February 2021 APPG on Liver Health newsletter
APPG on Liver Health news
The first APPG meeting of 2021 took place on Wednesday 27th January. The meeting featured a presentation from Dr Judy Wyatt, Consultant Histopathologist at Leeds Teaching Hospitals NHS Trust and a member of the Royal College of Pathologists, providing an overview of liver biopsies and her broader perspective on liver health as a clinical expert. Following this, Dr Rebecca Wilkinson from Public Health England reported on findings of an analysis of hepatitis C test and treat interventions for the homeless population during Covid-19 in England (outside London), with Dee Cunniffe of the London Joint Working Group on Substance Use and Hepatitis C then providing details of the work that took place in London. Minutes from the meeting will be circulated shortly and will be available on the APPG website here.
The next meeting of the APPG is provisionally set for 4pm-5pm on Wednesday 3rd March. Further details will be circulated soon by the secretariat.
New research by the APPG for Children of Alcoholics reported in The Telegraph found that alcohol-related hospital admissions in England have risen by 45 per cent in a decade. Despite this, local authorities have suffered a further 2 per cent cut in their drug and alcohol treatment services budget compared to the previous year. Read the Telegraph story here and the full press release on the research here.
Mark Gillyon-Powell, Head of Programme for HCV Elimination at NHS England, has written an article on the hepatitis C elimination programme for the Reform think tank as part of its ‘A New Deal for Prevention’ report. The article outlines progress towards elimination to date and the aims of the projects initiated as part of the hepatitis C elimination deal. Read the piece here.
A new survey by Public Health England and YouGov found that a million drinkers in England have increased their consumption to severely dangerous levels during the Covid-19 pandemic, with 5.7% of adults (2,520,000 people) drinking more than 50 units of alcohol a week in December 2020, compared with 3.4% (1,500,000 people) in March 2020 prior to the introduction of lockdown in the UK. Read a write-up of the findings in the Mail here.
To mark National Love Your Liver Awareness Month, British Liver Trust warned that the Covid-19 pandemic could lead to tens of thousands more liver disease cases in 2021 and urged people to consider their liver health and take a simple quiz to assess their risk. Read more here.
Public Health England published an analysis of the hepatitis C test and treat interventions for the homeless population during Covid-19 in England (outside London) – as covered in our latest meeting (see above). Across the 11 areas, testing was carried out in 63 settings. Within these settings, 1,263 clients were tested, with 133 (10.5%) found to have a current infection (HCV RNA positive). By the time data was submitted, 92 (69.2% of those testing RNA positive) had been offered treatment and 83 (90.2% of those offered) had started treatment. Read the report here and an overview by The Hepatitis C Trust of the findings from this report and the London Joint Working Group on Substance Use and Hepatitis C’s analysis of the interventions in London here.
Another report from Public Health England, the annual ‘Shooting Up’ report looking at infections among people who inject drugs in the UK, found that 23% of people who inject drugs in the UK had a chronic (current) hepatitis C infection in 2019, a modest reduction from the 29% infection rate in 2016. However, incidence of new infections is still believed to have remained relatively stable across the UK in recent years. Read the report here.
Researchers from University College London have reported promising results from clinical trials of a breakthrough treatment for liver cirrhosis. The researchers believe the treatment could cut the death toll from liver disease by between 25% and 40% and hope it will be available from 2024 or 2025 following another clinical trial to confirm its effectiveness. Read more here.
Relevant parliamentary activity
In response to a question from Shadow Secretary of State for Health and Social Care Jonathan Ashworth on excess deaths linked to drug and alcohol misuse during the Covid-19 pandemic, Public Health Minister Jo Churchill revealed that there were an estimated 522 excess deaths attributed to cirrhosis and other liver disease between 20 March and 27 November 2020, with a total of 6,046 registered deaths from cirrhosis and other liver disease in that period.
APPG Co-Chair Sir David Amess asked about steps being taken to reduce the number of hospital admissions as a result of alcohol-related liver disease. Responding, Jo Churchill noted the roll-out of alcohol care teams and work by PHE to increase early detection of alcohol-related liver disease.
Shadow Public Health Minister Alex Norris asked a series of questions about liver disease diagnoses, deaths and undiagnosed cases and was referred to a PHE comparison of liver disease to other causes of death.
January 2021 APPG on Liver Health newsletter
APPG on Liver Health news
Our next APPG meeting will be held virtually from 4pm-5pm on Wednesday 27th January 2021. The group will hear from researchers at Public Health England and the London Joint Working Group on Substance Use and Hepatitis C about hepatitis C interventions targeting homeless populations during lockdown, as well as Dr Judy Wyatt, Consultant Histopathologist at Leeds Teaching Hospitals NHS Trust, who will provide her perspective on liver health as a clinical expert. A full agenda and joining instructions will be circulated in due course.
NHS Digital released its ‘Health Survey for England 2019’ report. This found that drinking at increasing or higher risk of alcohol-related harm was most prevalent among those aged 55-64, particularly in men, and in the highest income households. The prevalence of children aged 8-15 reporting ever having had a proper alcoholic drink has declined significantly in the last few decades to 15%. The highest proportion of non-drinkers was in London and the West Midlands, and adults living in the North East were the most likely to drink more than 14 units of alcohol.
Public Health England’s latest ‘Hepatitis C in the UK’ report estimates that prevalence of the disease has fallen by around one third since 2015 (with 118,000 people now estimated to have a chronic hepatitis C infection in the UK), and that deaths have reduced by one quarter compared to the 2015 baseline. However, the report also notes that there has been no meaningful reduction in new hepatitis C infections and states that “the Covid-19 pandemic poses a serious threat to our ability to meet WHO HCV elimination goals”.
The London Joint Working Group on Substance Use and Hepatitis C has published a report on hepatitis C interventions targeting homeless populations in London during the first, spring lockdown, in partnership with the Mayor of London. It finds that the innovations of health services, peers, addiction services and others have led to over 1,000 people being tested for blood-borne viruses including hepatitis C between May and August 2020, leading to at least 43 people beginning treatment for the virus.
The Pfizer/BioNTech Covid-19 vaccination has been monitored in subjects with a stable hepatitis C or hepatitis B infection, and there were no meaningful clinical differences in vaccination efficacy reported in people with co-morbidities. In addition, Pfizer has said there is no warning about alcohol consumption associated with the vaccination.
The Institute of Alcohol Studies released a report on how nudge theory shapes alcohol policy. In particular, it warned that alcohol policy often framed the public as blameworthy for their own alcohol health problems, which it argues suggests a lack of understanding of or attention to the complexity of psychological factors in alcohol consumption.
Scottish Health Action on Alcohol Problems has called for a national chain of off-licences owned by the Scottish Government in the Nordic style to control alcohol sales.
Drink Wise Age Well published a report on addressing the needs of older adults receiving alcohol treatment during the pandemic, exploring the move to remote service provision and drinking habit changes.
The Institute of Alcohol Studies published a blog exploring the data around alcohol consumption in the UK in 2020. It concludes that alcohol consumption probably fell at the start of lockdown in the spring, but this has been more than made up for in the latter part of the summer, resulting in overall alcohol sales increasing in 2020 compared with previous years. It further highlights shifts away from beer and towards wine and particularly spirits.
The Daily Mail reported that alcohol consumption has risen 50% since the first lockdown, with one in 20 people drinking more than five bottles of wine a week.
The Grocer Magazine’s annual Top Products Survey found that consumer shopping habits shifted to the extreme, particularly on alcohol. Lager sales increased by more than a fifth, and sales of wine, spirits and tobacco also rose significantly.
Alcohol Health Alliance published a blog about the under-representation of people from Black and Asian backgrounds in drug and alcohol services, with 92% of all people in treatment for addiction recorded as White.
Google announced a new feature on 14th December allowing users to block gambling and alcohol adverts.
Relevant parliamentary activity
The Government consultation on introducing a total online advertising restriction for products high in fat, sugar and salt closed on 18th December. The Government’s response is expected next year. Following a question from Kenny MacAskill MP about the potential to run a similar consultation on alcohol advertising, Oliver Dowden said all advertising restrictions would be kept under review.
Chair of the APPG on Liver Health, Sir David Amess MP, asked for a debate on the relationship between alcohol and homelessness, citing research from Shelter that found two-thirds of respondents put drugs and alcohol as a reason for their being homeless.
During a Short Debate on gambling legislation, Baroness Finlay of Llandaff highlighted the need for an alcohol strategy linked to a gambling strategy. Baroness Barran confirmed that the Department of Health and Social Care was leading on a cross-issue addiction strategy.
Baroness Hayter of Kentish Town asked what steps the Government was taking to limit the sale of cheap, strong alcohol. Lord Bethell responded that the Government had banned sales of alcohol below the level of duty plus VAT and introduced a higher duty band on cider at 6.9% and 7.5% alcohol by volume in February 2019. He added that they would continue to work with industry to create more consumer choice and availability in the low and no alcohol sector.
Baroness Manzoor asked about the impact of Covid-19 vaccinations on people with pre-existing health conditions. Lord Bethell responded that the Pfizer/BioNTech vaccination had been monitored in subjects with a stable hepatitis C or hepatitis B infection and that there were no meaningful clinical differences in vaccination efficacy in people with co-morbidities.