Hep Community: We Need More Federal Dollars

Money Talks
The hepatitis community wants more federal dollars; hep a cases rising fast
by Larry Buhl

Here’s the good news on federal funding for hepatitis research and treatment. In its 2020 budget proposal, the Trump Administration has requested a $53 million increase, from the current level of $5 million, to fund the infectious disease and opioids programs at the U.S. Centers for Disease Control and Prevention (CDC). The bad news is the budget for the response to all forms of hepatitis, including hepatitis A, B and C, is flat, at $39 million. That’s not nearly enough, according to Frank Hood, Senior Policy Associate at The AIDS Institute. He’s calling on Congress to allocate the additional $95 million requested by the hepatitis community for CDC’s viral hepatitis programs, and says that the CDC needs massive funding to expand its work in prevention, education, and testing for individuals at risk of hepatitis C, surveillance of outbreaks, and linkage to care for those who need it.

“President Trump has kept the same level of funding [for hepatitis] flat for three years,” Hood told A&U. “Any budget increases were due to Congress. And we hope that with a Democratic House, that budget item will be increased.”

Not only are cases of hepatitis C rising throughout the country, new populations are being impacted. In 2016, there were 41,700 new cases of hepatitis C, a twenty-two percent increase from the prior year. Between 2010 and 2016, there was a 350-percent increase in new infections. Unlike previous outbreaks that affected baby boomers, the biggest increase in infections today are among people under forty years old with more than seventy percent of cases the result of injection drug use.

“One reason we need increased funding is linkage to care, and this funding can be used for harm reduction,” Hood said.

On harm reduction there has been a shift in recent years, Hood added. “To our surprise, there is brief but well-worded support for syringe programs. There isn’t a fear of backlash around this and other harm reduction programs, but we want to make sure they get up and running, and again, we need resources for them.”

Neither the Trump administration nor Congress has yet specified how the money might be allocated for syringe exchange services. But the funding could be allocated in two ways. The CDC could send all of the money for hepatitis research and prevention, including harm reduction, to the states and let the states choose how to use it. Or the CDC could set aside some money specifically for harm reduction and tell the states how to use it. The second option might be a challenge, because some states currently don’t have permission from the CDC to use syringe exchange programs.

And there is the conundrum of federal law, still in place, banning federal money from paying for syringes. However, the feds are able to allocate money for everything but syringes in syringe-exchange programs. Typically nonprofit organizations will pick up the tab for syringes, keeping program operators from running afoul of federal law.

Hood said Congress should be sharing the money it wants in the budget by early summer.

Hep A cases increasing fast
In other hep news, hepatitis A infections are soaring, up nearly 300 percent in just three years, according to a report published in the CDC’s May 10th issue of Morbidity and Mortality Report. This increase has come despite an effective vaccine, and it’s seen mostly among injection drug users and the homeless. Previously, large outbreaks of hepatitis A were rare and mostly attributed to contaminated commercial food products. Hepatitis A virus can be spread through contact with objects, surfaces, food or drinks contaminated by feces or stool from a person who has the virus.

Those most likely to develop serious liver illness from hepatitis A are those with other conditions like cancer or those with compromised immune systems. The most effective defense against this potentially deadly infection is vaccination, which is also the best way to prevent outbreaks, and the CDC recommends that those at the highest risk get vaccinated. The CDC has also pointed out that transience, economic instability and limited access to healthcare among the homeless have made the outbreaks more difficult for states to control. However, a recent outbreak of hepatitis A affecting more than 900 people across nine states included some, such as restaurant workers, who were not in the high-risk category.

In October 2018, the CDC’s vaccine policymaking committee, ACIP, voted to recommend the hepatitis A vaccine to be routinely given to people experiencing homelessness over one year of age. Right now there are three licensed vaccines to protect against hepatitis A. If approved, the CDC’s recommendation would allow these shots to be dispensed at clinics where homeless people receive healthcare and would be covered by Medicaid in some states.

Larry Buhl is a multimedia journalist, screenwriter, and novelist living in Los Angeles. Follow him on Twitter @LarryBuhl.