Professor: EU should establish roadmap for hepatitis C virus elimination

Angelos Hatzakis [The Hepatitis B and C Public Policy Association ]

This article is part of our special report The fight for viral hepatitis C elimination.

Eliminating hepatitis C should be tackled at EU level by establishing a clear political road map and mobilising public and private funding, Angelos Hatzakis told EURACTIV in an interview.

Angelos Hatzakis, MD, PhD, is Professor of Epidemiology and Preventive Medicine, National and Kapodistrian University of Athens Medical School, Founder and Co-Chair, Hepatitis B and C Public Policy Association.

He answered written questions sent by EURACTIV’s Claire Stam.

Why is hepatitis C a major and urgent public health problem?

The hepatitis C virus (HCV) is a global public health threat with significant morbidity and mortality. Due to its asymptomatic nature, it is a silent epidemic with an estimated 71 million people infected globally, but only 20% diagnosed.  In EU 28, 3 million people are infected by HCV, 32% are diagnosed, less than 6% are treated, resulting in 16.000 new liver cancers, 22.500 annual deaths and one death every 25 minutes.

In 2013, the introduction of new, safe and effective treatments for HCV created an unprecedented   opportunity to cure patients and eliminate the disease.  The elements of HCV elimination include surveillance, monitoring, awareness, screening, prevention and treatment programmes, as they are summarised in the WHO and National Action Plans for HCV elimination.

However, in some settings elimination represents a serious challenge for countries’ health spending as they are faced, for the first time in history, with a fast-acting curative treatment for a widespread chronic viral disease which offers little risk of resistance or relapse. In addition to treatment costs, the cost of scaling up testing to find the non-identified infected individuals and implementing effective models of care for diverse populations, represent an additional challenge.

What is Hepatitis B and C Public Policy Association?

The Hepatitis B and C Public Policy Association was established in 2009 and brings together thought leaders and stakeholders from across the board to reflect on recent advances and challenges in understanding, measuring, preventing, diagnosing and treating hepatitis B and C and to develop policy responses that can effectively an measurably address these challenges.

Over the past 8 years, it has organized three high-level meetings and two HCV Policy Summits in cooperation with the EU Presidency of Belgium, the EU Presidency of Cyprus, the EU Presidency of Greece and European Commission and has instigated and agreed with its partner associations on five Calls to Action addressed to the European Commission and the EU Member States.

In 2016 this Association organized the first ever European Policy Summit dedicated to the Elimination of HCV in Europe “Hepatitis C: The beginning of the end – key elements for successful European and national strategies to eliminate HCV in Europe” which took place on 17 February 2016 in Brussels and was attended by EU Commissioner for Health, Dr. Vytenis Andriukaitis. The launch of the HCV Elimination Manifesto “Our vision for a Hepatitis C-free Europe” provided a starting point for action to make HCV and its elimination in Europe an explicit public health priority.

With patients, civil society groups and other relevant stakeholders directly involved in developing and implementing HCV elimination strategies, now is the time to take the next step further and make the HCV elimination affordable. The economic crisis has impacted on public health spending more than on any other public life sector shrinking budgets and necessitate austerity.

Governments are faced with a dilemma related to hepatitis C: spend now to save later? On what? With what return on investment? The Second HCV Policy Summit entitled “Securing sustainable funding for Hepatitis C Virus elimination plans” took place in Brussels on 6th June 2018, represents a scientific and policy answer to those questions.

How you calculate the cost of HCV elimination in individual countries and EU-28?

Preliminary data suggest that the WHO HCV elimination strategy is cost-saving for many countries. That is the savings related to preventing and treating HCV may exceed the cost of HCV elimination, providing good value for money given the high initial spending.

Strategic Direction 4 of the WHO Global Health Sector Strategy on Viral Hepatitis 2016-2021 “Financing for sustainability” sets out financing recommendations for a sustainable hepatitis response, outlining actions to raise revenue to pay for viral hepatitis interventions and services, set-up financial risk protection, and improve efficiency in the use of health system resources.

The Call to Action of the 2nd HCV Policy Summit recommends that countries have a comprehensive, costed hepatitis C elimination strategy in place, to determine their country-level disease and economic burden of HCV by measuring direct and indirect socio-economic cost to improve the response towards HCV elimination and to develop country and population-specific models, as viral to estimate lifetime costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios of different screening and treatment strategies with comparison with no action. These are necessary to hepatitis elimination programmes as hepatitis investment cases.

In the Call to Action, you call for “innovative financing tools”. Would you like to elaborate more on that?

Innovative financing tools include social impact bonds and other tools, with the aim to raise upfront funds for launching new social services and financing prevention services, including harm reduction, contributing to HCV elimination in a sustainable way. Some European countries have important experience in creating social bonds and similar financing tools. Others may prefer to explore other opportunities through cooperation with the European Financial Institutions such as the European Investments Bank.

What role could the Commission play in terms of coordinating a joint response to this challenge?

The European Union should recognize the need and engage in HCV elimination by establishing a clear political road map and call for European financial institutions to raise public or private funding and use elimination programmes as development tools. Encourage and engage all the stakeholders to collaborate in the development of innovative financing tools like social impact bonds.

George Papandreou, President of the Socialist International, former Prime Minister of Greece and Keynote Speaker of the 2nd HCV Policy Summit commended: “At a time of euroscepticism, a time where the value of our Union is put into question both by internal political forces and external players, a project such as this one highlights the added value of a European Union.  A Union with the political will and the capacity to change the lives towards the better of so many of our citizens”.

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