Hep Advocacy Goes Global

[Hep Talk]

All Around the World
The war on hepatitis goes global
by Larry Buhl


The hepatitis crisis has been a global one for some time, but 2014 marks a watershed as NGOs, governments, activists, and pharmaceutical companies have set down important markers in how to address the pandemic. And they’re also beginning to acknowledge the enormity of the job in preventing, treating, and eventually eradicating the hepatitis C virus (HCV).

World Health Organization (WHO) statistics show more than 185 million people are infected with hepatitis C worldwide. That’s about three percent of the world’s population, and six times more than those infected with HIV—with between 130 million and 170 million of them living with the virus chronically. Egypt has the world’s highest prevalence at fifteen percent, almost all of which consists of genotype 4—different countries tend to have different genotypes of the virus, something that adds to the challenge of worldwide treatment. Each year, 350,000 die of HCV-related causes.

In May, the World Health Assembly (WHA), the decision-making body of the WHO, passed a Hepatitis Resolution, which commits the WHO and United Nations member states to urgent action to address HCV. The resolution sets policy that will help countries develop prevention, treatment, and harm reduction plans tailored to their individual populations.

In April, the WHO released its first guidelines for the treatment of hepatitis C, including recommendations for how to increase the number of people screened for HCV infection, how to mitigate liver damage for those who are infected and how to select and provide appropriate treatments for chronic hepatitis C infection. Some specific guidelines include:

• A screening test for people at high risk of infection, and a second test for those who screen positive to establish whether they have chronic hepatitis C infection.

• Alcohol assessment for people with chronic hepatitis C infection receive counseling to reduce alcohol intake for people with moderate or high alcohol use.

• Recommendations on existing treatments based on interferon injections as well as the new regimens that use only oral medicines. The WHO will update recommendations on drug treatments as new medications come to market.

• Measures to assure the safety of medical procedures and injections in health care settings and among persons who inject drugs, and guidelines on the reuse of injection equipment and lack of screening of blood transfusions.

These resolutions come as new life-saving drugs to treat HCV are entering the market. Direct-acting antivirals (DAAs), demonstrate cure rates of more than ninety percent and—this is crucial in lower-income countries—are easier to administer. And DAAs offer the unprecedented promise of global HCV eradication, especially in low- and middle-income countries where eighty-five percent of people with HCV live, according to Karyn Kaplan, International Hepatitis/HIV Policy and Advocacy Director for the Treatment Action Group, an HIV/HCV advocacy organization.

Worldwide challenges
Even as the WHO released its guidelines, it recognized some big hurdles in treatment. Possibly the largest of these is affordability. “The challenge now is to ensure that everyone who needs these drugs can access them,” says Dr. Peter Beyer, Senior Advisor for the Essential Medicines and Health Products Department at WHO said in a prepared statement.

Dr. Paul Farmer, chair of the Department of Global Health and Social Medicine at Harvard Medical School wrote in a Washington Post editorial that the world faces a “1996 moment” in the fight against hepatitis C. “As in 1996, highly effective new therapies are coming online. Regimens containing sofosbuvir, in particular, have the potential to cure 90% of patients after just 12 to 24 weeks of once-daily pills. But is there a plan that can link funding to delivery for those living in poverty?”

Price drops coming?
In February, more than forty international activists met in Bangkok to develop ideas for increasing international treatment access. Key issues addressed included intellectual property, patent updates, pharmaceutical negotiations and outreach to at-risk populations. But the pivotal issue was price, according to Karyn Kaplan of TAG. Kaplan tells A&U that the Bangkok meeting was “disappointing” on the affordability front—activists met with representatives from the largest pharmaceutical companies there—but she remains optimistic that prices for new DAAs in middle- and low-income countries will come down.

And Kaplan points to the recent success of several nations—India, Egypt, Brazil, Burma, Kenya, and Mozambique in negotiating access to Gilead Sciences’ Sovaldi (sofosbuvir) at a steep discount. But before price negotiating can be effective, more countries worldwide need to make hepatitis C treatment a priority, she says.

“The power comes from grassroots movements, where activists train about prevention and transmission and treatment,” Kaplan tells A&U. She said in that respect the HCV crisis and response mirrors that of HIV worldwide. “The difference here is there are six times as many people living with HCV as HIV.”

Larry Buhl is a radio news reporter, screenwriter, and novelist living in Los Angeles. His young adult novel, The Genius of Little Things, debuted last year.