According to the United Nations heath agency, since the approval of new medicines for hepatitis C – offering a cure rate of over 95 per cent, fewer side effects and complete cure within three months – about two years back, more than one million patients in low- and middle-income countries have been treated.
However, an initial estimated price of $85,000 for the drugs meant that most of the 80 million people with chronic hepatitis C infections worldwide, even those in high-income countries, were not able to afford the treatment.
But thanks to a series of access strategies supported by the UN World Health Organization (WHO) and its partners, a range of low- and middle-income countries, including Argentina, Brazil, Egypt, Georgia, Indonesia, Morocco, Nigeria, Pakistan, Philippines, Romania, Rwanda, Thailand and Ukraine – are beginning to succeed in getting drugs to people who need them.
“Maximizing access to lifesaving hepatitis C treatment is a priority for WHO,” said Dr. Gottfried Hirnschall, Director of WHO’s Department of HIV and Global Hepatitis Programme in a news release today.
“It is encouraging to see countries starting to make important progress. However, access still remains beyond the reach for most people,” he added.
The strategies to strengthen the access to Direct Acting Antivirals (DAAs), the new treatment first approved for the disease in 2013, include competition from generic medicines through licensing agreements, local production and price negotiations.
Making treatment more affordable but differences persist
According to a senior WHO official responsible for essential medicines, licensing agreements and local production in some countries have gone a long way to make these treatments more affordable.
As an example, the agency said the price of a three-month treatment in Egypt dropped from $900 in 2014 to less than $200 in 2016.
But there are still huge differences between what countries are paying.
“Some middle-income countries, which bear the largest burden of hepatitis C, are still paying very high prices,” said Dr. Suzanne Hill, WHO Director for Essential Medicines and Health Products. For instance, among middle-income countries, the price for a three-month treatment of sofosbuvir and daclatasvir, two medicines used to treat the disease, varies greatly. Costs range from $9,400 in Brazil to $79,900 in Romania.
According to WHO, high costs have also led to treatment rationing in some countries, including in the European Union, where price agreements have not accounted for the full cost of treating the whole affected population.
“[We are] working on new pricing models for these, and other expensive medicines, in order to increase access to all essential medicines in all countries,” added Dr. Hill.
The essentials: will, advocacy and negotiation
WHO, in a new report, Global Report on Access to Hepatitis C Treatment: Focus on Overcoming Barriers, released today highlighted that political will, civil society advocacy and pricing negotiations are helping address Hep C.
“Today's report on access, prices, patents and registration of hepatitis C medicines will help create the much needed market transparency which should support country efforts to increase access to DAAs,” said Dr. Hirnschall, adding: “We hope countries will update their hepatitis treatment guidelines, work to remove barriers to access, and make these medicines available promptly for everyone in need.”
In May 2016, at the World Health Assembly – the supreme decision-making body for the UN agency, 194 countries adopted the first-ever Global Health Sector Strategy on Viral Hepatitis, agreeing to eliminate hepatitis as a public health threat by 2030.
According to WHO, hepatitis C kills almost 700,000 people annually. The disease also places a heavy burden on the capacities and resources of national health systems.
The Global Health Sector Strategy includes a target to treat 80 per cent of people in need by that date.