Honor promise of hepatitis treatment
There is much to celebrate as China marked World Hepatitis Day this week. A largescale immunization program has led to the current generation of Chinese children being virtually hepatitis B free. In the past year, major policy developments have paved the way for significantly easier access to treatment for both hepatitis B and C. Now, we need to translate the promise of better access to treatment into reality for all.
About 100 million people in China are still living with chronic hepatitis B or C infection. That is one in 13 people! And the majority are unaware of the fact, making hepatitis a truly “silent epidemic”. Without treatment, up to one-third will develop life-threatening illnesses such as cirrhosis and liver cancer. All told, there will be about 10 million deaths among people living with chronic hepatitis B and C in the next 15 years.
Effective treatments for chronic hepatitis exist. There are now drugs available for hepatitis B infection that can reverse the damage to the liver and reduce the risk of liver cancer. For hepatitis C, direct-acting antiviral (DAA) medicines can actually cure the infection and get rid of the virus completely — with just a three-month course of treatment.
Yet only 1 in 50 people with hepatitis B or C in China are receiving the treatment they need. The biggest hindrance to hepatitis B treatment is the prohibitive cost, which is beyond the reach of people with average incomes. The cost can exceed 40 percent of the annual average household income, and the figure increases dramatically as the disease progresses.
For hepatitis C, the problem is not just one of cost. The DAA medicines which can cure almost everyone with hepatitis C in just 12 weeks are not available in China at all, because of complex and lengthy drug registration processes.
A person who needs treatment for hepatitis B now but can’t afford it will end up costing the healthcare system much more in the future if he/she develops a liver disease. And once liver cancer develops, healthcare costs escalate dramatically. In other words, not providing treatment now results in substantial costs to the healthcare system later on. Chronic hepatitis destroys not only the liver, in doing so it devastates lives, breaks up families, and breaks the bank.
Conversely, providing affordable and universal coverage to optimal treatment and care will save individuals and society substantial costs over time.
Fortunately, in the past year two major policy developments in China have established the foundation upon which large-scale access to hepatitis treatment can be built. The first is the significant reduction in the cost of the drug used to treat hepatitis B to a more affordable level — about 490 yuan ($76.9) a month, down from 1,500 yuan. The challenge now is to make sure that hepatitis B treatment is fully included in health insurance schemes, so that people living with hepatitis can get the treatment and care that they urgently need without crippling outof-pocket expenses.
The other major policy development is the unprecedented acceleration of the registration process for new hepatitis C medicines. On the surface, this is fantastic news. It simply isn’t right that people living with hepatitis C in China can’t access the best treatments readily available elsewhere in the world. But it is still not clear how long this accelerated process will take. So, people have to wait and suffer the consequences of hepatitis C infection in the meantime.
We have seen what China can do when it sets its mind to a task — the fact that hundreds of millions of Chinese children have been spared hepatitis infection through the immunization program is testament to this determination. Now is the time to apply the same approach to providing optimal and affordable treatment to those already afflicted with the disease. We simply cannot afford not to treat people with hepatitis. Only when people can actually get these medicines at an affordable price will lives be saved.