From despair to hope: Egypt and other countries’ journey to eliminate hepatitis C

(Science Times) (Global Health) In the past seven years, Suleimana Moussa He invested almost all his money in the war Fight Hepatitis C. His graduate student loan, high school teacher’s salary, money from selling yams for tests and medications to try to cure the virus that debilitated him. Musa, 27 years old, Living in Accra, the capital of Ghana, he gave up his dreams of starting a business, building a house and getting married.

He has saved enough money——$900, half his annual salary– buy one medical treatement Ten years ago, it started revolutionizing treatment Hepatitis C in the United States and other high-income countries.

this is unusual patient For those people, this treatment was not enough, so for many years he tried to save enough money for another person, but without success. “I’ve been waiting for God to create a Miracle“, he recalled.

Then, in March, his doctor Gave him extraordinary news: government of ghana He received donations of hepatitis C medication and received treatment at no cost. Within a few weeks, Moussa received the pills. In October, a blood test showed he was finally recovering.

He was broke, exhausted, and ready to dust off his ambition. The donation came from a highly unlikely source: Egypt, which just a few years ago had the highest hepatitis C burden in the world. An estimated 1 in 10 people, or nearly 9 million Egyptians, suffer from chronic infections. In a public health campaign of extraordinary scale and success, Egypt tested its entire population, negotiated a deal for deep discounts on medicines, and cured nearly all those infected.

“This is one of the greatest achievements in the history of public health,” said John W. Ward, director of the Global Health Working Group of the Global Alliance to Eliminate Hepatitis.

Egypt is on track to become the first country to achieve the World Health Organization’s goal of eradicating hepatitis C and is building on the success of its “health diplomacy” campaign, pledging to donate medicines and share expertise with the goal of treating 1 million African patients. It’s an unusual gesture in the world of global health, where high-income countries tend to lend a helping hand to developing countries.

“The Egyptian government saw an opportunity to extend its expertise beyond its borders and contribute to global health initiatives,” he said. Khalid Ghaffar, Egypt’s Minister of Health and Population. “This health diplomacy allows Egypt to leverage its success in treating hepatitis to bring greater benefit to humanity while improving its standing in the international community.”

According to the World Health Organization, nearly 58 million people worldwide are chronically infected with hepatitis C. WHO, the vast majority (50 million) of whom live in low- and middle-income countries. Four out of five people don’t know they have the disease. Nearly 300,000 people die each year from complications, mainly cirrhosis and liver cancer.

The virus is primarily spread through blood; in high-income countries, the virus is often spread through unhygienic needles used when injecting drugs, while in developing countries, transmission often occurs in health care settings, through unsterile needles and instruments or from quacks. Transmitted by traditional cutting method.

About one-third of people clear the infection on their own, but in most cases it becomes chronic and slowly damages the liver over time.

However, few countries have included the disease in their public health plans or conducted testing to understand the number of infections. Hepatitis C has not been the subject of any major international projects like HIV or malaria, and has been such a minor problem in low-income countries that governments rarely keep track of how many people have the disease, let alone him of treatment.

Until this year, only a handful of wealthy people in Ghana and other African countries were treated for hepatitis C through privately purchased drugs.

This was the case in Egypt until 2007. Mass vaccination campaigns that began in the 1950s and continued for 20 years used poorly sterilized needles and inadvertently spread hepatitis among the population. Few people can afford private treatment.

The virus was killing tens of thousands of people every year when the government decided to launch a national plan. At first, two ancient medicines were used in Egypt but only cured half of the patients. But in 2013, Gilead Sciences Inc. brought an antiviral drug to market: the first drug in the history of medicine to treat a viral infection.

The company sells its once-daily pills in the United States for $1,000, while Egypt negotiates to buy them for $10 each, then agrees to let Indian and Egyptian pharmaceutical companies produce cheaper generic versions in exchange for royalties. . Egypt has treated more than 4 million people and reduced the prevalence of hepatitis C to 0.4%.

Other companies have quickly introduced additional antiviral drugs that are highly effective and safe and have so far not been affected by the resistance issues that often plague antiviral drugs.

“The news about drugs is nothing but positive, the problem is countries are not getting medicines to people who need them,” said Ward, the alliance’s director.

Egypt chose Ghana as an initial partner because it is investing in developing national healthcare. Yvonne Ayerki Nartey, a doctor at the Cape Coast Teaching Hospital, has joined the Global Alliance to Eliminate Hepatitis to plan a new response in Ghana.

First, he must find out how many Ghanaians are infected and where they are; a national screening campaign found that one in 20 people in the north of the country, where poverty rates are highest and health services are weakest, has C. hepatitis. They went on radio shows and spread the word on Facebook and WhatsApp that the treatment would soon be accessible.

The drugs are being shipped from Egypt, but the next step is difficult: In the United States, liver specialists treat hepatitis, but Ghana has fewer than 20 liver specialists. Naert organized training courses for doctors in each region.

“Most people are never treated for hepatitis C because there is no treatment here,” he said. To expand the program across Ghana, Narte hopes to test 2 million people with a cheaper antigen test that costs about $1 per patient, and then test the viral load of the 200,000 people he predicts will have antibodies. quantity. Active infections were confirmed, and the first drugs Egypt had promised were used, ending the lives of 46,000 patients who could have been treated. Their prevalence studies indicate that an additional 300,000 people need treatment.

“It’s a lot, but we’re ambitious,” he said. Egypt is working to establish parallel hepatitis C programs in other countries such as Chad and Sudan. Meanwhile, Ward said, Ghana is improving blood safety and injection practices, drawing on lessons from Egypt and educating traditional healers to reduce the rate of new infections.

Ward hopes that if Ghana can expand its hepatitis program, neighboring countries will be encouraged to launch their own. “We have to make countries aware that the drug exists and is very effective,” he commented. “We should fight to eliminate hepatitis C because it is very feasible to do so.”

Moussa said that when he received the news that he was finally free of the virus, it was like the beginning of a new life: no longer spending much of the day wondering how he would be able to pay for medical bills or tests, or if he would even be able to pay for them. He can do this before the virus kills him. “Now, I am free to plan for the future,” he concluded.