by James Snodgrass
At the 69th World Health Assembly held in Geneva in May, delegates approved WHO’s draft global health sector strategy on viral hepatitis, 2016–2021. The strategy suggests that all nations affected by hepatitis should adopt five core interventions:
- vaccination against hepatitis B (and against hepatitis A where appropriate)
- effective injection, blood and surgical safety procedures
- prevention of mother-to-child transmission of hepatitis B
- harm reduction services for people who inject drugs; and
- treatment of chronic hepatitis B and hepatitis C infection
Inevitably the focus of much activist NGO intent has been on the final bullet in this list. However, while the activists are complaining about the price of treatment, there has been a revolution in access over the past decade. A presentation on the World Hepatitis Alliance website by Esteban Burrone of the Medicines Patent Pool (a mechanism which encourages the pharmaceutical industry to offer voluntary licences to generic manufacturers operating in poor countries) shows that many cutting-edge, patent-protected medicines for hepatitis B and C could be available at low cost in over 100 poor countries world-wide due to voluntary licenses. It took years to get to the same situation in treatment for HIV infection. In these countries, the delivery of treatment will be as big a problem as its cost.
That brings up an associated issue already faced in the fight against HIV/AIDS. In many countries, most of those at high risk of infection with hepatitis B & C are in marginalised populations: drug users and prison populations being the most prominent. Policymakers in those countries will be loath to provide funding for either prevention or treatment for those most affected – it will win them no votes or public acclaim. And the governments of many of the countries which are highly affected by hepatitis spend very little on health – in India’s case, less than 1.5 per cent of GNI. Will hepatitis really become a policy and spending priority?
Also prominent in the same presentation are figures from WHO showing the pricing of one of the most effective new treatments for HCV, sofosbuvir (Sovaldi). Of course, the list prices are shown, which often bear little resemblance to the price actually paid by health services to purchase the drug. Again, activists take the view that all countries outside Western Europe and North America should get these treatments at or near to the prices paid by the poorest countries. Yet we live in a world where the GNI per capita of Brazil is equal to that of Bulgaria. Is it not reasonable for middle-income countries to pay more than the poorest? In contrast, the activists who lambast the pharma industry’s pricing policies rarely criticise middle-income country governments who decide to spend very little on health. If those governments spent more, they could afford to provide decent prevention and treatment programmes for their people, and the WHO goal of 80 per cent treatment coverage by 2030 might be achievable.