30 June 2026
The WHO 2026 Global Hepatitis Report confirms something many working in this space have been saying for years: we will not eliminate hepatitis without harm reduction. Despite the availability of curative hepatitis C treatment, the world remains off track to meet its 2030 elimination targets. The report points to a major reason why. People who inject drugs account for around 44% of new hepatitis C infections globally, yet the coverage of harm reduction services remains nowhere near where it needs to be.
In the report’s own words, “to accelerate progress towards the 2030 target, the highest priority is to ensure that non-medical injections and practices are safe. In particular, the coverage of harm reduction services among people who inject drugs needs improvement.”
The target is for just 2% of people who inject drugs to acquire hepatitis C each year. The latest estimate is 8.6%.
Needle and syringe programs are one of the most effective interventions we have for preventing hepatitis C transmission. Without access to sterile injecting equipment, eliminating hepatitis C among people who inject drugs simply isn’t possible.
Yet according to the report, globally, only 35 needles and syringes are distributed per person who injects drugs each year, against a target of 300.
Looking at that figure, it’s tempting to assume the goal is simply to get from 35 to 300.
Earlier this year, however, WHO released revised operational guidance on needle and syringe programs, clarifying that the 300-syringe target is a population-level average and should not be used as a program benchmark. Programs should be aiming to provide sterile equipment for every injection, meaning actual provision will often need to be much higher.
The guidance was informed, in part, by discussions at the INHSU 2024 Policy Day, where participants highlighted how fixed numerical targets can be misinterpreted and, in some cases, restrict access rather than improve it. One of the resulting changes was explicit clarification in the new WHO NSP Operational Guide that the 300-syringe benchmark is a global coverage target, not a program target.
Read alongside the new guidance, the findings in the Global Hepatitis Report become even more concerning. Not only are we falling well short of the global target, but the target itself was never intended to define adequate access in the first place.
We spend a lot of time talking about the hepatitis C cure, yet the biggest barrier to elimination isn’t the absence of effective treatment. It’s the continued failure to provide harm reduction at the scale required.
And the data in this report make that very difficult to ignore.
