| • Stigma and discrimination leading to lack of patient voice (S1 Supporting Information; cases 5, 6, 7) [9]. |
| • Silent infection, which may never be diagnosed and is not apparent to onlookers (contributes to large pool of undiagnosed infection). |
| • Poverty, leading to lack of patient voice, lack of public profile, and underrepresentation (S1 Supporting Information; cases 4, 5, 7). |
| • Complacency that ongoing deployment of existing resources and approaches (e.g., suppressive antiviral therapy and vaccination) is sufficient to bring about elimination [10]. |
| • High burden in low-/middle-income countries [6], where investment is not a priority. |
| • Lack of public/media representation; no “high profile” cases. |
| • HBV is “eclipsed” by higher profile infections such as HIV and malaria. |
| • Poor education and knowledge among patients, the public, and healthcare workers (S1 Supporting Information; cases 6, 8, 9) including underrecognition of the global burden of infection. |
| • Lack of existing investment [11,12] contributing to a cycle of underinvestment (Fig 2). |
| • Lack of development of infrastructure through which to provide education, prevention, diagnosis, and treatment and as a way to collect robust data. |
| • Poor-quality data (poor understanding of epidemiology and risk factors, little recognition of the impact of stigma, lack of assessment regarding feasibility of interventions, etc.). (S1 Supporting Information; cases 7, 8) |
| • Lack of major dedicated funding agencies. |
