Hepatitis C Shouldn’t Become Another Ebola

Electoral pressure seems to have exerted its magical effect as the government announced during the state debate that all Hepatitis C (HCV) patients in our country will receive the new treatment in the next few weeks. The engagement has led to a soft loan to the autonomous communities (the “I invite, you pay” strategy, as the health advisor for Asturias said), as the estimations seem to be way below the real number of cases and nobody can say with certitude where the resources to treat the uncounted for patients will come from. Nevertheless, the kick-start will silence the affair, at least for now.

The question now is whether the Spanish society will do with HCV what it did with Ebola some months ago: once my problems are solved, I don’t care for the rest.

Because the case in Spain is only a microcosmos of a global problem where the high prices of the treatments prevents the access of hundreds of millions of HCV patients to life-saving drugs. According to WHO, between 130 and 150 million people are living with HCV worldwide, of which between 4 to 5 million are co-infected with HIV. Seven out of ten are living in developing countries (in first place, China, with almost 30 million people, followed by India and Egypt, with 18 and 12, respectively).

It is estimated that HCV mortality is greater than 350,000 people per year and most of them die without having received any kind of efficient treatment. Why is this? Although disease diagnosis, cost of infrastructure and paucity of healthcare professionals are a major problem in many countries, the main obstacle lies in the high costs of the medications, whose prices are different depending on the negotiation of each government with the pharmaceutical company. The rich countries are paying dearly the bill: Sofosbuvir (Sovaldi) received FDA approval the 5^th of December, 2013 and its market price is $84,000 per treatment (around 1,000 USD per pill). A member of the main drug management agency in USA declared that, with those prices, the cost of covering Medicaid beneficiaries and prison interns would rise to 55,000 million dollars, “a tax on all Americans”.

I wonder how long it will take us to raise the issue in our country. After all, the generosity of the Government is not borne by the autonomous communities but by the tax payers, that will pay the several thousand euros (the agreed price remains a mystery) that each treatment costs.

In Egypt, the cost of treating 100% of the patients with Sofosbuvir would represent five times the national health budget for 2011

For the great majority of the patients, price differentiation has not removed barriers to treatment access . In developing countries, Gilead has established a price of 2,000 USD per treatment (42 times lower that in USA), reaching a deal of ‘voluntary licensing’ with Indian generic companies for its production and distribution in at least 60 low-income countries. But this deal excludes great part of middle income countries where most of the patients are concentrated. In Egypt, where almost 12 million people are infected with HVC (14% of the population), the cost of treating 100% of the patients with Sofosbuvir would represent five times the national health budget for 2011.

A study showed that the drug could be produced for only 101 USD The difficulties encountered by patients and health systems to cover the medication cost stands in stark contrast with the unprecedented gains of Gilead that bought the molecule to another company that had developed it. While the global sales of Sofosbuvir may have exceded 10,000 million USD in 2014 (2,000 times more than what it paid for it in the first place), a study by the University of Liverpool showed that the drug could be produced for not more than 101 USD for a three-month treatment course. The estimated production cost ranges between 68 and 136 USD per 12 week treatment.

There is something inherently wrong in the current innovation and treatment access model that allows millions of people to die when the drug that could save their lives can be produced at a reasonable price.

...we have no other choice than to reform the existing model and establish innovation incentives that are compatible with the fundamental right to health

How can such a contradiction be resolved? We have the option to continue dancing to the tune of the pharmaceutical companies, but in view of the results it doesn’t seem the best idea. The alternative options in the short term imply questioning the true innovative nature of the patent (as India did a few weeks ago when it start to produce generics) or recognizing it but bypassing it on the basis of public emergency reasons (an option that is included in the WTO agreements and that several members of the European Parliament have requested for the first time for the European Union). But it will be difficult to go on based on exceptions when cases like HCV become the norm. In the medium term, we have no other choice than to reform the existing model and establish innovation incentives that are compatible with the fundamental right to health. Let’s just hope that the controversy raised in Spain and other countries has contributed to push the debate in the good direction andthat the organized protest spreads to low-income patients worldwide.

Previous posts on hepatitis C

Hepatitis C: the Patents Win, the Patients Lose

People Living With Hepatitis C—Victims of Patents