Eliminating hepatitis C

I REFER to news of a new generic drug combination for treating chronic hepatitis C that is ready to be rolled out under a government initiative and the reduction in the cost of treatment from about RM300,000 to just RM1,000. It was stated that some patients will benefit from this initiative.

This access to affordable medicines is the result of the issuance of compulsory licensing by the government to import or produce generic versions of Sofosbuvir and Daclatasvir.

My joy was short-lived upon learning that the drugs will only be available in 18 state hospitals run by the Ministry of Health (MOH). What happens to those who seek treatment at university hospitals or private hospitals? Does the MOH expects all 400,000 patients to go to these 18 state hospitals? Can the hospitals accommodate them?

Bear in mind these patients have yet to be fully evaluated before treatment and tests need to be done to determine eligibility to treatment and likelihood of response and such tests are not cheap.

Surely this is not the most brilliant way to eliminate hepatitis C in Malaysia? Such affordable drugs should also be made accessible to all other Malaysian patients including those who prefer to go to non-MOH hospitals as long as the standards of care are maintained. Hepatitis C can lead to chronic liver disease including liver cirrhosis and liver cancer. No point selecting only some patient groups to be treated and leaving others to fend for themselves. A public health approach is crucial in preventing transmission and eliminating the disease.

I appeal to the MOH to ensure that the drug combination be made available to all hospitals with expertise in managing such patients? If there needs to be some mechanism to introduce the drugs to private hospitals, so be it but no Malaysian patients should be deprived of getting these affordable drugs.

Viral hepatitis is a leading cause of death worldwide with 1.46 million deaths in 2013. More than 90% of this burden is due to the sequelae of infections with the hepatitis B virus and hepatitis C virus. There is no magic bullet for hepatitis B yet but there is real hope for patients with hepatitis C.

If we do not do anything tangible, 19 million hepatitis-related deaths are anticipated from 2015 to 2030. The 2014 World Health Assembly requested the World Health Organisation to examine the feasibility of eliminating hepatitis B and C and the 2015 Agenda for Sustainable Development commits to combating viral hepatitis.

For this to happen, we need to educate the public on how hepatitis gets transmitted, the importance of getting themselves tested, preventive strategies and treatment options available. For those found to be positive during screening, they must be provided with the link to see their doctors to get advice and treatment. We also need to train our healthcare providers on the best way to manage patients with chronic hepatitis.

We know that among those diagnosed, treatment has reached only a small fraction. In 2015, only 7.4% of those diagnosed with HCV infection or 1.1 million persons had started treatment. While the cumulative number of persons treated for HCV reached 5.5 million in 2015, only about half a million had received the newer, more effective and better tolerated direct-acting antivirals (DAAs). Drug compliance is also important and for hepatitis C, this should not be a problem as the duration of treatment is only for 3-6 months, some even shorter.

To eliminate viral hepatitis, we need to work together. MOH cannot carry on the fight alone. All stakeholders must be involved. The Malaysian Liver Foundation has made several overtures to work with MOH. So far there has been a deafening silence. I hope the authorities will now respond and lead the charge to eliminate hepatitis C once and for all.

Tan Sri Dr Mohd Ismail Merican
Malaysian Liver Foundation