Su Wang, MD, MPH is the Medical Director of the Center for Asian Health and Viral Hepatitis Programs at Cooperman Barnabas Medical Center in Livingston, NJ, and Senior Advisor for Global Health at the Hepatitis B Foundation. She leads initiatives to enhance access to care and health equity for Asian American and immigrant communities in New Jersey. Dr. Wang founded a primary care practice and community navigation program for Asian populations, directs viral hepatitis screening and treatment programs, and launched the SBMC Liver Center to connect patients to liver disease and transplant services. Her work blends clinical care, community engagement, and global advocacy to eliminate Hepatitis B and improve liver health worldwide.
Q: How has your role as Senior Advisor for Global Health at the Hepatitis B Foundation, and your experience leading international advocacy efforts, influenced new approaches you are taking to eliminate Hepatitis B and liver cancer both in the U.S. and globally?
This is an important question, as it highlights the value of understanding successful innovations both globally and locally, ensuring that we adopt best practices in our respective areas of work. While the overarching goal is global elimination, it is clear that micro-elimination efforts are essential for achieving this objective. Different communities and populations present unique challenges and opportunities, and every group can contribute to the effort in its own way, regardless of their specific circumstances. Observing the strategies implemented in various countries—particularly those where governments are not only committed to viral hepatitis elimination but also provide the necessary funding—provides valuable lessons. These examples offer great insights and are crucial for cross-pollination of ideas and practices that can be applied universally.
Interactions at both global and domestic levels are essential for learning and improving approaches across various settings, from state and local health systems to broader health policy. In our own health system, we launched the FOCUS program in 2018, which uses automated screening for Hepatitis B, Hepatitis C, and, more recently, HIV and Delta Hepatitis (HDV). The scale of these initiatives within our health system is remarkable; by leveraging Electronic Medical Records (EMRs) and system-wide processes, we can screen thousands of people that would otherwise be impossible for one individual to manage. The insights gained from others who have undertaken similar efforts—particularly regarding their system processes and algorithms—have been invaluable. As Senior Advisor and a former President of the World Hepatitis Alliance, I have been fortunate to serve on various committees, gaining a broad perspective on how others are tackling these challenges.
Q: Many prevention efforts focus primarily on Hepatitis B, but Hepatitis C remains the leading cause of liver cancer in the U.S. How can integrated screening and treatment programs for both Hepatitis B and C be improved to better address liver cancer prevention?
Surveillance for liver cancer remains a significant challenge. While there is much focus on the screening, diagnosis, and care for Hepatitis B and Hepatitis C, the importance of routine surveillance, including ultrasounds or imaging along with Alpha-Fetoprotein (AFP) screening, is often overlooked. It is crucial not only to integrate these tests but also to include liver cancer screening in standard practice. Identifying at-risk individuals—such as those with Metabolic dysfunction associated steatotic hepatitis (MASH), significant fibrosis or cirrhosis—and ensuring they are flagged for regular surveillance is essential. Too often, liver cancer is diagnosed at a stage when treatment options are limited, highlighting the need for innovation in screening integration.
In collaboration with the cancer center at my hospital, we initiated a quality improvement project focused on liver cancer screening. When we reviewed our data, we found a higher incidence of late-stage liver cancer—approximately 30 percent at stage four—compared to the national average of 13 percent. This underscored the need to start earlier, encouraging primary care providers to consider liver cancer screening in the same way they approach mammograms or colonoscopies. Primary care is well-positioned to take on this responsibility, especially as MASH and Hepatitis C are now more manageable, and patients treated by specialists often return to primary care. This is why we are advocating for a shift in Hepatitis B care towards primary care settings. To support this, we recently published new primary care guidelines for Hepatitis B on the University of Washington website. These guidelines include a one-page resource covering screening tests, interpretation, a simple treatment algorithm, and medication options, designed to facilitate the scaling of universal screening and decentralized care.
Q: What are the most effective ways to expand access to care and design public health campaigns that truly engage communities at highest risk for liver cancer, so that more people receive Hepatitis B vaccination, testing, and ongoing prevention and treatment services?
Expanding access to care requires improving the messaging around Hepatitis B and Hepatitis C within the healthcare system. There remains stigma and misconceptions that these diseases only affect individuals with specific risk factors, when in reality, they are concerns for the general population. We should be screening everyone, as it is common to discover cases of Hepatitis B in individuals who were unaware of their condition and did not fit the traditional risk profiles. Addressing Hepatitis B and C as issues that affect the broader population is critical to achieving elimination. I often remind primary care providers that Hepatitis B is relatively simple to treat. With only three oral medications—taken once a day, effective at all stages and ages, and with minimal drug interactions—it is far less complex than managing conditions like diabetes, where there are numerous medication classes that you have to adjust based on comorbidities, risk factors and possible side effects. Hepatitis B treatment is doable for primary care physicians including managing adherence discussions, which are similar to conversations we already have with patients about chronic conditions that require consistent medication to avoid serious consequences such as diabetic ketoacidosis, coma, or stroke.
On the public health campaign front, I believe we need internal campaigns within healthcare systems to shift the mindset around Hepatitis B and C screening. It is essential to communicate that the goal is not merely to check another box, but that we can be a part of global elimination of these diseases. When we trained emergency department nurses, many were unaware of the highly effective cures for Hepatitis C. Upon learning this, they were excited to be part of the effort to cure the disease. When we later showed them that their screening efforts had helped diagnose and link over 500 people with Hepatitis B and C to care they were able to see the direct impact of their work. Such feedback helps illustrate the importance of their roles and demonstrates that everyone, whether in primary care, emergency care, maternal-child health, community screening, behavioral health, or peer recovery, has a part to play. By connecting and supporting all of these entry points, we can engage communities at the highest risk and ensure individuals remain in care even after significant life events such as pregnancy or overdose.
Q: Given the significant increases in liver cancer rates and the unequal impact across states and populations, what trends are you seeing in your practice or research, and what policy or program changes are most urgent now—especially to ensure the ACIP hepatitis B birth‑dose decision does not widen existing disparities?
It is crucial to retain the birth dose as much as possible. The way we communicate and implement this measure will be pivotal, as there are considerable variability in its application. The new recommendations for the birth dose do not mandate that it be withheld from babies whose mothers are not Hepatitis B positive; rather, they allow for the decision to be made on an individual basis through shared decision-making. Thus, parents should request it if it is not being offered. We acknowledge that choice is important, and parents have always had the option to decline it
For effective implementation, healthcare providers—such as those in birthing hospitals, OB-GYNs, and pediatricians—must use their clinical judgment and best practices to ensure that the birth dose remains accessible without creating unnecessary barriers. While it’s important to ensure parents are fully informed of their choice, we must avoid complicating the process by requiring parents to prove risk, as this is not stipulated in the guidelines. It is urgent that we prioritize the birth dose, make the decision clear, and enhance educational resources. Our role now is to educate and ensure that parents have all the information they need to understand the safety and benefits of the birth dose, and why it is a simple but essential step towards ensuring a Hepatitis B-free (and liver cancer free) future for their child.
Q: What do you most want clinicians, parents, and policymakers to understand about the long‑term liver cancer implications of delaying or missing the Hepatitis B birth dose, especially given your own experience of acquiring Hepatitis B in infancy?
The opportunity to prevent Hepatitis B at birth is critical. If the birth dose is missed, the individual may develop chronic Hepatitis B, which, unfortunately, is not currently curable. Administering the birth dose is a simple, cost-effective, and safe procedure that requires no long-term adherence or daily medication. Parents are not charged for the vaccine, and its benefits far outweigh the minimal effort involved. It is a straightforward intervention with the potential to ensure a healthy life free from Hepatitis B for the child.
This issue has become unnecessarily contentious, despite the progress we have made in preventing mother-to-child transmission of Hepatitis B. We should remain committed to the course we have taken for over 30 years – the US has been the leader in this area and the universal birth dose has reduced cases of pediatric HBV by 99%. While there are still significant gaps in screening and care, we must focus on preventing the creation of a generation of children living with Hepatitis B. Staying the course is essential to continuing our progress and achieving the goal of Hepatitis B elimination.
Q: How does the burden of liver cancer highlight the urgency of preventing and treating Hepatitis B, and what can we learn from states and countries that have used vaccination and care to dramatically reduce this cancer?
Liver cancer remains one of the cancers most often diagnosed at a late stage, and in many cases, it is not treatable or curable. By the time most patients with liver cancer are diagnosed, they often have less than six months to live. However, progress is being made. If detected early enough, and if the tumors are small and have not spread, they can sometimes be resected. Additionally, immunotherapies are newer therapies that can extend life, and liver transplant options, along with treatments that shrink tumors, can make patients who were previously ineligible for a transplant eligible.
What makes Hepatitis B unique compared to Hepatitis C is that with Hepatitis C, liver cancer typically occurs only after cirrhosis has developed. However, Hepatitis B is an oncogenic virus, meaning it directly integrates into the host’s DNA. This integration can cause mutations, some of which may lead to tumors that can grow uncontrollably and evade the body’s immune response.
This is why it’s possible for younger people to develop liver cancer, even if their Hepatitis B infection wasn’t previously considered severe enough to warrant treatment. Dr. Brian McMahon from Alaska has shared heartbreaking stories of young patients with liver cancer—children as young as eight—who presented with symptoms such as abdominal distension, pain, and jaundice, but unfortunately, there was nothing that could be done, and these children died. In response, Alaska created a comprehensive program that has nearly eliminated Hepatitis B through vaccination, screening, and community care. This success story shows that if we address Hepatitis B through prevention and treatment, we can also significantly reduce liver cancer.
We can draw similar lessons from Australia, where the country has effectively eliminated cervical cancer through widespread HPV vaccination, with even bus-stop signs promoting the HPV shot. The same approach can be applied to Hepatitis B. We’ve already seen a dramatic decline in Hepatitis B infections due to vaccination, and it would be a tragedy to see that progress reversed. Hepatitis B is the leading global cause of liver cancer, and if we treat Hepatitis B early, we can potentially eliminate both the infection and the associated risk of liver cancer.
