Going Viral

While federal efforts move forward, hepatitis prevention remains unfunded
by Larry Buhl

Rep. Mike Honda at a Cupertino town meeting. Courtesy Office of Rep. Honda
During the seemingly interminable debate over health insurance reform, other health legislation was quietly making its way through Congress. Perhaps it was too quiet.

In October, 2009 Rep. Mike Honda (D-CA) introduced the bipartisan Viral Hepatitis and Liver Cancer Control and Prevention Act to address the epidemic of hepatitis B and C in the U.S. The bill, with a price tag of $90 million, would have increased the ability of the Centers for Disease Control and Prevention (CDC) to support state health departments in their prevention, immunization, and surveillance efforts.

The bill was the first major piece of legislation to address the hepatitis epidemic in years and it came not a moment too soon, according to the American Association for the Study of Liver Disease (AASLD), the CDC’s Division of Viral Hepatitis. AASLD has long complained that hepatitis has been underfunded in comparison with other CDC programs within the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. In 2009, for example, hepatitis prevention efforts only received just two percent—$19.3 million—of its budget.

Underscoring the need for more funding was a 2009 Institute of Medicine (IOM) report that contained two-dozen expert recommendations for improvement in combating hepatitis, including enhanced screening, physician education, and the creation of a coordinated system to identify people who have the disease and refer them to care. The IOM report found that the federal government’s current efforts to prevent and control these diseases are impeded by a variety of factors, including a lack of knowledge and awareness about chronic viral hepatitis on the part of healthcare and social service providers, as well as among at-risk populations, members of the public, and policy makers.

Honda’s bill was referred to the House Energy and Commerce Committee and House Energy and Commerce Subcommittee on Health but stalled there with no further action.

Senator John Kerry (D-MA) introduced sister legislation in the Senate last year. Kerry’s bill, which would authorize funding of almost $600 million over five years to fund a national strategy to prevent and control viral hepatitis, was referred to the Committee on Health, Education, Labor and Pensions but never made it out of committee.

The efforts of Rep. Honda and Sen. Kerry and other colleagues marked the strongest effort in years toward boosting prevention and education funding for hepatitis. But with a new Congress, every piece of pending legislation from the old Congress is automatically dead as the lawmaking slate is wiped clean.

A Kerry spokesman said the senator will reintroduce legislation and is currently updating the legislation based on new hepatitis reports and awaiting the results of an upcoming HHS report on hepatitis. A spokesman for Rep. Honda tells A&U that he remains very much committed to this issue and also plans to reintroduce the legislation in the 112th Congress and is currently working with Sen. Kerry’s office and the advocacy groups on this effort.

With new Republican leadership in the House and a sizable Republican majority pushed by so-called Tea Party supporters who see government spending as anathema, passage or even discussion of the bill is far from assured. Republican leaders have pledged to not only repeal the so-called “Obamacare” law but cut spending on just about everything. Congressman Fred Upton (R-MI), incoming Chairman of the House Energy and Commerce Committee, made the following statement today regarding legislation he and other House Republicans are proposing to repeal the entire healthcare law and “roll back” the size of government.

Still, if true fiscal responsibility is their goal, Republican leadership in the House could theoretically be persuaded by the ultimate cost savings that increasing funding for hepatitis prevention could bring. Honda has said the bill would eventually save billions of dollars by identifying sick people early. A study by the research firm Milliman found that without federal leadership, the cost of treating hepatitis C alone could more than triple, to $85 billion a year, by 2024.

Rep. Honda insists he is undeterred by the shifting of power in the House of Representatives. “Despite the fact that Democrats are now in the minority it doesn’t change the notion that this remains an important issue for many districts,” he said, through his spokesman. “We just have to get our coalition back together and make another push.”

Wilbert Jordan, MD, medical director of the OASIS Clinic in Compton, California, tells A&U that he’s not hopeful that the current leadership in Congress will make any progress in increasing funding for hepatitis. “There will be a lot of posturing for the next two years by Republican leaders and it’s mostly to make Obama look bad. It’s going to be a lot of time wasted.”

Larry Buhl wrote about the hep C protease inhibitor boceprevir in the January 2011 issue of A&U.

February 2011