The Price of War

Focus on treatment cost emerges at a global health summit on hepatitis

by Larry Buhl

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Participants at the World Hepatitis Summit. Photo courtesy WHS
Participants at the World Hepatitis Summit. Photo courtesy WHS

[dropcap]C[/dropcap]ost of treatment and prevention in the war on viral hepatitis was the overriding theme of the first World Hepatitis Summit, which drew more than 1500 policy makers, academics, ministers of health, patients, and patient advocates in September in Glasgow, Scotland.

Organized by the World Health Organization and the World Hepatitis Alliance, the summit was a response to the Alliance’s 2014 resolution calling for urgent action to reverse the rising death toll from viral hepatitis—which is the seventh leading cause of death worldwide.

Over three days delegates discussed public health research priorities, and practical steps countries can take to meet the forthcoming WHO Global Hepatitis Strategy, and share innovative ways to pay for treatment and prevention of the hepatitis B and C viruses.

In a keynote address, Stefan Wiktor of the WHO Hepatitis Program said that it would take global funding equivalent to $11 billion per year for the next ten years in order to achieve the WHO’s proposed targets for controlling viral hepatitis by 2030, including:

• a ninety-percent reduction in new hep B and C infections.
• a sixty-five-percent reduction in deaths from hep B and C.
• providing treatment for eighty percent of people with hep B and C.
• increasing the percentage of injections carried out safely worldwide from five percent now to ninety percent.

Using a model produced in collaboration with Aidsmap.com, Wiktor admitted that the final cost could change depending on the pricing, timing, and competition of generics of direct-acting antivirals for hep C when patents on the drugs expire.

And Wiktor said that $11 billion annual figure might peak in 2025, falling to $9 billion in 2030 as harm reduction and hepatitis B treatment costs begin to decrease.

Wiktor’s map assumed that drug prices would be sharply reduced by 2020 and he acknowledged that harm reduction intervention programs—like syringe exchange and opioid substation therapy—would be the costliest budget items over the next five years.

Who pays, and how?
Wiktor and others addressed the challenges of allocating money for hepatitis prevention and treatment. Several presenters at the summit shared innovative ways of paying for hepatitis treatment in lower-income and middle-income countries, where access to new antiviral drugs is very limited outside higher-income countries.

Greg Perry, Executive Director of the Medicines Patent Pool (MPP), said his organization, which was created with the help of UNITAID, could negotiate voluntary licensing agreements with pharmaceutical companies and overcome barriers to the development of fixed-dose drug combinations of products from more than one manufacturer.

Perry said that since its launch in 2010 MPP has negotiated voluntary licensing agreements with all major pharmaceutical companies that allow some or all of their antiretroviral products to be copied by generic manufacturers and sold at greatly reduced prices in lower- and middle-income countries, and that such an approach might be used for viral hepatitis meds. Perry said it would be possible to negotiate voluntary licensing agreements to allow the development of pan-genotypic combinations—or equally effective against all genotypes of the hep C virus—of direct-acting antivirals.

Some advocates, including a representative for Initiative for Medicines, Access and Knowledge (I-MAK), argued that compulsory licensing by governments would be required for widespread access to lower-cost hepatitis meds in middle-income countries. But an attorney with expertise in compulsory licensing told delegates that strategy was not the best way to provide low-cost drugs worldwide, because of its long timelines of litigating such licensing on a country-by-country basis.

Several presenters, including Brook Baker of Northeastern University in Boston and Peter Bayer of the World Health Organization urged governments to set up programs to test and treat for hepatitis C. Baker said that a high level donor funding for hepatitis treatment in lower- and lower middle-income countries was crucial to create the level demand that would make generic versions of direct-acting antivirals affordable.

Some presenters introduced other innovative funding approaches, such as sharing costs for meds and harm reduction with existing programs within the health system, such as HIV for harm reduction and for treatment of coinfected people.

More than one presenter used the examples of middle-income countries that are taking action against hepatitis, including Egypt, which has substantially increased access to medications; Georgia, which has set a goal for the national elimination of hepatitis C; and Mongolia, which will soon implement comprehensive strategy for controlling viral hepatitis.

The highlight of the Summit’s closing session was launch of the Glasgow Declaration, which called on governments to implement comprehensive, funded national hepatitis programs in line with the World Health Assembly Resolution 67.6. The full declaration can be found at www.worldhepatitissummit.com.

The second global summit will be held in 2016 in Sao Paulo, Brazil.


 

Larry Buhl is a radio news reporter, screenwriter, and novelist living in Los Angeles. His podcast on employment issues, “Labor Pains,” can be found at www.laborpainspodcast.com.