Egypt wins acclaim for aggressive campaign against hepatitis C
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Egypt has the highest rate of hepatitis C in the world. Now the country has undertaken an aggressive campaign to stamp out the disease, both domestically and abroad.
The hepatitis C epidemic in Egypt dates back to the 1960s and 1970s, when the needles used during a mass immunisation programme were not properly sterilised. In the ensuing years the disease spread rampantly, largely because there was little awareness. The result was that Egypt developed the highest infection rate in the world; in 2008 an estimated 14 percent of the population carried the virus, according to an Egyptian survey carried out at the time.
The disease was a major drain on the Egyptian economy, accounting for 4 percent of all direct healthcare expenditures, according to a study conducted by the Center for Disease Analysis (CDA) in the US and the National Liver Institute in Egypt. When indirect expenditures are factored in, hepatitis C costed Egypt an estimated 1.4 percent of its gross national product (GNP), according to the study.
And it was difficult to fight. Hepatitis c is a blood-born virus, and a person can be infected with it for years without ever having any symptoms. In most people the virus does slow damage to the liver, and can eventually cause cirrhosis and cancer. Globally, hepatitis C kills more people every year than any other chronic infectious disease, including HIV, malaria and tuberculosis.
A few years ago, the Egyptian government decided to tackle the issue head on, helped in large part by a new class of orally administered drugs that came on the market in December, 2013. Until then, the standard treatment was based around injections of interferon, which not only has debilitating side effects but a relatively low success rate of between 19 and 60 percent, depending on a person’s genotype.
The new drug, Sofosbuvir, sold in the US as Sovaldi, has few side effects. When combined with supplementary medications, which vary somewhat according to genotype, the success rate is between 95 and 98 percent, said Professor Wahid Doss, chairman of Egypt’s National Committee for the Control of Viral Hepatitis.
“The new drugs are more effective and easier to take,” said Charles Gore, president of the World Hepatitis Alliance.
While Sovaldi seemed to be a miracle cure, it had one major downside. A 12-week course of treatment cost about $84,000, placing it out of the reach of most patients, and launching a firestorm of criticism of its manufacturer, Gilead.
Gilead seems to have felt the heat, because in March 2014 it announced that it would begin selling the drug to Egypt at a 99 percent discount, or $600 per course. In 2015 an Egyptian company began manufacturing a generic version that costs about $80 for three months of treatment. The reduction in price enabled the Egyptian government to launch a massive and widely lauded program to wipe out the disease.
“There is no question that the government has taken it on,” Gore said. “They see a lot of value in doing a really good thing, and they are doing a really good thing here. Because it is so prevalent, everyone [in Egypt] knows someone with hepatitis C.”
“Egypt did marvelous work in combating hepatitis C,” said Dr. Alaa Hashish, a medical officer with the World Health Organisation (WHO) in Cairo. “But there is still a long journey.”
While infection rates had already started to fall, in large part due to the ageing of the population who had contracted it through the vaccination program, there were still an estimated 5 million people suffering from the disease, Doss said. The government opened 64 treatment centres across the country and made the medications available at another 100 small clinics, Doss said, to make the regimen accessible to those living outside of population centres.
In the years since the program started, 1.7 million of those have been treated, Doss said. Waiting lists for the drugs have since disappeared.
“All the member states [of the WHO] are looking to the Egyptian program as a pioneer program, based on the achieved numbers,” Hashish said.
With the majority of those diagnosed with the disease having already undergone treatment, the staff at those medical centres now has little to do. “We have a problem,” Doss said. “Most of our centres are devoid of patients.”
The government has set out to address that issue by launching a nationwide screening program to identify the estimated remaining 3.3 million people who don’t realise they are infected with the virus.
One of the partners in the treatment and testing programs is Pharco, the company manufacturing the lion’s share of the generic drugs being used to treat the virus in Egypt. To help find new patients, the company has put eight mobile clinics into service that will travel throughout the country providing free screening, said Pharco’s CEO Sherine Helmy. By 2018, 30 million Egyptians will have been tested, he said.
But even that isn’t enough, Helmy said. Without proper precautions, the virus will continue to spread. To that end, he has launched a public education campaign. Even those who think they are being careful might not be doing enough, he cautioned.
“The problem is, if you go to a barber shop, you take your scissors and your blade, but if the barber is using his hand without cleaning it, it can still transmit,” he explained, as can the brush used to wipe the hair off one’s neck. “That’s why awareness campaigns are so important.”