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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.  

Liver news

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

Consultations

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.

Parliamentary debates

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.

Parliamentary questions

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.

December 2020 APPG on Liver Health newsletter

APPG on Liver Health news

Thank you to those of you who joined our meeting last month; it was good to re-connect after not being able to hold a meeting since February due to Covid-19-related disruptions.

At the meeting, the group heard from Mark Gillyon-Powell from NHS England about the impact of the pandemic on the UK’s hepatitis C elimination targets. While lockdown undoubtedly presented challenges, particularly around testing in drug services and prisons, the ‘Everyone In’ policy to house those rough sleeping led to excellent work across England to test people for hepatitis C and support those found to be positive onto treatment. These case-finding initiatives resulted in treatment numbers being only around a third to half of what had been expected pre-Covid-19, and significantly better than all other countries in Europe.

Jennifer Keen from the Institute of Alcohol Studies and Baroness Finlay, Chair of the Commission on Alcohol Harm, then presented to the group on the Commission on Alcohol Harm’s report, ‘It’s Everywhere’, published in September 2020. The report highlights the sheer inescapability of alcohol in society, impacting not only on the individual drinker but also families and communities. Jennifer outlined the recommendations in the report, which cover alcohol services and action on the price and availability of alcohol, among others.

Minutes from the meeting can be found here. We expect our next meeting to take place early in the new year and will keep you informed as to the date.

Liver news

Alcohol Awareness Week occurred last month between the 16th and 22nd November, with this year’s theme focusing on the link between alcohol and mental health. Alcohol Change UK reported that 4,000 organisations, places and communities took part in awareness raising activities, many of which were documented in this blog.

The Institute of Alcohol Studies has released a second briefing on alcohol and Covid-19 which warns of the hidden harm from alcohol and the need for the Government to pay further attention to the issue. The briefing highlights that whilst there has been a modest overall decline in sales receipts, this masks important differences between lower risk/non-drinkers and heavier drinkers, many of whom report drinking more.

Research commissioned by Alcohol Change UK found that almost one in three drinkers have been drinking at increasing or high-risk levels over the past six months. In addition, over half of drinkers (53%) said they have drunk alcohol to try to manage how they were feeling the past six months, with people from BAME backgrounds, young people and parents most affected.

Two teams working on hepatitis C were announced as regional winners for the Health Equalities Award at the NHS Parliamentary Awards, nominated by Steve Baker MP and Jeremy Hunt MP for the South East region, and Hilary Benn MP for the North East and Yorkshire region. The overall winners will be announced in July 2021.

The Alcohol Health Alliance UK has written a report calling for a minimum unit price for alcohol in England, the only country in the UK not to have one, and warns that current costs are at “pocket money prices”. It is worth noting that the Government’s Alcohol Duty Review closed at the end of last month. Any developments and publications will be featured in future APPG updates.

More than two-thirds of serving and ex-Service personnel who reported an alcohol problem have not sought help, according to a new report from University of Liverpool and King’s College London. The research shows that recognition of alcohol misuse problems and help-seeking for self-reported alcohol problems among serving and ex-Service personnel is particularly low.

Drink Wise Age Well has launched a new, national helpline for over-50s which runs seven days a week. This follows the publication of research that finds more than four million over-50s in the UK are binge drinking at least once a week during lockdown.

The Covid-19 guidance for commissioners and providers of services for people who use drugs and alcohol was updated in November. It specifically recommends testing all service users for hepatitis C and offering a variety of options for treatment delivery, as well as offering harm reduction advice and needle and syringe programmes.

A global systematic review published in The Lancet of hepatitis C prevalence and incidence in men who have sex with men found that those who are HIV-positive had a substantially increased risk of hepatitis C, compared to just a slightly elevated risk for those who are HIV-negative. Co-infection of HIV and hepatitis C is common and worsens health outcomes for both diseases: this World AIDS Day (1st December) the Scottish Government has announced its ambition to eliminate transmission of HIV by 2030.

Relevant parliamentary activity

Parliamentary debates

In a debate on obesity and Covid-19, Andrew Selous MP pressed the minister on when the Government plans to publish its consultation on the labelling of alcoholic drinks.  

Parliamentary questions

Munira Wilson MP asked whether the Government will introduce a new cross-government alcohol strategy which takes account of the effects of the Covid-19 outbreak and what steps are being taken to prevent an increase in harmful drinking during the pandemic. Public Health Minister Jo Churchill pointed to various existing resources and guidance in her response.

Alan Campbell MP asked, with reference to the September 2020 report by the Commission on Alcohol Harm, whether the Government plans to publish a new alcohol strategy. Jo Churchill’s response stated that the Government’s “wide-ranging approach negates the need for a separate stand-alone alcohol strategy”.

Navendu Mishra MP asked what assessment the Government has made of the effect of Covid-19 restrictions on levels of alcohol consumption. Jo Churchill referred to Public Health England findings that “intake across the population as a whole remained about the same during the pandemic. Those aged 18 to 34 were more likely to report consuming less alcohol each week than before and those aged 35 to 54 were more likely to report an increase. There was also an increase in the proportion of ‘high risk’ drinking from April to September”.