There are up to 170 million people living with hepatitis C infection worldwide. In March 2010 the World Health Assembly, the governing forum of the World Health Organization (WHO), adopted a viral hepatitis resolution urging member states to take steps to address this public health problem.
The U.S. Centers for Disease Control and Prevention reports that hepatitis C has superseded HIV as a cause of death in the United States. Between 1999 and 2007, deaths from hepatitis C increased to more than 15,000, whereas deaths from HIV declined to less than 13,000.1 In the regional context, Southeast Asia and India also see more deaths from viral hepatitis infection than from HIV.2
In high-income countries, the standard of care for treating hepatitis C is combination therapy with pegylated interferon (an injectable medicine) and ribavirin (an oral pill), with some patients being treated by adding newer regimens of expensive oral pills to the standard of care. In most of Asia, treatment is not accessible, as pegylated interferon remains under patent in many countries and is without low-cost generic equivalents.
A standard course of pegylated interferon is 48 weeks, which costs approximately US$18,000 in India and US$14,000 in Malaysia but only US$2,000 in Egypt. Depending on the country, price variations may be based on the availability of generic options and the involvement of governments in negotiating reductions for national procurement. These variations in pricing and the consequent burden to individual patients and governments reflect one of the central challenges to implementing hepatitis C treatment, underscoring the need for more consistent global pricing mechanisms to allow broader access to these effective treatments.
Most low- and middle-income Asian countries do not include hepatitis C treatment as part of their public health programs, forcing patients to bear the burden of the expense or go without treatment. In India, which supplies more than 80 percent of the developing world's HIV medication, patents preventing the generic production of pegylated interferon have been under challenge in courts since May 2007.
The global community has learned from the HIV epidemic that access to life-saving treatments is ensured only when governments intervene at the national level. A growing movement calls for policymakers to apply these lessons to overcome the pricing and political barriers currently limiting access to hepatitis C treatment.
After saving the lives of so many infected with HIV, we now risk losing them to liver diseases, which would undermine the advances that have been achieved in the HIV response. Asian governments urgently need to initiate national programs for prevention and treatment of hepatitis C and put the WHO's viral hepatitis resolution into action.
1. Kathleen N. Ly, Jian Xing, R. Monica Klevens, Ruth B. Jiles, John W. Ward and Scott D. Holmberg. The Increasing Burden of Mortality From Viral Hepatitis in the United States Between 1999 and 2007. Annals of Internal Medicine. 2012 Feb 21; 156 (4): 271-8.
2. Samlee Plianbangchang. Viral Hepatitis kills more than Malaria, Dengue and HIV/AIDS in South-East Asia. The Dili Weekly. 2011 Aug 24. http://www.thediliweekly.com/tl/editorial/sikun-editores/116-viral-hepatitis-kills-more-than-malaria-dengue-and-hivaids-in-south-east-asia (Accessed 14.4.2012)