Hepatitis C: A Public Health Problem—Not Only in Spain

The recent statement by Spain’s Health Minister regarding the Government’s Strategic Plan for Hepatitis C has brought hope to a group of patients who have been fighting for a long time for the right to receive the new oral therapies for hepatitis which achieve high cure rates but are not accessible to most of the people affected by the virus owing to their high cost on the market. According to the Ministry of Health, the new treatments will be available to all patients in Spain who have been diagnosed with hepatitis C virus infection and are in the later stages of the disease. While the government has not made public the price negotiated with the pharmaceutical companies for these drugs, they have said that the estimated total expenditure involved in the purchase will be €727 million.

This encouraging news has not, however, been free from controversy, and differences of opinion emerged when the topic was discussed at the Hepatitis C Seminar organised by the General Council of Medical Colleges in Spain on 6 March last, an event attended by doctors, affected patients and representatives of various political parties. During the seminar, the pledge made by the governing party that the new drugs will immediately be made available to patients was at odds with the view expressed by the opposition party, which criticised and raised doubts concerning the proposed method of funding the cost of the drugs through the regional governments (autonomous communities) and the fact that representatives from bodies with expertise in health planning, such as the agencies responsible for public health and primary care, were not involved in the negotiation process.

The hepatitis C virus is not only a public health problem in Spain; it is estimated that there are 185 million people infected worldwide, many of whom have never been diagnosed, and that the disease currently causes some 350,000 deaths a year. While wealthier countries negotiate with the large pharmaceutical corporations for deals on the new treatments required to cover their national needs, in most low- or middle-income countries, where the infection is highly prevalent, the authorities are still struggling to obtain the old therapies at affordable prices. Even though the regimen used in conventional therapy is poorly tolerated due to various side effects and is associated with only mediocre cure rates, it is still the combination being used to treat thousands of patients infected with the virus who live in countries with scant resources.

Strategies to Increase Access to Hepatitis C Treatment, a recent study that analyses the access to hepatitis C therapies in three eastern European countries, concluded with a number of recommendations, including a call to mobilise civil society to increase political commitment and to address the problem globally. Six months later, hepatitis C is in the news, and our hope is not only that the government will keep its promise and Spanish patients will receive treatment but also, by extension, that all patients with this disease, irrespective of where they live, can have access to the best treatment available.

[Anna Cusí presented the study Strategies to Increase Access to Hepatitis C Treatment: A Question of Price or Public Health? as her final thesis for the ISGlobal-UB Master of Global Health. The study has now been published by the ISGlobal Department of Analysis and Global Development]