Hepatitis
World Health Organization
“ Although hepatitis can be cured , there ’ s a vicious circle that stands in the way of providing treatment to all in need : the disease is mostly a silent killer , the diagnostic process is complex , so people go unfound , and drugs are often too expensive .”
Malaysia is now one of the model nations in its approach to hepatitis eradication , after seeing cases rise from 2.56 in 2010 to 11 per 100,000 population in 2016 when the WHO initiated its global eradication target .
When Hiebert travelled to �uala Lumpur in 2017 to develop a strategy for hepatitis C screening , she was impressed by the way the Malaysian Ministry of Health had recognised the problem and was willing to address it .
�From what I ’ ve observed , Malaysia has a plan , they ’ ve done the modelling and investment case analysis , they ’ ve done pilot projects for scaling up , they ’ ve solved the treatment access issue and made treatment more affordable , and so they ’ re very much on the path to elimination . There ’ s still a long way to go in terms of scaling up , but certainly the key elements are in place ,” she said .
While a hepatitis � vaccine is available , none has been developed for the C strain . The disease occurs within the first six months of exposure to blood with the virus , often through intravenous drug sharing , sex , or unsuitable healthcare settings .
Some people may develop symptoms within two weeks of infection , while others might experience a longer delay before noticing them , anywhere from six months to 10 years or more . This lack of awareness leads to one of the main barriers to eradicating the disease and puts a focus on the need for widespread screening of those most at risk .
The United States recently introduced one-time screening of all adults due to the wide prevalence of intravenous drug use there , and other countries with similar problems are likely to move in the same direction .
In Malaysia , where there ’ s less of an intravenous drug problem , a risk-based strategy to identify potential patients and treat them is central to the government ’ s approach to eradicating hepatitis C . This is being done by integrating testing and treatment into harm reduction centres and needle and syringe programmes .
The country has also released a drug that is far cheaper than other direct-acting antivirals that are successful for treating hepatitis but can cost over US��2,000 in Malaysia for a 12-week course .
The new drug , ravidasvir , in combination with sofosbuvir , costs US�300-500 for a course , is available for free at public clinics and hospitals , and has shown the same high cure rates as the more expensive antivirals . It gained local regulatory approval in �une .
�Although hepatitis can be cured , there ’ s a vicious circle that stands in the way of providing treatment to all in need : the disease is mostly a silent killer , the diagnostic process is complex , so people go unfound , and drugs are often too expensive , � said Dr Noor Hisham Abdullah , director-general of health , on announcing the new drug .
“ Malaysia decided to act to break this vicious circle . We ’ re actively screening to find �missing ’ patients , rolling out simpler diagnostic tests , and ensuring we have access to the best prices for treatments , including by conducting clinical research to identify additional affordable treatment options . This announcement is a milestone on Malaysia ’ s long journey to achieve the World Health Organization goal of eliminating hepatitis C by 2030 , � he added .
Despite the notable successes of Malaysia and other early movers , such as Egypt and �eorgia , in meeting the WHO ’ s elimination target , there ’ s still much more to be done . Even with cheaper and more effective drugs available , it remains increasingly difficult to identify hepatitis cases , especially among people whose lifestyles are seen as taboo in many countries .
�The key issue is around finding and testing people , and a lot of countries that have started programmes have found that the first few years are easy going because they have this pool of already identified patients , but that last mile of really finding those patients who don ’ t know they ’ re infected is the big test , and doing that in a cost-efficient way , � said Hiebert .
�There will definitely be regions or countries in the next five years that will have eliminated hepatitis . Countries like Malaysia , Egypt , and �eorgia have been setting good examples and are showing the tools that are needed to succeed .” n
44 AUGUST 2021 GlobalHealthAndTravel . com