Elimination targets for hepatitis (2030) and sickle cell (2047) require more than screening. Discuss the challenges.

India aims to eliminate Hepatitis B and C as public health threats by 2030 and sickle cell anaemia as a public health problem by 2047 [1]. Screening has scaled impressively — about 225 million screened under the National Viral Hepatitis Control Programme and 7.29 crore under the Sickle Cell Mission [1] — but elimination is measured by treatment continuity and prevented new cases, not tests conducted.

Hepatitis: the linkage-to-care gap

• Screening exists at ~1.80 lakh facilities but treatment at only 1,039 centres [1] — a diagnosed villager must travel far to begin therapy, and many never do.
• Hepatitis B needs lifelong antivirals with periodic monitoring, so each centre carries a growing cumulative caseload, not one-time cases.
• Globally, only 13% of hepatitis B patients were diagnosed and 3% treated by end-2022, against a WHO target of treating 80% by 2030 [2]; India is among ten countries holding nearly two-thirds of the global burden [2].

Sickle cell: prevention, counselling, stigma

• Being inherited, elimination means stopping new affected births — requiring genetic counselling for the over 20 lakh carriers identified, against 2.5 lakh diagnosed patients [1]. Hospitals alone cannot shift this.
• Only 4.93 crore Sickle Cell Cards were issued against 7.29 crore screened [1], leaving results unconnected to follow-up care.
• Carrier status invites stigma in marriage and employment, making confidentiality and trained counsellors indispensable.

Cross-cutting: financing and outcome data

• Out-of-pocket spending has fallen to about 39.4% of health expenditure (2021-22), with the government share rising to ~48% [3] — genuine progress, yet assurance schemes like AB-PMJAY are built largely around hospitalisation, not years of outpatient drugs.
• Affordability is India's strength — it offers the world's lowest generic prices, tenofovir at about US$1.20 for 30 days [4] — which must now be matched by published outcome data.

Both missions have built the diagnostic base; the next phase must convert detection into sustained treatment, counselling and published outcome indicators. Strengthening referral chains, district-level counsellor cadres and outpatient drug coverage under the National Health Mission [1] would align these targets with SDG-3's promise of health for all.