Hepatitis C: A viral time bomb

Azadeh Momenghalibaf, Open Society Foundations

“Hepatitis affects everyone, everywhere. Know it, confront it.” This is the slogan for this year’s first-ever World Health Organization–sponsored World Hepatitis Day, slated for this Thursday, July 28.

It is a fitting message for the day—the reality is viral hepatitis does, in fact, affect everyone, everywhere. Consider, for instance, that three percent of the world’s population is infected with the hepatitis C virus, a leading cause of liver disease. That’s 130 to 170 million people chronically infected globally. In the United States alone, as many as 3.9 million Americans are living with hepatitis C, and about half are unaware of their status.

Although hepatitis C is curable, most patients outside of the developed world are unable to access treatment. In countries as diverse as Thailand, Indonesia, Georgia, Ukraine, Russia, India, and many parts of Africa, where hepatitis C is a major public health problem, access to diagnostics and treatment barely exists. This is particularly true for people living with HIV/AIDS, for which hepatitis C is now becoming one of the leading causes of death.

One of the critical drugs in the standard treatment regime for hepatitis C today—pegylated interferon-alfa— is under patent protection and costs as much as $50,000 per course. Because of a duopoly held by the pharmaceutical giants Roche and Merck—the two companies which currently produce pegylated interferon-alfa—there is no competition by generic manufacturers that could deliver desperately needed cheaper alternatives to hepatitis C treatment. Two new hepatitis C treatments were recently approved by the FDA, yet they have to be used with pegylated interferon, adding another $30,000 to $50,000 to the cost of treatment. At these prices, how can a country like Ukraine, with more than 1 million people infected, really commit to treating its citizens?

Prohibitive pricing of lifesaving medicines is unethical and unacceptable. The only way to increase access to hepatitis C treatment is if pharmaceutical companies—in this case, Roche, Merck, and the firms with new hepatitis C drugs in the pipeline—commit to reducing their prices substantially to levels that become affordable to the majority of people in need of treatment. And because millions of people need access to these lifesaving treatments, national governments and international bodies, including the WHO, must provide the political push to make this happen.

More than a decade ago, HIV/AIDS patients marched the streets of South Africa, Thailand, and Brazil demanding affordable access to medicines that could save their lives. And with success—in a matter of months the cost of AIDS drugs dropped from over $10,000 per person per year to less than $100 today, resulting in more than 5 million people currently on treatment in low- and middle-income countries. Today, these same people are surviving on cheap generic AIDS drugs only to die from their untreated hepatitis C.

Demanding greater access to treatment is a primary reason that strong civil society groups, including people living with hepatitis C, initiated World Hepatitis Day. Roche and Merck must support people living with hepatitis C by substantially lowering the prices of pegylated interferon-alfa.