Hepatitis C: A silent killer and a story that deserves more attention

Hepatitis C is a silent killer (people can have it for decades without any symptoms) and a story that is not commonly known in Canada. Yet this virus affects many people, highlights inequities in our health and social systems and is part of an important Canadian story.

Canada has a history of being on the forefront of addressing hepatitis C, starting with Dr. Michael Houghton, an internationally recognized microbiologist at the University of Alberta, who was the first to co-discover hepatitis C and continues to work with his team to create a vaccine for the virus.

Despite Canada’s significant role in discovering the virus, the sad fact is that more than half of Canadians who have hepatitis C do not know that they have it, and even fewer people have access to the lifesaving medications, which are now more widely available.

Approximately 330,000 Canadians are estimated to have hepatitis C, but limited awareness and narrow testing guidelines have meant that most Canadians do not get tested for hepatitis C, even though they may benefit from treatment.

In addition to limited testing, the curious and maddening fact is that most Canadians with hepatitis C need to become very sick from the virus before they can access the treatments. Liver injury (called fibrosis) gets worse the longer a patient has Hep C, and historically access to treatment was limited to those with particularly severe fibrosis because of the high cost of the medications. This situation is, thankfully, improving somewhat.

Last February the pan-Canadian Pharmaceutical Alliance negotiated an agreement with several pharmaceutical companies to lower prices for six hepatitis C medications, which will make it easier for those with Hep C to qualify for drug access. A number of provinces have announced changes in their provincial criteria and access is improving. In some provinces, however, access to medications is still somewhat restricted.

The story of hepatitis C also highlights broader social inequities and gaps in our health care system. Hepatitis C incidence are highest amongst the most marginalized and vulnerable Canadians: people who use injection drugs, Indigenous peoples and people in prisons.

Thirty-five per cent of the infections in Canada are among newcomers who come from high prevalence countries and have been exposed to Hep C through the medical system. Yet these populations face the biggest barriers in accessing health care services.

Prevention methods also remain somewhat inaccessible to populations who need them the most.

In Canada, hepatitis C is primarily spread through injection drug use and the best way to prevent the spread of the virus is to provide new needles and comprehensive harm reduction programming to individuals who inject drugs. Needle and syringe programs have proven effective at reducing transmission, yet such programs are not available in prisons where the prevalence of hepatitis C and of drug use is extremely high. Needle and syringe programs are also very limited in rural and remote areas, as well as on reserves.

Canada could be poised to become a leader in its global response to hepatitis C.

Last year Canada endorsed the World Health Organization’s global health sector strategy on viral hepatitis, 2016-2021, committing us to the goals of eliminating viral hepatitis as a public health threat by 2030 and, specifically, to achieving a domestic diagnoses rate of 90 per cent, with 80 per cent of people living with hepatitis C being treated by 2030.

Hepatitis C could be – should be – a proud Canadian success story, building on the stellar work of Michael Houghton, our strong Canadian medical expertise, and the leadership coming from communities most impacted by hepatitis C.

We need all Canadians to encourage our federal and provincial health departments to take action, ensuring medical access and health care for all.