July 28, 2023

Hepatitis treatment is more affordable than ever, but we still need more resources for elimination

Eliminating hepatitis has never been more affordable.

Earlier this year, the price of treatment for viral hepatitis dropped by over 90 percent[1], thanks to a breakthrough pricing agreement announced at the first-ever Global Hepatitis Resource Mobilization Conference in Geneva in May.

Globally, over 80 percent of people living with hepatitis lack access to prevention, testing, and treatment services. The new drug prices will significantly reduce the cost of treatment in low- and middle-income countries (LMICs)—an estimated savings of US$2 billion—enabling programs to treat more patients within existing budgets.

The pricing for sofosbuvir and daclatasvir, a 12-week, once-daily oral treatment for hepatitis C, will be available at or below US$60 from leading generic manufacturers Hetero and Viatris, while a month’s treatment of hepatitis B using tenofovir disoproxil fumarate (TDF) will be offered at a ceiling price of US$2.40.

Dr. Keo Samley, Vice Chief of Bureau Prevention and Control of Communicable Disease Control Department, Ministry of Health, who was present at the conference, shared: “We are so excited to hear about this ground-breaking announcement. These new ceiling prices will reduce the cost of hepatitis elimination in Cambodia. We can redirect these cost savings to save even more lives and achieve elimination goals. We are keen to work with partners to incorporate these pricing agreements into our procurement contracts, continue implementing services, and secure more resources for nation-wide scale-up.”

From left: Rahul Lande, Hetero, Dr David Ripin, CHAI, Finn Jarle Rode, The Hepatitis Fund, and Kedar Madhekar, Viatris.
Photo ©: Steve Forrest/Workers’ Photos/The Hepatitis Fund.

Way forward for countries to access better pricing

While this milestone is cause for celebration, these pricing agreements are only as effective as public programs’ ability to access the prices in-country. Here are some crucial steps for hepatitis programs to take:

  1. Amplify Communication: All stakeholders involved in hepatitis elimination need to amplify communication on these pricing agreements. Within countries, it is critical this information is shared with procurement divisions, national hepatitis program managers, other relevant disease programs and departments, healthcare workers, community advocates and the general population.
  2. Understand country price points and mark-ups: Public programs need to ensure that ceiling prices translate to lower in-country prices and favorable terms in procurement contracts. Where prices differ from the above, stakeholders need to understand points of mark-ups that are contributing to these higher prices, identify pain points, and work together to reduce them in a feasible manner. CHAI, for example, has engaged with various suppliers and partners in the past to bring transparency to in-country pricing and mark-ups. Such mark-ups could include costs related to freight, taxes, distribution, service and support, and distributor margins. CHAI’s HCV market reports from 2020 and 2021 contain real-world examples of how these might look like.
  3. Foster demand for hepatitis drugs to sustain accessibility and reach elimination: To sustain the accessibility and affordability of the hepatitis drugs market, and reach elimination, stakeholders must accelerate service scale-up and drive demand for services. To achieve this, it is crucial for public programs and partners to strengthen and expand hepatitis B and C testing and treatment service delivery. Priority should be given to key and vulnerable populations who are more susceptible to infection and may face political, social, and economic challenges. This can be accomplished through targeted investments in awareness campaigns, engagement with civil society organizations, and the implementation of screening campaigns. In addition, effective collaboration among stakeholders, including public programs, technical partners, civil society organizations, diagnostics and therapeutics manufacturers, and various government entities involved in planning and implementation, is essential. Regular meetings to assess progress, identify challenges, and seize opportunities will ensure that services remain available and accessible.

Need for resource mobilization

This is an opportune time for governments to increase financing towards viral hepatitis elimination to demonstrate strong political will and interest to attract donors.

Rwanda’s hepatitis C elimination journey serves as an excellent example for countries. In late 2018, Rwanda’s President Kagame announced its intention to eliminate hepatitis C well ahead of the WHO 2030 timeline. CHAI supported the country to secure—for the first time globally—a 12-week WHO-prequalified treatment course to treat hepatitis C at US$60. The government followed up on this announcement with a financial investment, appealing to multilateral, bilateral, private sector, and religious donors to support its ambitions. Coupled with detailed planning and implementation, and investments from other donors and partners, Rwanda has screened over seven million people and treated close to 60,000 patients[2].

Donors also have a vital role to play in complementing the limited resources of LMIC governments. To this end, we are seeing promising signs of catalytic investments.

  • The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) has stepped up its commitment to viral hepatitis elimination, evolving its policies to increasingly enable countries to request resources to support viral hepatitis, harm reduction, and triple elimination services. CHAI’s Resource Toolkit on the GFATM 2023 Funding Opportunity for Hepatitis lays out intel and tools to understand the policies and develop strong proposals.
  • Unitaid has made strategic investments with the aim of shaping markets for the introduction of hepatitis C diagnosis and treatment resources and supporting innovative methods of harm reduction among populations that have a higher risk of HCV infection, including prisoners and people who inject drugs.
  • GAVI, the Vaccine Alliance, under its 2021-2025 Vaccine Investment Strategy, approved support for the introduction of a hepatitis B birth dose vaccine in 38 eligible countries, estimating that this could avert up to one million infection-related deaths and 1.5 million new infections cases in newborns between 2021 and 2035. Roll-out has been delayed by COVID-19, but just last month, GAVI’s board approved to re-start paused vaccine programs.

While catalytic, these investments are limited and insufficient. With these price reductions, viral hepatitis elimination has become more attainable than ever before with modest financing. Governments must prioritize investments in viral hepatitis prevention, testing, and treatment, recognizing the urgent need to address this public health challenge. Additionally, in-country, private, multilateral, and bilateral donors must step up their commitments to support gaps in domestic financing.

Finn-Jarle Rode, Executive Director of The Hepatitis Fund, shared: “We urgently call upon governments and donors to seize this opportunity and take decisive action to provide treatment to all individuals affected by hepatitis.”

By combining political will, financial investments, and thoughtful planning, we can pave the way for the complete elimination of hepatitis. We simply can’t wait for a world without hepatitis, and we should make it happen together.

[1] These ceiling prices are the lowest prices for WHO-prequalified hepatitis B and C drugs globally, representing over a 90 percent reduction from the lowest cost of hepatitis C treatment by originators in 2016 and align the price of TDF for hepatitis B with that of HIV treatment

[2] https://www.moh.gov.rw/news-detail/hepatitis-c-elimination-rwanda-on-the-last-mile

Written by Ritubhan Gautam, Manager, Global Markets Team, CHAI; Yuhui Chan, Manager, Hepatitis Country Support and Strategy, CHAI
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