The global AIDS response can help in fighting hepatitis C
By Paul Farmer, Published: February 12
Paul Farmer is a professor at Harvard University and an infectious disease physician with the Brigham and Women’s Hospital in Boston. He co-founded Partners in Health.
A decade after the global AIDS response began in earnest, it’s worth asking whether the lessons learned will be sustained over time and used to avoid past mistakes when tackling new challenges.
One such challenge is chronic hepatitis C
When I trained as an infectious disease physician in the mid-1990s, I traveled frequently between Boston’s teaching hospitals and rural Haiti
This divergence was thrown into relief at a 1996 AIDS conference where researchers presented data showing that combination antiretroviral therapy could transform HIV infection from a death sentence into a manageable chronic disease. The conference’s theme that year was “One World, One Hope.” A coalition of activists, noting the $15,000 annual cost of the lifesaving drugs
By 2000, more than 6 million people were dying in poor countries
Thankfully, and in no small part because of the relentless efforts of AIDS activists, an abiding cynicism about the limits of an international response to these pandemics gave way to an unprecedented “delivery decade.” This was inaugurated in the early 2000s with
As I recounted in the New England Journal of Medicine
Despite such progress, much remains to be done. Nearly half of all people living with HIV who need treatment still don’t receive it
Today, the world faces a “1996 moment” in the fight against hepatitis C.
As in 1996, highly effective new therapies are coming online. Regimens containing the new polymerase inhibitor sofosbuvir
Sofosbuvir’s initial price has been set at $80,000 to $90,000 per 12-week course — about $1,000 per pill. Like those infected with HIV, 90 percent of hepatitis C patients live in low- and middle-income countries
In the face of such numbers, it is tempting to give in to pessimism. “Poor countries could never afford these prices; the demand simply isn’t there,” some say. But when the share of those infected with hepatitis C reaches 1 in 40 people alive today, claims of weak demand are not credible. Such language is often code for ability to pay, not actual burden of disease. In many years practicing medicine, I have yet to meet a patient — rich or poor — with a treatable disease who doesn’t want to get better.
Drug prices are not immutable, and price is not the same as cost. Pharmacologists with Liverpool University recently analyzed manufacturing processes for new hepatitis C regimens and concluded
Precipitous drops in price are not unprecedented; in the delivery decade, innovative partnerships through financing mechanisms such as UNITAID
Smart investments in accurate diagnosis and in effective therapy for hepatitis C could save millions of lives in the coming years, radically cut transmission and pave the way toward eradication of the virus. Or, we could choose to ignore the lessons of the AIDS response and stand by as outcomes improve solely among the fortunate few who enjoy ready access to the fruits of modern medicine. Divergence of outcomes occurs within nations and across them; they grow whenever innovation is not coupled with implementation among the most vulnerable.
But we live in one world. As infectious pathogens such as HIV and hepatitis remind us, our hopes are tied together more closely than we might imagine.
Thank you Jill Gatwood, MS, Health Services Outreach Officer, ECHO Institute, University of New Mexico, for sending me this article