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Member Research and Reports

Member Research and Reports

Millions of People with Hepatitis C Blocked from Treatment in Low and Middle-Income Countries, Yale Report Finds

Worldwide leaders came together in Geneva at the World Health Organization just last week to begin developing a five-year strategy to combat Hepatitis C. The disease, which affects 185 million people worldwide — five times as many people with HIV and who live predominantly in low- and middle-income countries — has been called a “silent epidemic.”

Now, a new report by the Global Health Partnership (GHJP) at the Yale Schools of Public Health and Law, the Treatment Action Group (TAG) and the Initiative for Medicines, Access and Knowledge (I-MAK) warns that the global effort to extend treatment to millions is imperiled unless key obstacles to access are immediately confronted.

The 50-page report, Ending an Epidemic: Overcoming Barriers to an HCV-Free Future, offers a comprehensive strategy for improving access to a new class of medicines for the disease, directly acting antivirals (DAAs), in low-and middle-income countries and addressing these barriers.

“The new treatments for HCV are a game-changer: they are remarkably effective and have few side effects,” said Ms. Christine Monahan, a student at the Yale Law School who co-authored the report. “Unfortunately, they are prohibitively expensive for the vast majority of people who need treatment.”

The strategies used with other diseases, particularly HIV/AIDS, to extend treatments to millions who need it has largely depended on getting less expensive, generic versions of these drugs on the market, by pressuring companies to allow other manufacturers to produce their drugs.

“Millions of patients in need of HCV treatments are in middle-income countries. As we have also seen with AIDS, while big drug companies may allow generic access for low-income countries, they are not willing to relinquish control of these more lucrative markets so easily,” said Mr. Tahir Amin, I-MAK’s director of intellectual property.

Sovaldi, one of the first new DAAs on the market, costs $1,000 a pill or $84,000 for a full course of treatment in the United States. Though its maker, Gilead Sciences, has discounted the price for low- and middle-income countries in some cases, the price is still too high in countries like India where treatment costs about 20 percent of the average annual income. Yet generic companies could produce the drug for a few hundred dollars for a full course of treatment.

The report also details the other barriers to providing HCV treatment to those who need it. “Even with lower prices, countries can’t cover HCV treatment on their own,” said Ms. Karyn Kaplan, advocacy director of TAG’s International Hepatitis/HIV Policy. “Just as with HIV/AIDS we’re going to need international donors to step up to make HCV treatment a reality for millions around the world.”

The report also details the specific needs of key populations at high risk or with high prevalence of HCV, such as people who inject drugs. “We need a comprehensive approach to treatment of HCV for these individuals, that is integrated with the services they also require to live healthy lives, including needle and syringe exchange programs and opiate replacement therapy” said Ms. Sara Heydari, a 2014 graduate of the Yale School of Public Health, who is a co-author of the report.

The Global Health Justice Partnership is a partnership between the Yale Law School and Yale School of Public Health. It was established in 2012 to promote interdisciplinary, innovative, and effective responses to global health disparities. By bringing together people with different academic backgrounds, it seeks to make critical policy interventions.