Rwanda shows elimination is possible. But without urgent global action, treatment access could vanish—and lives with it.
Hepatitis C: A curable disease we’re choosing to ignore
In the time it takes to read this article, hepatitis C will claim another life. One person dies from the virus every two minutes—adding up to 244,000 lives lost each year. Not because there’s no cure. Not because it’s too expensive. The cure has existed for years and costs as little as US$60.
But the world is walking away.
More than 50 million people globally are silently living with hepatitis C. Most don’t know they have it until the infection causes life-threatening complications. Yet simple blood tests and a short, 12-week course of oral treatment—over 95% effective—can cure the disease entirely.
Countries like Rwanda and Egypt have shown that hepatitis C elimination is not only possible, but also cost-effective and scalable. These aren’t isolated successes—they’re models the world could follow.
But just as global momentum was accelerating, it’s now unraveling. Faced with shrinking foreign aid budgets and shifting health priorities, we’re abandoning a winnable fight against a curable disease.
This isn’t unfortunate timing—it’s a catastrophic policy failure unfolding in real-time.
Rwanda shows the way: A blueprint for hepatitis C elimination
“When I was diagnosed with hepatitis C, I was terrified I wouldn’t live to raise my children,” says Dativa, a farmer in Rwanda’s Southern Province. Her story is not unique, but her outcome is. Dativa was diagnosed during a nationwide screening campaign and cured with a simple, free course of treatment delivered through her local health center. “Now I tell everyone—this disease can be beaten.”
Rwanda’s national response shows exactly how to do it.
In 2018, Rwanda became the first country in sub-Saharan Africa to launch a national plan to eliminate hepatitis C. At the time, an estimated 4 percent of the population were living with the virus. The scale of the challenge was immense. But Rwanda acted quickly and decisively.
With support from CHAI, the government of Rwanda:
- Developed a costed national elimination strategy
- Negotiated affordable pricing for generic medicines—under US$60 per treatment course
- Trained over 1,500 health workers across the country
- Integrated hepatitis C care into existing HIV and primary care platforms
- Used digital tools for real-time tracking and follow-up
The results: From just a handful of treatment centers in 2018, Rwanda scaled care to over 500 facilities by 2024. The country conducted mass screening campaigns, reaching more than 7 million people—nearly the entire adult population. Over 60,000 people have since been treated, with cure rates exceeding 95 percent.
What sets Rwanda apart isn’t just technical execution, but financial leadership. The government invested over US$5 million of its own budget upfront, mobilizing the rest of the US$43.5 million required through domestic and international partners.
Today, Rwanda is nearing the finish line. The country is aiming to reach elimination by 2027 and stands to become the first country in sub-Saharan Africa—and among the first globally—to eliminate hepatitis C as a public health threat.
Rwanda’s story is proof: with political will, smart investment, and strong partnerships, elimination is not just possible—it’s within reach.
A decade of progress at risk
Just ten years ago, hepatitis C treatment cost upwards of US$10,000 per patient and involved toxic, injectable drugs with serious side effects. Today, thanks to market shaping and strategic partnerships, a full 12-week course of curative treatment costs as little as US$60 in many countries.
Countries have mobilized creative financing mechanisms. Egypt combined domestic investment with a World Bank loan. India established a national program using federal and state funding. Cambodia, Myanmar, and Vietnam leveraged Global Fund resources to integrate hepatitis C into HIV programs.
But this progress is now at risk. The global effort stands at a crossroads.
Hepatitis C remains dangerously underfunded as global health budgets tighten. Simultaneously, the treatment market that made elimination affordable is beginning to collapse. Key pricing agreements have expired. With low demand and fragmented procurement, major generic suppliers are reassessing whether to stay in the market.
Countries ready to scale up are already encountering barriers: diagnostics remain underfunded, health workers are overstretched, and procurement is fragmented—driving up prices and weakening manufacturer interest.
If we fail to act now, we risk reversing a decade of progress. Costs will rise again, and the world will have squandered a historic opportunity to eliminate a curable disease.
The window is closing
Elimination is still possible, but only if we act swiftly. The next 12 to 18 months will be critical. What’s needed is not new technology, but renewed commitment:
Political will and targeted financing can drive national momentum. Modest investments in diagnostics, workforce training, and simplified service delivery can unlock integration into existing platforms.
Market stewardship is essential to sustain access. Countries and partners must coordinate or pool demand, re-engage suppliers, and negotiate sustainable pricing, alongside exploring initiatives like local manufacturing. Without this, the affordable treatment market may disappear.
Strong partnerships between global and national actors are critical to share data, align strategies, and hold each other accountable.
We have the cure. The tools. The blueprint. Rwanda has shown elimination is achievable. Countries like Egypt, India, and Cambodia are demonstrating what’s possible with bold leadership.
Now the question is: will we choose to finish the job?
