式、改善获得适当诊断的机会、融资举措以及快速落实从 COVID-19 大流行中汲取的经验教训。