Provided by The Guardian
It took decades for HIV/Aids drugs to reach the world's poorest – history must not be repeated with hepatitis C treatments
The hepatitis C virus, new treatments for which are at an advanced stage in clinicial testing, but promise to be prohibitively expensive. Photograph: Bsip/UIG via Getty
A public health showdown is brewing over a virus that affects the lives of millions of people every year.
The face-off will involve activists on one side and pharmaceutical companies on the other. It will play out in the richest cities in North America and the poorest countries in Africa. The viral scourge at the centre of this brewing confrontation is spread through blood-to-blood contact, but is treatable with expensive medicines.
This scenario may remind some of the decades-long struggle to obtain access to life-saving medicines for HIV and Aids. But here we are talking about another public health threat: hepatitis C.
An estimated 150-180 million people worldwide are infected with hepatitis C, and up to 500,000 die every year. The virus attacks the liver, yet the vast majority of people are unaware they are infected because the initial stages have no symptoms. It is the long-term effects that can be the most devastating: cirrhosis, liver cancer and liver failure.
The showdown is over the cost and quality of medicines. Until recently, the only cure for hepatitis C involved an expensive combination of injections and tablets that lasted a year. In addition to having limited efficacy, this regimen caused serious side effects that deterred patients from finishing the full course. Now, new drugs are poised to enter the market that work more quickly, are more effective and may not require weekly injections. About 10 of these drugs have reached an advanced stage in clinical trials.
But battle lines are being drawn over the cost of the treatments. Two products were approved by the US Food and Drug Administration recently, including the first pill that does not require a complementary injection. The pill, sofosbuvir, costs $84,000 (£50,370) for a 12-week course. Echoing the concerns of HIV activists who demanded cheaper treatment, protesters point out that such prices will keep hepatitis C drugs beyond the reach of those in need.
The similarities with HIV and Aids do not stop there. Hepatitis C is a leading cause of death for people with HIV. Approximately 5.5 million people have both diseases, so just as people with HIV are living longer thanks to powerful medicines, some are being struck down by hepatitis C.
A decade ago, the high price of HIV treatment meant that access was limited in developing countries. Today, almost 10 million people in low- and middle-income countries are able to receive life-saving HIV medicines, thanks to generic competition slashing prices from $10,000 in the mid-1990s to just $140 a year. The success in providing HIV treatment to the world's poorest people can pave the way to ending hepatitis C.
Manufacturers of new hepatitis C medicines are likely to offer the poorest countries a less expensive version. But according to the Lancet medical journal, pharmaceutical firms will not offer discounts to middle-income countries they regard as emerging markets, where about 75% of people with hepatitis C live. For this reason, a diverse alliance of countries – Brazil, Colombia, Costa Rica, Egypt, Moldova and South Africa – sponsored a resolution at a recent meeting of the World Health Organisation, urging the international community to act quickly on hepatitis.
Governments, pharmaceuticals and civil society must work together. We need to learn from our experience with HIV and Aids and negotiate better prices from all manufacturers. Generic competition should be encouraged to bring prices down.
Pharmaceutical firms are starting to realise that they cannot leave people in poor countries behind. Initiatives such as the Medicines Patent Pool have allowed several major companies to share their patents, enabling affordable generic versions of their HIV medicines to be made. We need to see the same spirit of co-operation for hepatitis C.
We must also avoid a prolonged international showdown. Almost 20 years passed since the first HIV antiretrovirals emerged in the 1990s and the moment people in low-income countries began to get access. For the millions with hepatitis C – and for those who are unaware they have the disease – we must act faster.