Call to Action

Background

The hepatitis C virus (HCV) is a global public health threat with significant morbidity and mortality. Due to its asymptomatic nature, it is also a silent epidemic with an estimated 71 million infected globally, but only 20% diagnosed (1,2).

In 2013, the introduction of new, safe and effective treatments for HCV created an opportunity to eliminate the disease. However, in some settings, this development 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.

Greater efforts are needed to ensure that all elements of cost of HCV elimination, which include surveillance, monitoring, awareness, screening, prevention and treatment programmes, are affordable. Preliminary data suggest that the WHO HCV elimination strategy may be cost-saving for many countries (3, 4). 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” (5) 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.

On 17 February 2016, 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 (6, 7). 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.

We, the signatories of the Call to Action “Secure sustainable funding for hepatitis C elimination plans” are committed to HCV elimination in Europe.

In line with the 2015 United Nations’ General Assembly Resolution “Transforming our world: the 2030 Agenda for Sustainable Development”, in line with the Sustainable Goal 3 Good Health and Well-Being and its Target 3.3 to Fight Communicable Diseases, in line with the 2014 World Health Assembly’s Resolution 67.6 on hepatitis, in line with the 2016 HCV Elimination Manifesto, in line with the WHO Global Health Sector Strategy on Viral Hepatitis 2016-2021 “Towards ending viral hepatitis”, and in order to encourage policy-makers to fulfil the Strategic Direction 4 of the WHO Global Health Sector Strategy on Viral Hepatitis 2016-2021, and make HCV elimination affordable, we are calling on the European decision makers to:

1. Ensure that countries have a comprehensive, costed hepatitis C elimination strategy in place, including a comprehensive monitoring along with the cascade of care in line with the criteria developed by ECDC and WHO Europe;

2. 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, paying attention to the close link between HCV and HIV in some populations;

3. Develop country and population-specific models, as viral hepatitis investment cases, to estimate lifetime costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios of different screening and treatment strategies with comparison with no action;

4. Allocate sufficient resources for training and research, developing robust models of care for tackling HCV, and urgently and effectively fulfil Strategic Directions 2, 4 and 5 of the WHO Global Health Sector Strategy;

5. Recognise the need for the European Union to 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 a development tool;

6. Encourage and engage all the stakeholders to collaborate in the development of innovative financing tools like social impact bond and others, with the aim of launching new social services and financing prevention services, including harm reduction, contributing to HCV elimination in a sustainable way;

7. Exchange and implement best practices on funding healthcare and HCV elimination, including via micro-elimination approaches (8), at the national, regional and local levels to meet the WHO elimination goals by 2030 and preferably much earlier.

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REFERENCES

1. WHO Global Hepatitis Report 2017.
2. The Polaris Observatory HCV Collaborators. Global prevalence and genotype distribution of hepatitis C virus infections in 2015: a modelling study. Lancet Gastroenterology Hepatology 2017 Mar,2(3):161-176.
3. Kondili L et al. Modeling cost-effectiveness and health gains of a “Universal” versus “Prioritized” hepatitis C virus treatment policy in a real-life cohort. Hepatology 2017 Dec;66(6):1814-1825.
4. Chhatwal J. “Is hepatitis C elimination cost saving?” 2nd EU HCV Policy Summit, Brussels 2018.
5. Global Health Sector Strategy on viral hepatitis 2016-2020. WHO, 2016.
6. Action plan for the health sector response to viral hepatitis in the WHO European region. WHO, 2017.
7. Papatheodoridis G. V. et al. Summit review: HCV Policy Summit Hepatitis C: The Beginning of the End  Key elements for successful European and national strategies to eliminate HCV in Europe, Journal of Viral Hepatitis, Volume 25, Issue S1, 2018
8. Lazarus JV, Wiktor SZ, Colombo M, Thursz M on behalf of the EASL International Liver Foundation. Micro-elimination – a path to global elimination of hepatitis C. Journal of Hepatology, July 2017.