The European Commission Supports Harm Reduction For People Who Inject Drugs. Does Your Country?

We know what works. Opioid substitution therapy in prisons, safe needles in the streets, direct-acting antivirals (DAAs) for anyone who’s infected. No, what we need to eliminate hepatitis C isn’t more interventions. What we need is the political will to implement what works.

What we need to eliminate hepatitis C isn’t more interventions. What we need is the political will to implement what works

Alas, it seems like it’d be easier to develop a new vaccine than to develop a political spine, but it does happen. I was reminded of that recently in Bucharest, at the 4th European Harm Reduction Conference. During the closing session, I listened to Portugal’s shadow minister of health, Ricardo Baptista Leite, tell a story I never tire of hearing – how the Portuguese government dramatically reversed the spread of two deadly diseases. First, they did it with HIV, by decriminalising drugs and embracing harm reduction, and now they’re doing it with HCV, by making DAAs freely available to everyone. In just three years, they’ve already cured one third of the population with chronic hepatitis C, saving more than 60 000 life-years and €270 million in the cost of treating complications.

Source: Ministry of Health. National programme for viral hepatitis. Available here (accessed August 2018); @RBaptistaLeite

As both a public health expert and a member of parliament, Baptista Leite knows just how hard it is to change public policy. And he shared a simple method for doing it. The key? Show politicians that the new policy has four qualities that will make it worth their while:

1. Relevance. Align the policy with an issue of public concern.

2. Effectiveness. Demonstrate how it makes a difference with before-and-after data.

3. Cost-effectiveness. Show them how much money it will save – or at least how little it will cost.

4. Timeliness. Plan implementation to show results when they need them – e.g., in time for the next election.

The success of the Portuguese approach makes it that much easier to argue for harm reduction and universal treatment in other countries

Of course, the success of the Portuguese approach makes it that much easier to argue for harm reduction and universal treatment in other countries.

Source: Tato Marinho R, Rodrigues J, Paula Martins A, Andreozzi V, Vandewalle B, Félix J, Castro Alves E, Mota-Filipe H. Long-Term Effect of the Portuguese Universal Access Program to New Generation Direct-Acting Antivirals for Treatment of Hepatitis C. EASL 2016, Barcelona, Poster #SAT-178. @RBaptistaLeite

Still thinking about advocacy and policy, I chaired a partnership forum being held for HA-REACT, the European Joint Action on HIV and Co-infection Prevention and Harm Reduction. Much of the forum focused on a simple evaluation of what HA-REACT has accomplished as it enters its final months.

Given the complexity of EU joint actions, it’s no surprise that people have difficulty wrapping their heads around them. HA-REACT is no exception, with 8 work programmes being implemented in 18 EU Member States by 22 partners and 14 collaborating partners. Yet it dismayed me to read one of the few indicators used to assess the joint action: has HA-REACT had an impact, including at the policy level?

That represents a fundamental misunderstanding of how joint actions work. They’re not policy advocacy projects per se, because the countries are already committed to carrying out the project interventions. Moreover, they choose their own implementing partners, many of them state institutions or agencies.

On the other hand, HA-REACT has created better conditions for advocacy – by strengthening the relationships between government bodies and implementing partners, by developing a better body of evidence for effective interventions, by creating pilots that countries can then continue and expand – and by demonstrating that the European Commission is firmly committed to harm reduction.

That’s far from the case in countries as diverse as the Philippines, Russia, Turkey and the United States. Now that HA-REACT is coming to an end, I hope that the European Commission will continue to put its money where its mouth is and support harm reduction, the end of HIV and the elimination of viral hepatitis, in line with the commitments its Member States made to achieve the Sustainable Development Goals and the WHO strategies on viral hepatitis and on HIV.

More information

HA-REACT harm reduction video

HA-REACT harm reduction brochure