There is much to celebrate as China marked World Hepatitis Day this week. Large-scale immunization program has led to the current generation of Chinese children being virtually hepatitis B free. In the last year, major policy developments have paved the way for significantly improved 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.
Currently, an estimated 100 million people in China are living with chronic hepatitis B and hepatitis C infection. That’s 1 in 13 people! The majority are unaware they are carrying the virus, making the hepatitis epidemic 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 3-month course of treatment.
Yet only 1 in 50 people with hepatitis B or C in China are receiving the treatment they need currently. The biggest hindrance to hepatitis B treatment is the prohibitive cost, which is beyond the reach of people on average incomes. Today, the cost to individuals for treatment of hepatitis B can exceed 40% of the annual average household income; this figure increases dramatically as the disease progresses.
For hepatitis C, the problem is not just one of cost. The newest, cutting edge treatments (DAAs) 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.
Beyond the tragic loss of life and emotional impact on families and communities, hepatitis also imposes a tremendous cost to the health system, economy and society.
A person who needs treatment for hepatitis B now but can’t afford it will end up costing the health system much more in the future if they develop liver disease. Once liver cancer develops, health costs escalate dramatically. In other words, not providing treatment now results in substantial costs to the health 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, by avoiding hospitalization and care costs associated with serious diseases including liver cancer.
Fortunately, in the last 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 – approximately 490 RMB per month, down from 1,500 RMB. 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 out-of-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 – because it will speed up access to the best hepatitis C treatments. 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. However, it is still not clear how long this accelerated process will take. So, people wait and continue to suffer the consequence 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 a universal 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. Only when people can actually get these medicines at an affordable price will lives be saved.
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