General Questions
Where do the funds for Polaris Observatory come from?
Polaris Observatory was created by grants from the John C. Martin Foundation.

Updates of the Polaris Observatory are made possible by the generous grants from the following organizations:

If you find our data valuable, please consider a donation to support our work.
Why use Polaris Observatory data?
The Polaris Observatory has been in operation since 2015 collecting and analyzing national data. The Center for Disease Analysis have been doing the same since 2012. We have reviewed our analyses with national experts in over 80 countries/
Who is funding the operation of Polaris Observatory?
The Polaris Observatory was created through grants by the John C. Martin foundation. The operation of the Polaris Observatory in 2021 is supported by the John C. Martin Foundation, the ZeShan Foundation, the EndHep2030 Hepatitis Fund, Gilead Sciences and AbbVie. The funders do not influence the data or analyses presented here.
Why is the data presented here different than my national data?
Many national reports present data without taking into account the impact of new infections, mortality, treatment, and vaccination (HBV) since the data was collected. We update every model annually to make sure that each country’s/
Why is your data different than those reported by the World Health Organization (WHO) or Global Burden of Disease (GBD)?
Updating the Polaris Observatory takes a dedicated team that works on modeling only hepatitis B and C every single day. We spend months reviewing our dataset and questioning its validity. We also spend hours discussing our inputs with national experts in each country/
We develop bottoms-up estimates by collecting data from each country/
WHO works with external partners as well as WHO country/
Where is the cascade of care data for my country/territory?
The Polaris Observatory stopped reporting cascade of care data for individual countries/
Will Polaris data change over time?
Yes. We update every national model and regional models once a year taking into account the latest available data and impact of time. When referencing our data, please use the following format to indicate what dataset was used: CDA Foundation’s Polaris Observatory; INSERT YEAR [updated INSERT UPDATE DATE SHOWN ON THE BOTTOM OF THE PAGE]. Available from https://cdafound.org/
Why are some numbers in the cascade of care reported at the end of the year while others are reported at the start of the year?
Imagine you are in Egypt and you have treated and cured 500,000 HCV patients in a given year. How would you report your numbers? The Polaris Observatory reports HCV prevalence at the start of the year (January 1) and diagnosed, treated and mortality at the end of the year (December 31). Thus, HCV prevalence is not dependent on the total diagnosed, treated and deaths in the same year. This approach has minimal impact on HBV prevalence since it is only dependent on mortality (HBV treatment is not curative).
Can I use the data presented here in my presentation / report?
Yes. However, we ask that you reference the data. A recommended format follows: CDA Foundation’s Polaris Observatory; INSERT YEAR [updated INSERT UPDATE DATE SHOWN ON THE BOTTOM OF THE PAGE]. Available from https://cdafound.org/
How do I reference the data presented here?
We recommend the following format: CDA Foundation’sPolaris Observatory; INSERT YEAR [updated INSERT UPDATE DATE SHOWN ON THE BOTTOM OF THE PAGE]. Available from https://cdafound.org/
How can I copy the figures for my presentation?
There are two types of charts used on this website. If you see three parallel lines on the upper right corner of the graph, you can click on it and it will allow you to save the graph locally.

For the other figures, we recommend making a screenshot and saving it locally to insert in a presentation.

Can I use the data on Polaris Observatory on my website?
No. You can provide a link to the Polaris Observatory from your website. Exceptions are made for national governments and Ministry of Health websites. Please contact us at info@cdafound.org.
HCV & HBV epidemiology data explained
Population and adult population source
Division UNDoEaSAP. World population prospects: The 2019 revision New York: United Nations; 2019 [updated 2019 Online version updates various data. Available from: https://population.un.org/

World Bank classification source
World Bank Country and lending Groups, The 2020 revision. Available from: https://datahelpdesk.worldbank.org/

HCV Diagnosed
This number represents the percent of cumulative viremic infections already diagnosed by the end of 2022. When data was available, annual registry data was collected, and adjusted for mortality, treatment and SVR. When data was not available, the diagnosis rate was extrapolated from regional data. For more details, please see the appendix associated with: Blach S, Zeuzem S, Manns M, Altraif I, Duberg A-S, Muljono DH, et al. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. The Lancet Gastroenterology & Hepatology. 2017;2(3):161-76.

HCV Treated
This number represents the percent of total viremic infections treated from January 1, 2016 to December 31, 2016. When data was available, annual treatment rate was collected for public and private markets. When data was not available, the treatment rate was extrapolated from regional data. For more details, please see the appendix associated with: Blach S, Zeuzem S, Manns M, Altraif I, Duberg A-S, Muljono DH, et al. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. The Lancet Gastroenterology & Hepatology. 2017;2(3):161-76.

HCV Annual Deaths and Deaths per Period
This number is an output of the CDAF’s Bright HCV Model. It takes into account the number of liver related deaths due to cirrhosis, hepatocellular carcinoma and liver transplantation associated with HCV by the end of 2016. This number excludes all-cause mortality due to other causes. For more details, please see the appendix associated with: Blach S, Zeuzem S, Manns M, Altraif I, Duberg A-S, Muljono DH, et al. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. The Lancet Gastroenterology & Hepatology. 2017;2(3):161-76.

HBV Infections (2022)
The total number of HBsAg+ infections, and HBsAg prevalence at the end of 2022. If the country/

HBV Diagnosed
This number represents the percent of cumulative HBsAg+ infections already diagnosed by the end of 2022. When data was available, annual registry data was collected, and adjusted for mortality. When data was not available, the diagnosis rate was extrapolated from regional data. For more details, please see the appendix associated with: Polaris Observatory Collaborators. Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling study. Lancet Gastroenterol Hepatol. 2023 Jul 27:S2468-1253(23)00197-8. doi: 10.1016/

HBV Treated
This number represents the percent of total number of HBsAg+ cases treated by the end of 2022. The PRoGReSs model takes into consideration treatment discontinuation and treatment start, each year, the corresponding impact on disease progression. When data was available, annual treatment rate was collected for public and private markets. When data was not available, the treatment rate was extrapolated from regional data. For more details, please see the article and appendix associated with: Polaris Observatory Collaborators. Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling study. Lancet Gastroenterol Hepatol. 2023 Jul 27:S2468-1253(23)00197-8. doi: 10.1016/

HBV Prophylaxis
WHO data was the starting point for HBV birth dose and three dose vaccination rates (WHO. WHO-UNICEF estimates of HepB_BD coverage. 12-Oct-2020 https://apps.who.int/

Year of achieving elimination targets graphs explained
CDA Bright (HCV) and PRoGReSs (HBV) models were used to forecast the year in which each country/
Each graph is scaled from achieving the goals from year 2015 to 2055. The yellow line shown in 2030 indicates the WHO goal year. The year each country/

HCV Diagnosed
In the Bright model, it is assumed that number of screened patients remains constant after the last year of available data. This translates to a decrease in the number of newly diagnosed cases as diagnosis rate increase over time.
HCV Treated
In the Bright model, we assume a 50% drop in the annual number of treated patients over five years from peak treatment, unless better data was available to inform a more accurate forecast. Historical data has shown that it is very difficult to keep the annual number of treated patients constant and it eventually drops in every country/
HCV Mortality
This is a calculated file that calculates the year in which liver related deaths drops by 65% or more as compared to liver related deaths in 2015. In countries/
HCV Incidence
In the static version of the Bright model, the change in incidence is tied to prevalence in the population with no fibrosis (F0). If there are treatment restrictions in the country/
We do have a dynamic version of the Bright model and it has been used in 13 countries/
HBV Diagnosed
In the PRoGReSs model, we assume that the number of newly diagnosed cases remains constant after the last year of available data.
HBV Treated
In the PRoGReSs model, we assume that the total number of treated HBV patients per year is constant after the last year of available data.
HBV Mortality
This is a calculated file that calculates the year in which liver related deaths drops by 65% or more as compared to liver related deaths in 2015.
HBV Prevalence Among 5-Year-Olds
The PRoGReSs model is fully dynamic and calculates both horizontal and vertical transmission. The prevalence of HBsAg among five year olds is calculated by the model using the incidence of HBV and clearance rate in infants to five years old. This measure is highly dependent on the HBV vaccination rates and the duration of vaccination, which can result in a lower HBV prevalence among women of child bearding age. For a more detailed description of the model, see Polaris Observatory Collaborators. Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling study. Lancet Gastroenterol Hepatol. 2023 Jul 27:S2468-1253(23)00197-8. doi: 10.1016/
Progress towards elimination targets graphs explained
HCV progress toward elimination targets graph
The grey bars represent WHO 2030 elimination targets – 90% of total HCV infections diagnoses, 80% of eligible population treated, 100% of the population has access to safe blood, 100% of injections are safe and 300 sterile syringes & needles are distributed for every person who injects drugs (PWID) (source: Global Hepatitis Report 2017. Geneva: World Health Organization; 2017).
For simplicity, the number of sterile syringes & needles per PWID was put on a scale of 0-100% with 100% indicating 300 distributed per year per PWID. The bars in the front represent how the country/

HCV Diagnosed Cumulative
Cumulative number of patients diagnosed previous to December 31, (year indicated in the title) divided by 2015 prevalence. This WHO target does not take into account new infections after 2015 since it relies on 2015 prevalence. Thus, total diagnosed can be 100% if a country/
HCV Treated Cumulative
Cumulative number of patients treated between January 1, 2015 and December 31, (year indicated in the title) divided by 90% of 2015 prevalence (90% of all infections are diagnosed and eligible for treatment). This measure excludes mortality among those who were treated from 2015 forward.
Blood Safety
This data came from the following sources: Global status report on blood safety and availability 2016. Geneva: World Health Organization; 2017. Current Status on Blood Safety and Availability in the WHO African Region — Report of the 2013 Survey. Geneva: World Health Organization; 2017. Pan American Health Organization (PAHO). Supply of blood for transfusion in Latin American and Caribbean countries, 2014 and 2015. Washington, D.C.: 2017. [Azerbaijan: Iranian Blood Transfusion Organization Department of International Affairs . ECO Blood Safety Network. October 2013. http://www.ecobsn.com/] When data for the latest year of analysis was not available, rate in the last year of available data was kept constant.
Injection Safety
This data came from the following source: ICF, 2015. The DHS Program STATcompiler. Funded by USAID. http://www.statcompiler.com. November 13 2019. Pepin J, Abou Chakra CN, Pepin E, Nault V, Valiquette L. Evolution of the global burden of viral infections from unsafe medical injections, 2000-2010. PLoS One. 2014;9(6):e99677. Epub 2014/
Syringes / PWID
This data came from the following source: Larney S, Peacock A, Leung J, et al. Global, regional, and country-level coverage of interventions to prevent and manage HIV and hepatitis C among people who inject drugs: a systematic review. Lancet Glob Health 2017; published online Oct 23. http://dx.doi.org/
HBV progress toward eliminating target graph
The grey bars represent WHO 2030 elimination targets – 90% of all HBV infections diagnoses, 80% of eligible population treated, 90% of the infants receive a timely birth dose, 90% of all infants receive three doses of HBV vaccine, 100% of the population has access to safe blood, 100% of injections are safe and 300 sterile syringes & needles are distributed for every person who injects drugs (PWID) (source: Global Hepatitis Report 2017. Geneva: World Health Organization; 2017).
Treatment eligibility used WHO treatment protocols: HBV diagnosed individuals with a high viral load (=20 000 IU/
For simplicity, the number of sterile syringes & needles per PWID was put on a scale of 0-100% with 100% indicating 300 distributed per year per PWID. The bars in the front represent how the country/

HBV Total Diagnosed
Cumulative number of patients diagnosed previous to December 31, (year indicated in the title) divided by the same year’s HBsAg prevalence.
HBV Treated
Number of patients on treatment by December 31, (year indicated in the title) divided by total treatment eligible population by December 31, (year indicated in the title). We are using WHO’s definition of eligibility which is: HBV diagnosed individuals with a high viral load (=20 000 IU/
Birth Dose
Percent of infants born in (year indicated in the title) who receive a timely birth dose (within the first 24 hours of life) HBV vaccination. WHO country/
HBV 3+ Dose
Percent of infants born in year indicated in the title who receive Three or more doses of HBV vaccination. WHO country/
Blood Safety
This data came from the following sources: Global status report on blood safety and availability 2016. Geneva: World Health Organization; 2017. Current Status on Blood Safety and Availability in the WHO African Region — Report of the 2013 Survey. Geneva: World Health Organization; 2017. Pan American Health Organization (PAHO). Supply of blood for transfusion in Latin American and Caribbean countries, 2014 and 2015. Washington, D.C.: 2017. [Azerbaijan: Iranian Blood Transfusion Organization Department of International Affairs . ECO Blood Safety Network. October 2013. http://www.ecobsn.com/] When data for the latest year was not available, rate in the last year of available data was kept constant.
Injection Safety
This data came from the following source: ICF, 2015. The DHS Program STATcompiler. Funded by USAID. http://www.statcompiler.com. November 13 2019. Pepin J, Abou Chakra CN, Pepin E, Nault V, Valiquette L. Evolution of the global burden of viral infections from unsafe medical injections, 2000-2010. PLoS One. 2014;9(6):e99677. Epub 2014/
Syringes / PWID
This data came from the following source: Larney S, Peacock A, Leung J, et al. Global, regional, and country-level coverage of interventions to prevent and manage HIV and hepatitis C among people who inject drugs: a systematic review. Lancet Glob Health 2017; published online Oct 23. http://dx.doi.org/
If you have additional questions that are not answered here, please contact us at info@cdafound.org.
Hepatitis elimination policies – qualitative assessment graphs explained
We reviewed the national strategies and compared them against countries/
We found that the primary predictor of achieving the elimination targets was political will. There are many examples of countries/
We developed a qualitative scoring system for each factor and asked experts from each country/

(1) Political will
Political will to eliminate hepatitis is a key predictor of achieving the elimination targets. All countries/
We use a multi-objective decision analysis scaling framework (Keeney RL, Raiffa H. Decisions with Multiple Objectives: Preferences and Value Tradeoffs. Cambridge University Press 1993) which uses a non-linear scoring scale. The definitions for political will scores are shown below.


(2) Finance the national program
A key barrier to hepatitis elimination is financing the national program. However, study after study has shown that the cost of doing nothing is higher than going after the elimination targets. All countries/

(3) Implement harm reduction
Elimination of viral hepatitis will not be possible unless the number of new infections is reduced. The risk factors for new infections vary by country/


(4) Expanded treatment capacity
There are simply not enough liver specialists to treat all hepatitis B and C infections. The shortage of liver specialists is exacerbated in low and middle income countries/


(5) Remove all restrictions
For hepatitis C treatment, some countries/

(6) Put in place monitoring and evaluation systems
A robust monitoring and evaluation program will assure that the elimination programs are implemented in an efficient manner. These systems can be used to monitor progress toward elimination and help validate the countries’/territories’ accomplishment. The definition for each score is shown below.

(7) Actively screen & implement awareness programs
Active screening in needed to find the portion of the hepatitis infected population that remains undiagnosed. This has been a key barrier to the global elimination efforts. However, active screening without an awareness program will result in suboptimal outcomes. There are numerous examples of high income countries/

(8) Linkage to care programs
Screening and awareness are not sufficient to achieve the elimination goals. Active programs to link patients to care are also needed. For example, most blood banks notify donors who test positive for HCV or HBV and recommend that they see a physician. However, none have a program that links those testing positive to care. In countries/

Elimination of mother to child transmission
The highest risk factor for new chronic HBV infections is still perinatal transmission. Thus, we added a separate factor to assess how countries/
