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Even as health activists mark World Hepatitis Day today, some 18 million Indonesians with the disease continue to be plagued by the high cost of treatment and medication.

Unggul Budihusodo, chairman of the Indonesian Liver Research Association (PPHI), told the Jakarta Globe on Tuesday that there was an urgent need to stress the importance of vaccinating against the hepatitis B and C viruses.

“A vaccination is the most effective way to combat hepatitis,” he said. “It is guaranteed to prevent an infection, but most people remain unaware of its urgency.”

He added that 11 million Indonesians had hepatitis B while seven million had hepatitis C.

The main stumbling block, Unggul said, is the cost of the inoculation. “It’s a three-shot process, at Rp 80,000 [$9] per shot.”

But he pointed out that the cost of treating the condition once it developed was far greater.

“People might think twice about the vaccination once they realize that treating hepatitis requires weekly shots that cost Rp 2.5 million each,” he said, adding that the treatment could last from months to a year.

“Without a regimented treatment program or vaccination, the virus will remain in the body and may develop into cirrhosis and even liver cancer within 10 to 20 years,” Unggul said.

“Most people remain unaware of the condition because of the lack of early symptoms,” he said, pointing out that most hepatitis C patients experienced no symptoms or nonspecific ones.

Symptoms of hepatitis A include fever, abdominal pain and jaundice.

“It can be transmitted through contaminated food and drinks,” Unggul said, “so people need to watch what they consume.”

Hepatitis B shares similar early symptoms as hepatitis A, but is more difficult to treat, and is transmitted through exposure to infected blood or bodily fluids containing blood, including through the use of non-sterile shared needles or dental implements, blood transfusions, shaving razors, saliva, breast milk and unsafe sex.

“The worst of the variants is hepatitis C because of the difficulty in treating it and the damage it causes to the liver,” Unggul said.

Tjandra Yoga Aditama, director general for disease control and environmental health at the Ministry of Health, said the prevalence of hepatitis cases ranged from 2 percent to 10 percent by province.

“The problem is not as severe as before, because there is now greater access to health services across the country,” he said. “The government also provides free programs to treat the disease at state-run health care institutions countrywide, which is progressing well.”

Tjandra added the government was doing its part to raise awareness of the disease.

“We were one of the countries that initiated the WHO resolutions on hepatitis and proposed World Hepatitis Day,” he said.

He also said Indonesia introduced a vaccination scheme for newborns in 2003 to prevent them contracting the hepatitis B or C viruses through their mothers.

World Hepatitis Day, marked since 2008, aims to raise global awareness of hepatitis B and C and encourage prevention, diagnosis and treatment.

An estimated 170 million people worldwide, one-twelfth of the global population, have either hepatitis B or C, while 1.5 million die from the infection annually, the WHO says.