Eliminating viral hepatitis, a ‘silent killer’

DISCLAIMER: All opinions in this column reflect the views of the author(s), not of EURACTIV Media network.

Blood is taken to be screened for hepatitis in Cambodia. [Cambodia4Kids/Flickr]

The target of eliminating viral hepatitis infection by 2030 is achievable, especially in Europe. But on a global scale, new healthcare funding mechanisms are needed for the dream to become a reality, writes Pierre Van Damme.

Professor Pierre Van Damme is Executive Secretary of the Viral Hepatitis Prevention Board (VHPB).

In February, the first high-level meeting in Brussels on hepatitis C was held, where the alarm bell was raised on the burden of the disease on Europe’s health systems. Updated guidelines from the World Health Organisation (WHO) for the treatment of hepatitis C infection, to “promote the transition to newer, more effective medicines that have the potential to cure most persons living with hepatitis C infection” provides not only a European challenge but also a global one.

This silent epidemic of hepatitis B and C affects one in 12 people worldwide. Recent breakthroughs in available treatment options make the WHO target of eliminating viral hepatitis by 2030 feasible. While Europe is getting underway to achieve this goal, for low- and middle-income countries (LMIC) it is going to be far from simple.

Like with other infectious diseases, LMICs bear the biggest burden of hepatitis B and C, with some regions experiencing high endemicity, precarious prevention of transmission and low access to treatment.  We need to explore game-changing solutions to help these countries, in particular with regards to finding sources of funding.  This is the theme of a report that the Viral Hepatitis Prevention Board (VHPB) launched at the European Association for the Study of the Liver last month.

Investing today in hepatitis B (HBV) and hepatitis C (HCV) prevention and treatment means a fundamental alleviation of disease burden for individuals and their families, in addition to relieving pressure on national health systems. Nevertheless, these new treatments pose significant challenges in some countries.

Like with other infectious diseases, a major question is how to make access affordable to a large number of patients, especially in low-and middle-income countries, where the burden of HBV/HCV and out-of-pocket payments for healthcare are significantly higher than in high income countries.

Early 2015, we set ourselves the task of exploring how innovative funding mechanisms could help tackle this major public health issue. We reviewed over 20 different existing funding mechanisms and examined how these could be used to support health systems in LMICs deliver them. Almost to nobody’s surprise, we found that there is no panacea, as one single financing mechanism is unlikely to be feasible.

We found a number of financing mechanisms that offer considerable promise, including non-infrastructure public private partnerships that build on social impact bond funding, shared value projects, and micro-financing. A mixture of approaches which considers the local context may be most effective.

Mitigating financial barriers to prevention and treatment is only one element in a comprehensive public health approach to managing chronic viral hepatitis. Optimal conditions for financing mechanisms will require political support, and competence in selecting the mechanisms best adapted to country-specific challenges and that meet the needs of all the stages of the therapy cycle.

Furthermore, funders will only be convinced on the basis of a strategic plan that delineates its benefits. Can countries give a stronger signal to funders about their political will and commitment to control viral hepatitis by developing a national control programme?

We hope that the report gives stakeholders from regional banks, leaders both from a public health and a financing perspective, investors, patients, health professionals and services, pharmaceutical and diagnostics industries and independent assessors and evaluation advisors, each with potentially unique roles to play, a good basis for discussion on how to contribute to eliminating viral hepatitis in LMICs. A core characteristic of innovative finance lies in the collaboration between various stakeholders which traditionally do not consider themselves as business partners.

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