As the epidemics of HIV, malaria, and tuberculosis receded, viral hepatitis became more visible as a leading killer worldwide. Many hard-won lessons from the HIV experience provided a head start for a targeted approach to a disease situation that mirrors the early years of HIV. For example, while it took nearly a decade to get the price of antiretroviral therapy down, prices for the new hepatitis C cures plummeted within two years.
Making hepatitis C treatments affordable
Work to reduce the prices of the new direct-acting antivirals that can cure hepatitis C is already bringing dramatic results for some populations in a number of countries. Mechanisms being used include licensing agreements that stimulate competition among generic manufacturers, local production, price negotiations with the originator company, and use of a game-changing Medicines Patent Pool.
The Medicines Patent Pool
Relies on products prequalified by WHO, was set up in 2010 to improve access to antiretroviral therapy in low- and middle-income countries. Its remit was later expanded to include hepatitis C and tuberculosis treatments. It is sponsored and fully funded by UNITAID, a drug purchasing facility that draws substantial and sustainable funding from a levy on airline tickets.
In October 2016, WHO announced that more than one million people living in low- and middle-income countries had been treated with the revolutionary hepatitis C curative medicines since their introduction two years earlier.
The announcement coincided with the release of a WHO report on Access to Hepatitis C Treatment: Focus on Overcoming Barriers. The report provides comprehensive data on levels of access, prices charged in different countries, and the situation with patents and registration of the medicines.
The report demonstrated the burden of unmet needs but also introduced transparency to the market, allowing price comparisons across countries. For example, costs per patient per treatment course range from $9,400 in Brazil to $79,900 in Romania. Egypt, which has the world’s largest hepatitis C burden, has also had the greatest success in getting prices down, from $900 in 2014 to less than $200 in 2016.
Including in the European Union, where price reductions are insufficient to allow national health budgets to cover all in need of treatment. However, several countries, including Australia, France, and Georgia, are now providing hepatitis C treatment through their public health budgets.
Inclusion of the new hepatitis C medicines in the 2015 WHO Model List of Essential Medicines is another step that is expected to further stimulate efforts to get prices down. To achieve the targets set out in the global health sector strategy for viral hepatitis, WHO estimates that 80% of patients with hepatitis C will need to be treated.
As happened with antiretroviral treatments for HIV, several civil society organizations, including Médecins Sans Frontières, have simultaneously filed patent challenges against the originator company in an effort to remove affordability barriers, improve access, and end the need to ration medicines. Opposition of this nature has already led to the revoking of patents in China and Ukraine; decisions are pending in other countries, including Argentina, Brazil, India, the Russian Federation, and Thailand.
To date, the number of countries that have secured hepatitis C medicines at affordable prices is much too low for a disease that affects some 71 million people. The world needs to show more outrage over a situation in which the high price of medicines denies so many millions a cure for a disease that is highly stigmatized and so often fatal.