World Hepatitis Day

The 28th of July is World Hepatitis Day. Joining me in the studio is Dr Peta Gardam, a sexual health specialist, to talk about practical next steps you can take toward preventing and managing viral hepatitis B and C. 

If you have any questions about hepatitis or need support, call HepLink: 1800 437 222. 

Transcript

SPEAKER_00 0:02

You're listening to Positive Futures. In the community health and social services sector, we are often faced with complex challenges, but there is a lot to be optimistic about. Throughout this series, I'll be chatting with the people who work in this space to talk to them about the challenges they face and to find those moments that remind them why it matters. Yeah, what are you studying?

SPEAKER_01 0:30

I have my fellowship exam, like my final like to become a sexual health fellow in two weeks.

SPEAKER_00 0:37

Thanks for fitting this in. You're welcome.

SPEAKER_01 0:39

You're lucky, I love you. That's so hey dick. Alright, let's not talk about that in straight away.

SPEAKER_00 0:50

And I'm joined once again by Dr. Peter Gardam. Peter, how are you today?

SPEAKER_01 0:55

I'm good. How are you?

SPEAKER_00 0:56

Very well. Thanks so much for coming back on the show. As you all probably remember, Peter's was the best episode from last year for the World AIDS Day series. And so Peter's kindly joined me again, even though she's got exams coming up. She's taken time out today to talk about hepatitis as World Hepatitis Day is coming up. For those listening, the theme for World Hepatitis Day this year is take the next step. So I wanted Peter to come in as a clinical frontline worker to talk about some of the appropriate steps you can take towards managing hepatitis. But we're going to start at the very beginning, if this works for you, Peter, to actually tell people listening what hepatitis is and whether I'm even using the right terminology just saying hepatitis like that.

SPEAKER_01 1:32

Yeah, great. I think it's really important because it often gets confused, and if we take it back to basics, the term hepatitis by definition means liver inflammation. So if we think about inflammation, you know, there could be so many causes of that in various body parts. And so there's multiple types of hepatitis. So alcohol use can contribute to something called alcoholic hepatitis. And so what we're referring to today we would call viral hepatitis, so caused by various viruses, which people may or may not have heard of, but generally we talk about there's five different strains of viral hepatitis we tend to talk about hepatitis A, B, C, D, and E.

SPEAKER_00 2:12

Very easy. Then the ABC of hepatitis.

SPEAKER_01 2:14

Yeah, pretty much.

SPEAKER_00 2:15

And a few extra. Yeah. Well, that's thank you for that. That's that's good clarification, and I should point out that's why we talk about viral hepatitis here at my work, the hepatitis council. And maybe we should change the name to the viral hepatitis council. Today I think we want to focus on the two major strains, hepatitis C and B, mostly because that's the area we work in. And is that true for you as well?

SPEAKER_01 2:36

Yeah, for the majority. I must admit, at our service, because we uh look after a lot of men who have sex with men, the risk of hepatitis A is higher. So I mean, very briefly, hepatitis A and E, we don't talk about a lot. A, uh sorry, E is quite rare in Australia. We do see A, but they're transmitted via something we call the fecal oral route. So it can be via water or for people that have anal sex, for example. So we do see some hepatitis A, but there's a really great vaccination for it. And it's a self-limiting problem, so people will get a little bit unwell and it tends to resolve. Otherwise, we primarily see hepatitis B and hepatitis C.

SPEAKER_00 3:16

And cases of D, I imagine, given that it's relationship to B.

SPEAKER_01 3:20

Exactly. So hepatitis D is this a funny kind of virus that can only exist if someone has hepatitis B. And I must admit, I've never seen a case of hepatitis D, and I don't know if we have anyone in our service that has hepatitis D. It's exceedingly rare, particularly in Australia. Yeah, yeah.

SPEAKER_00 3:38

So it's more for maybe international visitors or migrants to the country from those higher prevalence areas that we need to worry about. Yeah. Which is an increasing problem, I imagine, with not migration.

SPEAKER_01 3:48

Absolutely, and I think that's one of the probably the main points around hepatitis B today is talking about migration.

SPEAKER_00 3:55

Yeah, yeah. Well, seeing as we're doing the ABC of hepatitis, and but actually not, B and C, let's do it in alphabetical order, maybe. So let's talk about hepatitis B. So for those people not uh who maybe are not aware of it, now they sort of know that it's inflammation of the liver, that it's a viral infection, just very briefly. We don't need to go into heaps of clinical detail, you can call us or find out that information online or go and visit Peter at Clinic 60. What is hepatitis B?

SPEAKER_01 4:20

So hepatitis B is a viral hepatitis that can affect various people in various ways. So most people can be symptom-free. A lot of people live with no symptoms and may not even know that they have hepatitis B. And the biggest message we put out is that hepatitis B is preventable and manageable. So the key with hepatitis B is knowing if you're immune via vaccination or knowing if you have hepatitis B, so your status. Because the way that hepatitis B is transmitted, so sexually acquired, is reasonably common in Australia for something that's not common. However, worldwide, the biggest transmission is mother to child. So a mother that has hepatitis B gives birth to a child, that person becomes an adult, have never been tested because it might not happen in their country and have it and are completely unaware.

SPEAKER_00 5:15

Yep, or they might not have symptoms, like you just said, and so they might not even think about testing for it.

SPEAKER_01 5:19

Exactly. And for those people, there's hepatitis B is quite complex in that there's four kinds of stages people can fluctuate between. But there are times when people need treatment. Yep. And you know, one of those can be pregnancy. So if um someone born female is pregnant and has HEP B and they don't know, we obviously don't want them to transmit it to their child, we want them to stay well, and so it's really raising awareness that HEP B is something that happens.

SPEAKER_02 5:49

Yep.

SPEAKER_01 5:49

A lot of people feel fine, but when they they aren't fine, it can be quite bad. There's risk of liver cancer, cirrhosis, which is like the hardening of the liver, and death.

SPEAKER_00 6:00

Because I think HEP B is one of the leading causes of liver cancer in Australia at the moment.

SPEAKER_01 6:04

Absolutely. Yeah.

SPEAKER_00 6:05

And so in that case of vertical transmission or mother-to-child transmission, are we doing, at least in Australia, let's keep it to the Australian context, are there tests that happen during the birth cycle, you know, once you sort of go in for t your routine tests and things like that? Or is it a questionnaire that people get asked, or what's happening in the street?

SPEAKER_01 6:21

So hepatitis B vertical transmission, as you said, would be super uncommon in Australia. We just don't see it. So I actually would have to, I'd have to review with our obstetrics colleagues. I don't believe hepatitis B is part of screening from mothers.

SPEAKER_00 6:40

I'll update everyone listening on the uh on the liner notes about that one.

SPEAKER_01 6:43

We know for sure that babies are vaccinated. So this is one of the vaccinations that baby r babies receive at birth. So within hours of birth, babies receive hepatitis B and then they get it as part of their uh childhood immunisation, so usually at two, four, and six months. So the majority of people in Australia are born after I think 2000, is it? Yeah, I was gonna say 96 to 2000, as long as they've been they've had their childhood vaccinations, should be immune.

SPEAKER_00 7:12

On that vaccination question, what's the step for someone to, let's say they're not even at risk or haven't had an episode where there might be a risk of transmission, but they're just thinking about it, maybe as a result of listening to this podcast? What's the next step for them to take? Should they, can you go get a test to check your vaccination levels if you can't remember that you've been vaccinated as a child? Or do you go and get a HEP B test and that does that show up that you've got immunity via vaccine?

SPEAKER_01 7:34

Yeah, so basically all of these are an option.

SPEAKER_00 7:36

Right, okay.

SPEAKER_01 7:37

Um so essentially most people, it's a bit trickier for those that are older, but most people should be able to access their vaccination records. So via Medicare, via the app, the councils for people that are a little bit older as well. And on that you'll be able to tell if you've had hepatitis B vaccination and the appropriate course. If you're seeing your GP or sexual health, we can access your immunisation record fairly easy, often through our computer program, and we can say, look, yep, we can see you've had an appropriate course. And for the majority of people, if we know that they've had the immunisation, we know they're immune. And we don't we don't often tend to check it.

SPEAKER_00 8:14

That immunity lasts for life.

SPEAKER_01 8:16

Yeah, it does, it lasts for life, uh lasts for life. So the exception to that is people living with HIV because of the the issues that come up with co-infection, we tend to check their immunity because numbers can wane on blood tests. We just know that once people have been immune, they stay immune. But for HIV, people need to have the that immunity boosted if they lose it on their blood tests. Yeah.

SPEAKER_00 8:40

Thinking about those people, so maybe they're sitting in that sort of range where maybe they've had a test, they know they have HEP B. I'm just thinking about what you were talking about with vaccines and testing and monitoring. Someone living with hepatitis B, you know, they've already got it, so the vaccine's obviously not going to do anything and things like that. Is monitoring then the next level? Because I'm just thinking about that asymptomatic nature. You said there's maybe no signs or symptoms, and maybe the damage like liver psoriasis or cancer comes later. What do you we recommend? Like what should somebody do? Let's say they do know that they maybe have HEP B and they're living with it, but maybe a bit younger or something, and they haven't had any symptoms, or maybe they've recently tested as a result of finding out about this. What's sort of how do you manage it? What do you do with it?

SPEAKER_01 9:22

To answer that simply, it's very complex. And I think it's probably too much to go into. I mean, the very basics are people knowing their status because of the sexual transmission risk. So that's a big one that we see people that might have some virus, they don't need to be treated, but they're still at risk of transmitting to others, so that's the big thing. But then it comes down to what stage they are in their disease, whether their liver is, you know, upset and inflamed, how much virus they have in their blood, their nationality, depending on. So we know sub-Saharan African people need screening for liver cancer from the age of 20.

SPEAKER_02 10:02

Yeah, right.

SPEAKER_01 10:02

Whereas Asian women from the age of 50. So there are different demographics that are more at risk. Yes. It's very nuanced. Yeah, okay.

SPEAKER_00 10:10

Very complex is the answer. Uh you can find out more in various sources. We'll we'll put some links up for more information at the end. It does remind me of the difference as well, which I think is interesting to note for people listening, between or the risk factors for adults and children. Because I think it's quite radical, isn't it? Like, isn't is this true? This figure sound correct that it's about 95% of adults don't acquire HEP B even after an exposure event, even if they're not vaccinated?

SPEAKER_01 10:38

Yeah, I'm wondering if the statistic you're referring to is the development of chronic hepatitis B versus acute hepatitis.

SPEAKER_00 10:46

Yes, that's my confusion, yes.

SPEAKER_01 10:47

So people can get acute hepatitis B and become unwell, but then the body kind of gets on top of it. Yep. So if a child under the age of five has hepatitis, so through vertical transmission, or they've obtained it somehow, they have a 95% likelihood of it becoming chronic. Chronic.

SPEAKER_00 11:04

That's that's where I was convinced.

SPEAKER_01 11:06

Yeah, so if an adult gets hepatitis B, it's the other way. So it's much more likely to be acute and that they'll get through it as opposed to becoming a chronic illness. Yeah.

SPEAKER_00 11:16

Is this a logical extrapolation or maybe incorrect with this? Because you know, part of this podcast is to raise awareness around hepatitis uh B and C and the other causes, uh types. Should we be doing lots of work uh for children, you know, and and obviously prevention in the vaccine, or is it still I mean, I know you said it's quite rare in Australia and you know maybe it's more of a high prevalence area issue. And is this more of a childhood campaign? Do we just need to keep up childhood vaccinations in the in this country and things like that?

SPEAKER_01 11:41

Just given those statistics of Yeah, I think it's a bit of both. I think our vaccination routine is great. We have really good statistics. I think targeting, you know, younger people or older people who know that their parents didn't support vaccination and perhaps they think vaccination is important for them. That's a good point. Hepatitis B is one that I would definitely recommend if they're open to chatting to their doctor about it. Again, sexual transmission because you know we have a a really diverse community, particularly here in Tasmania, and if people are from overseas and they don't know. So knowing your status about immunisation, knowing that it's still a risk even though it's low.

SPEAKER_02 12:20

Yep.

SPEAKER_01 12:21

And then, yeah, for those migrant populations that you know we look after that don't have Medicare, that might not have other ways to get their monitoring done, we're we will always check those kind of things so we can support them if they're not sure.

SPEAKER_00 12:33

Yeah, amazing. And so I think that's sort of that's a really nice takeaways for that for that hepatitis B segment is that know your status, like you said. And the testing is quite simple and straightforward. I mean, it might not be on the clinical uh side of things, but for a person going in, right, it's it's a fairly standard procedure.

SPEAKER_01 12:49

If people are referring to checking hepatitis B immunity, it's on the same bit of blood we check for HIV and syphilis. It's no extra.

SPEAKER_00 12:56

So you can just so bundle it in if you are going for any of those tests aforementioned. And the vaccine, I mean it's it's it's effective, it's safe, you know, it's being rolled out, it's been been around, it's good. Go and get it if you need it. Well, that's brilliant. Thank you so much for that overview on hepatitis B. Let's move down the alphabet to see. And actually, I should mention before we move on, if you do need a HEP B test or you know you want to do a vaccine check, what what are the places to go? Obviously, you can go see yourself at Clinic 60, GPs.

SPEAKER_01 13:26

Yep. As I said, accessing your own records if you want to see if you've had it. They often go by brand name, so you might need to do a bit of Googling to see if it had a hepatitis B in it if you're unsure.

SPEAKER_00 13:36

Yeah. If let's say you try and look up your vaccine history and maybe it's hasn't been up on My Health or kept in some record that you can access, does that mean you can't find it, or would that involve getting a vaccine test, like an antibody test or whatever it is?

SPEAKER_01 13:52

Yeah, so I mean it's very possible that it wasn't uploaded because given record keeping since exactly and it's much yeah, much different now. Um so then that's where the blood test may come in handy because you can check if it says you've got immunity, we know you've got immunity. And I mean this is very detailed, but we expect that even if that immunity wears off, like I was saying before, on the blood test, the idea and the thought is that you're still immune for life, regardless. Um if you've had the blood test, if we were to see someone they were unsure about whether they've had a hepatitis B vaccination, we did their bloods and they weren't immune, what we would usually offer is either a one-off vaccination and then check their response to that a month later, or offer them the three-course, the full three-course dose.

SPEAKER_00 14:38

Because the standard is a three-course dose, yes.

SPEAKER_01 14:40

Yes, absolutely. Yeah, over six months it takes. Yes.

SPEAKER_00 14:42

So, yeah, let's talk a little bit about HEP C or viral hepatitis C because it's slightly different, well, vastly different on one hand, because there's a cure.

SPEAKER_01 14:51

Exactly, which is super exciting.

SPEAKER_00 14:53

So exciting. And there's even a better cure than there was um pre prior to 2016, which we'll get to. So I guess let's start at the very beginning again, because it's a great summary. What's hepatitis C?

SPEAKER_01 15:04

So again, a viral hepatitis that people are at risk of progression if they're unaware. A lot of people are asymptomatic and just don't know that they have it, and it's easy to check and it's easy to treat. So my main messages were HEP B is preventable, hep C is treatable, which is really exciting. The thing about HEP C is we have a much more significant issue in Australia with hepatitis C, and it affects our population of people who inject drugs. So that is the primary transfer risk of hep C is shared injecting equipment. And often, not always, but often these people are already in a very vulnerable position without support, and half the time even knowing that they can access treatment is a real challenge.

SPEAKER_00 15:49

Or being able to get there or access the services and also uh incarceration.

SPEAKER_01 15:53

I was just gonna say, yeah, also incarceration. So there's often a lot stacked against them.

SPEAKER_00 15:58

Yeah.

SPEAKER_01 15:58

Yeah. It is also sexually transmitted, but far, far less likely.

SPEAKER_00 16:02

Yeah, I definitely have fielded a few questions in my time in this job about that, and we don't say it doesn't happen. You know, it's not possible, but those that the main transmission pathways are injecting drug use, as you said, at least in Australia.

SPEAKER_01 16:13

Yeah. And I think the, you know, I'm talking about this in, you know, this current population that, you know, might have more challenges. But when I was working as a GP before I moved into sexual health, I recall having older patients that I'd known for a long time, and as I was learning more about hepatitis, started asking more questions about their past history. And I found positive hepatitis C testing in a variety of patients that injected a few times when they were in their 20s years ago in the 60s. Had no idea. And then they could get treatment.

SPEAKER_00 16:48

Well, I think, yeah, this is the interesting thing about I mean hep B similarly like we discussed, but particularly for hep C, given that well, the asymptomatic nature, so the fact that there can often be no signs or uh indications that you have it. And then because of the sort of timeline, is this correct, its impact on the liver can take a while. It makes sense that you're seeing the older people now maybe, like you said, had one exposure, you know, whether it was injecting drug use or drugs at a party or well, blood transfusions prior to 1990, I think. Yes, yeah. Which weren't screened and then overseas, maybe medical procedures in sort of higher risk areas.

SPEAKER_01 17:22

Yeah.

SPEAKER_00 17:23

So it's interesting that you're seeing, or maybe not interesting, maybe it makes sense that we're seeing some older patients now suddenly coming out of the woodwork if you were.

SPEAKER_01 17:29

Yeah, and I mean they weren't even unwell.

unknown 17:32

Yeah.

SPEAKER_01 17:32

I just had been learning more about it and thought I should start asking. And so that's where, you know, I'm saying this population is most at risk. But really, when it comes down to it, we can all be at risk. Yeah. And we, you know, anything is Yeah.

SPEAKER_00 17:45

I mean tattoos is another tattoos and piercing is another higher risk category. I wouldn't say it's up there with those other two first versions.

SPEAKER_01 17:51

But the ones you suggested, so if someone wants to have a tattoo overseas or they, you know, and did end up having a medical procedure as an emergency or whatever it might be, or you know, you're listening and you did inject drugs 50 years ago, maybe not that long ago. But you know 30 years ago. It's so easy to get a test and treat.

SPEAKER_00 18:12

Yep, yep. And I think it's a nice reminder, I mean, not about nice, but a good reminder that like sort of to destigmatize the space, I mean, it can just, you know, you could have had, yeah, one case of injecting drug use or got a tattoo, which you think isn't, you know, totally normal behaviour. So it's not, you know, it's not a drug using disease, it's not an imprisoned, you know, virus, sorry, not disease. And I think, is this correct as well, though, is they're often re-infections in those circles.

SPEAKER_01 18:38

Yeah, they can be. And I think just that the nature of the risk-taking behaviour, often through no fault of their own, with shared equipment, that's really the key. So, you know, they may not have a way to access clean equipment, they may not understand, so their health literacy might not be good enough to understand clean equipment. But that's one of the big spaces we've been working really hard in. So, like I believe you guys are a needle and syringe program here.

SPEAKER_00 19:02

Yeah, so which is the first episode of this season's of uh Positive Future. So go and have a listen and then come back in.

SPEAKER_01 19:09

Yeah, so having just access to that that's non-judgmental, we would much rather, you know, practice harm minimization.

SPEAKER_02 19:16

Yep.

SPEAKER_01 19:16

There is no judgment. We would rather if you want to inject, that is absolutely up to you, but please have some clean equipment. Yeah, and do it safely. Yeah.

SPEAKER_00 19:24

So we've you know been glossing around the uh I wouldn't say the elephant in the room, but the great ray of sunshine in the room that is the cure.

SPEAKER_01 19:31

Yeah.

SPEAKER_00 19:31

So we won't go into too much history, but since 2016 there has been I mean, it's not new now, but you know, it's only the last ten years. Um, but the newest version or latest version of the cure. There are two drugs, I think, names out there.

SPEAKER_01 19:44

Yeah. So people may hear of Epcluza or Maverick.

SPEAKER_00 19:48

Yep. And they are the new hepatitis C cure, they're direct-acting antivirals? Correct. Awesome. Um and how don't tell me how they work, that's that's not what I mean.

SPEAKER_01 19:57

But um, you'll be testing me there.

SPEAKER_00 19:59

Yeah, that's right. Super effective, safe, easy to do. What's the you know, what's the scoop?

SPEAKER_01 20:03

So they are, they're just amazing. They're very easy. I I don't know the stats off the top of my head, but it would be high 90% effective.

SPEAKER_00 20:12

I think it's I think we say above 95% effective.

SPEAKER_01 20:14

Yeah, if it's taken how it's meant to be, it's very, very effective. And so if people have, you know, listening have had hepatitis C before and perhaps had older treatments, often they're quite traumatized. Yes. Because things like pegulated interferon was pretty nasty. Yeah. And I think an important point to make along that is having had treatment before doesn't stop you from having treatment again. Very good point. Ongoing injecting will not stop us treating you. So it's important to realise that you can get reinfected, you aren't immune once you've had it. But the treatments are absolutely nothing like they used to be. They're nothing like they were even five years ago. There used to be really big restrictions on what you could have based on your genotype, and like there was all this extra testing, but now it's if you have Pep C, we do a couple of tests, so checking that cirrhosis of your liver, so how hardened it might be, having a look at you know, your liver function um via a blood test, so how well your liver is actually functioning, how it's producing a few different bloods, and then giving you tablets, and then checking you 12 weeks later and it's gone.

SPEAKER_00 21:20

Yeah, amazing. Yeah, yeah, it really is that easy, isn't it? I did have a couple of questions for you, which you know we have answered along the way, and you know, I like keeping these uh episodes free form anyway, so we can just cruise along. Uh the theme, as I said earlier in the episode for this year's world hepatitis sort of day, uh a reminder, you know, and a good time to think about uh things uh to do with hepatitis, viral hepatitis is take the next step. So I guess you've already answered this, but just to reiterate for people listening, the sort of the next steps for well, both viral hepatitis B and C is simply to know your status. So whether that's through checking your vaccine status or getting a test. And then what the next steps would Maybe be conversations, would you say? Like, you know, destigmatizing, like talking to people, making it like you said, I think normalizing it because tattoos, you know, piercings, one drug use a million years ago, like you said, you know, I mean, especially both, even though hepsi is lower risk of STI transmission or I mean sexual activity. I don't think people think about that when they go into a new relationship or walk up, are they?

SPEAKER_01 22:23

No.

SPEAKER_00 22:24

So these are just good reminders that, you know.

SPEAKER_01 22:26

And I think the conversations are how things move. I think it's up to all of us to have conversations and talk about what's out there or what we may have seen. So one of the things that is happening at the moment is the it's your right campaign.

SPEAKER_02 22:40

Yep.

SPEAKER_01 22:40

And so we talked about the needle and syringe program. So if you're there, you know, getting clean equipment, often we'll have we have amazing outreach nurses that will go to these venues and at the moment there's financial and to have your testing done. They you know they've got vouchers they can give you because they want to support you as best they can. And I find word of mouth for that is significant.

SPEAKER_00 23:02

Is it? Yeah. Yeah.

SPEAKER_01 23:03

So people telling other people, you know, if they're they've got a network, you know, if you're going to get clean equipment or whatever you might be doing, there's a nurse there, they want to help us if we've got Hep C.

SPEAKER_00 23:13

So that's a good on-the-ground initiative happening. Yeah. That's right now, it's current, isn't it?

SPEAKER_01 23:17

Yeah, it's still happening. It's heading towards the end. But um, our outreach team for Hepsi run various programs all throughout the year, uh often at various places looking to connect with people and support them.

SPEAKER_00 23:30

Yep. And so if you do want to find any of those clinic dates, they are actually on our website, luckily. So there's a tab at the top of the website or finding walk-in clinics, so you can do that across the north and south of the state. Testing as a measure of prevention in terms of not preventing the virus itself, but further liver damage or cancer or something, liver cancer.

SPEAKER_01 23:47

Yeah.

SPEAKER_00 23:48

Is probably a really big thing, eh?

SPEAKER_01 23:50

Absolutely. And I think the the thing it comes down to is diseases don't discriminate.

SPEAKER_00 23:54

Yeah. Right. Yep. Yep. I think that was your tagline last time, and it's slowly through and so accurate. It was great. Or at least maybe it was HIV doesn't screw up. But it's such an important point. We would love to normalize in this space. They are just illnesses, doesn't really matter, and they don't care who you are or what you do or where you're from. They're just, they're either there or they're not, you know. Exactly. And there's there's ways to prevent, treat, and manage, I think. These are the important takeaways. Well, we are running out of time as usual because the conversation's so good. In keeping with the theme, I would like to ask you one final question, which is, I guess, what you're hoping for or excited for or positive about.

SPEAKER_01 24:26

Yeah, I think just the continued movement when it comes to hepatitis, particularly hepatitis C. It's phenomenal. I started work as a GP in 2016 and just thinking about that last 10 years of the space that we've been in and how great it has been, and just really supporting access and availability of care to everyone and recognising that yeah, it doesn't matter who you are, what you've done, what you do, if you need treatment more than once, we just want people to be treated. So just seeing everyone know their status and get access to treatment.

SPEAKER_00 25:07

Yeah. Because this is all working towards, I should have said this much earlier, but you've just reminded me, virtual elimination of both these viruses. And so we do that through prevention. We do that through vaccinations, through getting treated and not getting uh, you know, re reinfected with the virus.

SPEAKER_01 25:22

Um I think that's my long, long-term goal would be to see HEP B eliminated because the vaccine is so excellent. Yeah, you know, the same way we got rid of smallpox in various places. HEP B, hepatitis B could be eliminated. It's gonna be a real challenge because of you know various other places around the world, but that would be really nice to see in my lifetime.

SPEAKER_00 25:44

Yeah, and possible, right? You know, like you're saying, it it's not that's not an unfeasible goal to have even in the next sort of 10 years or something like that in this space, in this in in Australia at least, where we do have all these protocols. Brilliant. Thank you so much for coming on another episode. Peter might have to become our you know, Todd Sampson and uh Russell of uh of the Gruen or something and just continuously come on the show because she's so excellent. Thank you so much, and good luck with your exams.

SPEAKER_01 26:09

Thank you.

SPEAKER_00 26:09

And we'll talk to you soon. Great, thanks. Thanks, Peter. You've been listening to Positive Futures, a Red Thread media production. You can find past episodes on Apple and Spotify podcasts. And if you'd like to be on the show, head to redthread.org.au to apply.