A stark epidemiological reality is unfolding across Europe that most health-conscious adults may not appreciate: chronic viral hepatitis is now deadlier on the continent than HIV/AIDS and tuberculosis combined. With 29 million Europeans living with chronic HBV or HCV infection, the gap between available medical tools and real-world outcomes has become one of public health's most consequential failures — and understanding why matters for anyone tracking longevity threats at a population level.
This Lancet Regional Health Europe series paper systematically reviewed models of care implemented across the WHO European region between 2015 and 2025, synthesizing scientific literature and policy documents to evaluate what is actually working. Point-of-care testing, decentralized service delivery, harm-reduction programs, and prison-based interventions all demonstrated measurable gains in reaching high-risk populations. Childhood HBV vaccination programs and targeted adult vaccination strategies advanced elimination goals. Integrated, simplified treatment pathways — particularly for HCV, where highly effective direct-acting antivirals can achieve cure rates exceeding 95% — showed clear clinical benefit when deployed pragmatically. Yet despite these tools, overall hepatitis-related mortality has not declined, exposing a fundamental implementation gap.
The persistence of large undiagnosed populations represents the central paradox here: curative and preventive therapies exist, yet most infected individuals remain unaware of their status. The review highlights that healthcare worker knowledge gaps, regional disparities between Western and Eastern Europe, and structural inequities affecting migrants, people who inject drugs, and incarcerated populations collectively undermine elimination targets. From a longevity research perspective, this is a striking case study in how treatment efficacy does not automatically translate into population-level health gains without robust case-finding infrastructure. The WHO's 2030 elimination target now appears ambitious absent urgent acceleration in diagnosis rates, data system modernization, and equitable access reforms. This analysis functions as a roadmap for policymakers, but its implications for population healthspan — given hepatitis-driven cirrhosis and hepatocellular carcinoma — extend well beyond infectious disease management.