Hepatitis C: Pushing for access to the cure

Din Savorn, 50, has his blood pressure taken by MSF nurse Em Thyda at the MSF Hepatitis C clinic at Preah Kossamak Hospital in Phnom Penh, Cambodia.
CAMBODIA 2017 © Todd Brown
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The hepatitis C virus (HCV) kills 400,000 people every year, despite the existence of breakthrough medicines that can cure the disease in just 12 weeks. As we mark World Hepatitis Day on July 28, Doctors Without Borders/Médecins Sans Frontières (MSF) underscores the urgency of greater access to HCV screening and treatment.

Around 70 million people worldwide live with chronic HCV infection, millions of whom cannot access lifesaving treatments. Without treatment, the blood-borne disease can lead to liver failure, liver cancer, and death. It can take years for HCV to progress, and the years are often marked by constant fear of what may come.

While newer, pill-only direct-acting antivirals (DAAs) are simpler for patients to take, have far fewer side effects, and have a 95 percent cure rate, exorbitant prices remain a deadly barrier to treatment in both high-income and developing countries. In fact, although the estimated manufacturing cost for a 12-week course of sofosbuvir and daclatasvir is less than $100, the manufacturers Gilead and Bristol-Meyers Squibb priced them at a staggering $147,000 per treatment when they launched these drugs in the United States.

MSF has been fighting for years to close the HCV treatment gap with strategies aimed at increasing access to affordable, quality-assured generic versions of the drugs. In a major milestone, MSF announced in 2017 a deal with generics manufacturers to procure DAAs for just $120 per treatment in almost all MSF projects, allowing teams to start more people on treatment. MSF provided HCV treatment with DAAs to 5,926 people in 13 countries in 2017.

One patient who benefited from an affordable cure is Din Savorn, a 50-year-old father of three living in Phnom Penh, Cambodia, who was diagnosed with HCV in 1999. In recent years, he heard about people being cured with newer treatments but lost hope of being cured himself until he was given the newer drugs sofosbuvir and daclatasvir.

“I wanted to get treated, but I couldn’t afford it,” he said. “I would have had to sell my house. Then my children would have no shelter. So, I just waited.”

In early 2017, Din started treatment at a MSF clinic in Phnom Penh, the only facility in Cambodia providing HCV treatment free of charge. A few months later, he got the news he had waited almost 20 years to hear: his treatment was a success. He was cured.

Hepatitis C - Clinic Cambodia
Din receives treatment at the MSF Hepatitis C clinic in Phnom Penh.
CAMBODIA 2017 © Todd Brown

But Din is one of the lucky ones; fewer than five per cent of people worldwide who could benefit from DAAs have received them.
 
MSF hopes last year’s announcement to offer $120 per treatment in almost all MSF projects will have a domino effect by increasing transparency and giving governments more power to negotiate better prices. However, the outlook is worrying, especially in middle- and high-income countries where patent monopolies block the production and importation of generic DAAs and allow pharmaceutical companies to keep prices high for 20 years or more.

Cambodia Hep-C
"I wanted to get treated, but I couldn’t afford it," Din said. "I would have had to sell my house. Then my children would have no shelter. So, I just waited."
CAMBODIA 2017 © Todd Brown

Patents are granted according to technical criteria defined in national patent laws. Technologies that do not meet these criteria should not be awarded patent protection, even if they offer significant medical benefits for patients. When unmerited patents stand in the way of affordable access to medicines, MSF challenges them by supporting and filing legal oppositions.

MSF filed two such challenges to HCV treatment patents in 2017, and both are currently under review. The first challenges a patent application in China that would block generics companies from producing and exporting affordable versions of a treatment that combines two crucial DAAs. The second—filed together with a broad coalition of health advocates in the European Union—challenges a patent that could block 38 European countries from producing or importing generic sofosbuvir.

We finally have the tools we need to cure and prevent transmission of HCV, and almost all governments have committed to eliminating the disease as a public health threat by 2030. Making good on that commitment requires bold, decisive action to rapidly expand access to HCV screening and treatment.

This article is adapted from a chapter written by Jason Maddix, senior communications officer for MSF’s Access Campaign, published in the International Activity Report 2017.