July 28 is World Hepatitis Day, and it’s fitting to remind ourselves that Canadians’ lives are imperiled unnecessarily by hepatitis C — stemming from a lack of knowledge about the disease and from barriers to gaining access to treatment.
New research recently published in the Lancet indicates that “viral hepatitis is a leading cause of death and disability worldwide.” In Canada, an estimated 330,000-plus people have been infected by hepatitis C; that’s one out of 100 Canadians. Their lives are in danger because an estimated 44 per cent of people with hepatitis C in Canada don’t know they have the disease. That’s because people can have hep C for 20 years or more and not have any noticeable symptoms — a tragic circumstance, as the virus is a leading cause of cirrhosis and liver cancer.
Canadians need to know it is important to get tested for hepatitis C. Recent advances in medicine mean that hepatitis C can now be cured in almost all cases in as little as eight to 12 weeks, and the treatment itself is not difficult.
Informing Canadians of the reality of living with hep C, and the fact that it can now be cured, is crucial to our country working toward the World Health Organization’s global goal of, as Canada’s Health Minister Jane Philpott stated recently, “doing the work to end hepatitis as a public health threat by 2030.”
We can applaud Canada’s commitment to this global goal. In order to reach that goal, Canada needs a national plan to address key barriers to achieving an effective response to hepatitis C. That goal will be more achievable if more Canadians are aware of this “silent killer,” and access to treatment is improved.
One key factor related to accessibility is cost. The price tag on these highly effective drugs is exorbitant. Federal, provincial and territorial governments need to negotiate with the pharmaceutical companies to bring down costs, which can range to upwards of $80,000. With the cost reduced considerably, access to these drugs by patients would increase.
Currently, access to treatment is typically tied to the degree of infection in the liver as measured by levels of fibrosis (the degeneration and hardening of the liver), and patients must wait until the infection has reached a more advanced stage of liver disease before they are treated. Many in the health-care community argue for eliminating that criterion of achieving a certain level of infection.
While we have highly effective treatments, these remain largely out of reach to populations that could benefit from them the most. One of the highest prevalence rates of hepatitis C is among those who use injection drugs. Canada’s prisons have high prevalence rates for hepatitis C — between 28 and 40 per cent of the prison population. Introducing needle- and syringe-exchange programs and other harm-reduction programs in prisons would be a welcome measure to address this high prevalence of hepatitis C.
There are also issues of stigma and structural barriers to treatment access among populations particularly impacted by hep C — other people in the general population who inject drugs, indigenous communities, immigrants and newcomers from countries where hepatitis C is endemic. People most affected by hepatitis C face high levels of discrimination, as well as challenges such as poverty, lack of housing and physical and mental illness. All these factors create distance between the person with hep C and the treatment and care they need.
The federal commitment to see an eradication of hepatitis C by 2030 is admirable. But there is a great deal of public education and policy change needed to make that goal realistic.
Laurie Edmiston is the executive director of the Canadian AIDS Treatment Information Exchange.