By Giten Khwairakpam, Community and Policy Program Manager, amfAR/TREAT Asia programme, Bangkok and member of the Medicines Patent Pool’s Expert Advisory Group for Hepatitis.

How Giten became engaged in the fight against hepatitis C

 “When my father became ill suddenly in 2001, he had never heard of hepatitis C, nor had anyone else in my family. We had no idea what was happening. He passed away three months after first entering the hospital. The doctors did not really explain how many months the treatment would take, nor how it would work, and the medicines were very expensive for us at the time.

This drove me to learn more about the disease. I only knew that it was serious and that the existing medications were inadequate, even toxic. I had also started noticing that something was happening in my neighbourhood: people around me, including friends, showed signs of hepatitis symptoms.

Now, 17 years later, I know what this disease is and what causes it. And I have since learned that my father died of intolerance to interferon, the drug used at the time to treat hepatitis C. Fortunately, hepatitis C medicines have improved since then and have less side effects.”

To fight hepatitis C, we first need to find the patients wherever they are.

Since hepatitis C does not exhibit symptoms, this is a difficult task. All the more so because a large number of people may be affected. If you were born before the 1980s, for example, have been to a dentist, donated blood, received an unsafe injection or a tattoo, you could have been infected with the virus.

And it is highly probable that you would not know your status until you were randomly tested or developed a complication so severe that you were hospitalised. At this point, the disease would be very advanced, your liver damaged and regression unlikely. Despite access to treatment, most patients with this state of the disease die of liver complications.

This is why building awareness of hepatitis C is key. Public health programmes, which already benefit from large-scale public engagement — such as maternal and children care programmes — and targeted ones — such as harm reduction programmes and HIV care and treatment programs, can go a long way in spreading awareness among key populations.

If we find patients at an early stage of the disease, we could cure them before their liver becomes too damaged. We could see a global decrease in mortality if we screened and diagnosed people whenever the opportunity arises. This could be when people come to a healthcare facility for outpatient care or the first day they become part of a health-related government programme or decentralized screening programs offering testing in care facilities.

Screening, diagnostics and treatments should also be made simpler and easier to access.

Let me give you an example. We are currently advocating for policy changes so that a larger number of doctors can screen and treat people. In South-East Asia, the region where I work, China, India, Vietnam, Indonesia, the Philippines and Pakistan bear a very heavy disease burden. And the situation is such that, in some countries in the region, only trained gastro-physicians are allowed to diagnose and treat hepatitis C patients. This was very important when Interferon was the only drug available, since its very serious side effects had to be closely monitored by experts. But this is no longer necessary with the new medicines now available on the market. These types of restrictions should be lifted as soon as possible to prevent access issues and typically situations where, at country level, only a hundred trained gastro-physicians are available to screen and treat thousands of people.

For wider screening and treatment schemes to be put into place, hepatitis C needs to become a high priority in governmental planning. Since this type of decision-making is based on evidence, it is difficult for governments to define thresholds or epidemic status and modify public health strategies because there is currently limited to no data on hepatitis C. To develop a set of indicators and targets, we need studies to be conducted and data to be collected and analysed. We have learned from the international response to HIV that data and scientific evidence are crucial to ensuring long-term support from governments, medical staff and civil society.

And early screening is only part of the battle. While effective treatment should immediately follow a hepatitis C diagnosis, several issues can arise at this stage, which is why we should focus on the availability and affordability of medicines, as well as on the quick registration and roll-out of new treatment options. Current voluntary licensing initiatives improve public health outcomes. The Medicines Patent Pool’s public health oriented licences contribute to scaling up access to quality assured generic medicines and combinations in low- and middle-income countries, e.g. for daclatasvir (licence agreement with Bristol-Myers Squibb) and ravidasvir (licence agreement with Pharco Pharmaceuticals). To make sure that most people can access them, hepatitis C medicines must become part of public health programmes and strategies. We should focus on making this happen.

To put it in a nutshell, hepatitis C can be cured very easily, within a short treatment span. All in all, we are not very far from achieving the 2030 global elimination target. Political will and conviction, coupled with advocacy efforts and increased public awareness, can support this goal.