Last World Hepatitis Day, we announced that CHAI, with the support of DFID, was launching its program in viral hepatitis to address the massive burdens of hepatitis B and C. Over this first year, we have seen tremendous progress in the global response to viral hepatitis. We have seen the release of new WHO treatment guidelines that pave the way for the simplified diagnosis and treatment algorithms that help those in need of treatment to access quality care. We have seen the World Health Assembly adopt the first ever “Elimination Plan for Viral Hepatitis”, which aims to cure 56 million people of hepatitis C and treat 80 percent of eligible people with hepatitis B by 2030. We have seen the price of a treatment for hepatitis C fall much faster than anyone had predicted, with a 12-week course of treatment now available in India for as low as US$325 (although not yet reviewed by a stringent regulatory authority for quality).
CHAI actively assisted five of its country programs to revise viral hepatitis treatment guidelines to eliminate unnecessary genotyping and viral load testing and prioritize treatment with sofosbuvir/daclatasvir, a combination which can achieve cure rates of over 90 percent. Furthermore, CHAI helped secure a donation of daclatasvir from Bristol-Myers Squibb and Americares, and negotiated price reductions for sofosbuvir and key diagnostic tests that will allow generic-accessible lower income countries to bring the total cost of diagnosis and treatment with WHO-prequalified products for hepatitis C down to US$400-$750 at participating health facilities. On this World Hepatitis Day 2016, ministries of health in several CHAI countries will officially launch their public screening and treatment programs, backed up by ambitious national strategic plans.
World Hepatitis Day provides us a day to celebrate these achievements. However, it is also a day to recognize that while the progress of the past year have been significant, it has not made a large enough dent in mortality or incidence rates from these diseases. The Global Burden of Disease study published data this year showing that viral hepatitis is now the seventh leading cause of death in this world: the number of deaths has increased 62 percent since 1990, from 890,000 to 1.4 million annually in 2013. Viral hepatitis now kills more people annually than either HIV/AIDS, tuberculosis, or malaria. Between 6-10 million people a year continue to be newly infected by viral hepatitis, culminating today in 70 million people needing treatment for hepatitis C and 240 million for hepatitis B. Despite these figures, less than 1 percent of patients eligible for treatment for either disease received it in 2015, due to lack of awareness about the disease and the existence of affordable treatment options.
Progress in achieving faster scale-up has faced several challenges, among them slow product registration and limited awareness of the diseases among the public, which contributes to fewer than 5 percent of cases being properly identified. Each of these barriers contributes to the most critical barrier of all: the slow adoption of viral hepatitis as a publicly-funded program. To address these challenges over the next year, CHAI plans to focus its efforts on achieving four key goals, in order to lay the foundation for accelerated treatment uptake:
1) Increase availability of robust local epidemiological and financial data that will clearly demonstrate to governments that investing in treatment now is a cost-effective strategy. CHAI is supporting governments to use their existing data to develop rational and affordable strategies for targeting screening and treatment scale up.
2) Achieve widespread registration of generic hepatitis B and C medicines. This process has begun and governments must continue to prioritize hepatitis medicines for fast-track registration encourage registration of several different products to stimulate competition to keep distributor margins and prices low. CHAI has supported governments to successfully fast track sofosbuvir waivers and registration and is now expanding its efforts to the registration of generic daclatasvir.
3) Increase the number of countries with dedicated public funding of viral hepatitis. This will require governments and partners to collaborate to define public programs that are effective and financially feasible. CHAI is providing governments with cost analysis and budgeting support to make the case for domestic funding and to support international fundraising efforts.
4) Launch or expand mother-to-child transmission-based hepatitis B programs in all countries with moderate transmission rates. CHAI continues to advocate to countries and donors the positive impact that this strategy can have on cutting transmission and mortality.
CHAI will continue to work with partner governments and the global community to address these key barriers, and to help ensure that the momentum created this past year begins to bear fruit in terms of accelerated access to hepatitis screening and treatment throughout the world.