It is a disease estimated to afflict more than 150 million people worldwide, infecting from three to four million more each year, and killing about 700,000. In Egypt, the World Health Organization estimates that 10 percent of people between 15 and 59 years old live with the disease. That’s hepatitis C alone. The combined impact of hepatitis B and C, both spread through unsafe injections, unchecked blood supplies, sexual contact, and from mother to child, takes nearly one and a half million lives a year, and causes 80 percent of deaths from liver cancer.
Fortunately, recent years have seen a breakthrough, with medicines that can cure hepatitis C in nearly everyone, relatively quickly, with manageable side effects, without injections. Compatible with treatment for HIV, and effective for people co-infected with both diseases, a combination of two of the medicines, sofosbuvir, patented and marketed by Gilead as Sovaldi, and daclatasvir, from Bristol-Myers Squibb, has been found effective in settings where need outruns resources. But the medicines represent scientific breakthroughs that have yet to translate into a public health breakthrough, a joint release from the International Treatment Preparedness Coalition and Treatment Action Group note, because high prices continue to keep the medicines out of reach where they are needed most.
Consider Egypt, where WHO is holding what it calls its “flagship event” of World Hepatitis Day, in recognition to the enormous impact of the disease there. Last year, in the midst of outrage over the $84,000 price tag for a three-month course of Sovaldi — estimated to cost from $68 to $136 to produce — Gilead offered Egypt a deep discount, pricing a treatment course of the drug at $900 there. One problem? If the 10 million people in Egypt who needed treatment for hepatitis C got it, the price still would break the back of the public health system. In addition, while Bristol Myers Squibb followed Gilead’s example of offering licenses to produce generic versions of its drug, which is estimated to cost from $10 to $30 per course of treatment to produce, in some lower and middle income countries, it has not in Egypt.
This is just one of an obstacle course of barriers between effective treatment that could stem the spread of hepatitis C, and the people who need it, ITPC and TAG say. They are asking Gilead and Bristol-Myers Squibb to drop their prices, and speed registration of the drugs and remove barriers to generic production where the drugs are needed most. They are calling on governments to address intellectual property barriers to generic production and to allocate resources to get more people on treatment. And they are calling on the World Health Organization to support countries in efforts to ensure access to affordable effective hepatitis medicines.
In the meantime, BioMed Central is announcing the launch of a new open-access, peer-reviewed journal, Hepatology, Medicine and Policy, to examine the intersection of advances in science addressing the disease and the systems that determine its delivery.