THE ECONOMIST SPECIAL
Over a year after the publication of The silent pandemic: Tackling hepatitis C with policy innovation, the hepatitis C virus (HCV) continues to pose a rising threat to healthcare systems worldwide.
As many as 170m people, or 2.4% of the world’s population, are infected with HCV, according to the World Health Organisation (WHO), nearly five times the number estimated to be living with HIV. While mortality rates as a result of acute hepatitis have remained relatively constant over the past ten years, deaths from HCV complications, such as cirrhosis of the liver, have seen a much sharper upward trajectory.
There are countries in each region of the world that suffer from high rates of infection: Georgia and Romania in Europe, Brazil and Argentina in Latin America, Mongolia, Indonesia and Taiwan in Asia, Egypt and Sub-Saharan countries in Africa, and the United States in North America. As a result, a number of these countries have played a leading role in multinational efforts to combat HCV.
In our earlier report we found that the lack of sufficient knowledge and data about the disease and its prevalence, poor public awareness, the failure to follow through consistently with treatment where testing is available, and high rates of infection among marginal populations had created significant barriers to tackling HCV. In this update, we look at what progress has been made and the barriers that remain.
The key findings include the following.
Epidemiological data remain scarce, but awareness of the disease is growing. The continued lack of data remains a problem, with 2010 being the most recent year for which comprehensive global data are available. A number of governments as well as non-governmental organisations (NGOs) in countries ranging from Thailand to Brazil are accelerating efforts to improve education (particularly of high-risk groups), increase outreach programmes and make testing for the virus more accessible. Yet the number of those providing free testing remains small, eliminating another potential source of data about the spread of the disease. In addition, the relatively recent emergence of HCV means that many awareness campaigns and multinational initiatives are still focused on viral hepatitis more broadly, making it difficult to assess the extent to which national health authorities are addressing HCV separately from other strains of viral hepatitis.
NGOs and patient groups are taking the lead. Patients and advocacy organisations are playing a key role in shaping the policy agenda to tackle HCV. On a multinational level, groups such as the World Hepatitis Alliance (WHA), the European Liver Patients Association (ELPA) and the Coalition to Eradicate Viral Hepatitis in Asia Pacific (CEVHAP) have mobilised lawmakers and officials from the WHO to commit to a more integrated policy approach to help developing countries cope with what is expected to be an explosion of HCV cases over the next decade. “It’s an odd dynamic, where people are becoming more aware, but that hasn’t yet translated into real concrete action,” says Stefan Wiktor, team lead for the Global Hepatitis Programme at the WHO. “The idea is to try to harness some of this excitement and start moving it in a more aligned direction.” As a result, many initiatives during the past couple of years have focused on establishing multiple official pathways for the exchange of information and advice between the WHO, technical advisers, patient groups and national governments, including the WHO’s Framework for Global Action in 2012.
A better knowledge of the disease underscores the need for a co-ordinated response covering a range of areas. Healthcare stakeholders are becoming more aware of the way in which HCV progresses and of the potential for curing a significant percentage of those who are infected if they are identified sufficiently early. As a result, more rapid testing and earlier diagnosis have become a priority for patient groups and health officials, as well as an important component of prevention. “What we see in general is that detection rates are slowly increasing, largely thanks to the activities of NGOs,” says Achim Kautz, vice president of the ELPA. Initiatives with the greatest success rate so far tend to focus on HCV in a holistic way, rather than on one individual aspect.
Global variations in addressing HCV persist. The ways in which governments deal with the threat posed by HCV vary substantially, with only a minority of countries—such as Egypt, which has the worst-affected national population (nearly one in five people have the virus)—taking a more aggressive approach to testing, surveillance and treatment. On a regional basis, countries in Africa (with the exception of Egypt), eastern Europe and Central Asia have begun to expand access to testing and diagnosis of the disease only relatively recently. By contrast, larger middle-income countries in Latin America and South-east Asia appear to be mobilising resources more successfully.
 Bulletin of the World Health Organisation, 2012; 90:540-550; Guidance on prevention of viral hepatitis B and C in people who inject drugs, World Health Organisation, July 2012.