by Karyn Kaplan, Director, International Hepatitis/HIV Policy & Advocacy, Treatment Action Group (TAG), New York
“If the prices (of new HCV treatments) were to be unaffordable once more in history, it would be one more scandal around inequity of access to health care.”
-- Michel Kazatchkine, the United Nations Secretary General’s Special Envoy on HIV/AIDS in Eastern Europe and Central Asia
On 22-25 February 2014, treatment advocates from 22 countries came together in Bangkok, Thailand, for the “1st Hepatitis C Virus (HCV) World Community Advisory Board (CAB)” meeting to strategize for increased access to hepatitis C virus (HCV) diagnostics and treatment. Thirty-eight activists met with six originator pharmaceutical companies that produce pegylated interferon (PEG-IFN), the current standard of care (SOC) for treating HCV in most of the world, and/or HCV direct-acting antivirals (DAAs), which constitute the new SOC in the US and Western Europe. New DAAs are safer, less toxic, and more powerful, and are demonstrating cure rates of up to 100% in clinical trials. Pegylated interferon, on the other hand, on average
cured only 50% of people with HCV.
cured only 50% of people with HCV.
Globally, about 185 million people are infected with HCV, or six times the number of people with HIV/AIDS, and 350,000 people die each year of HCV-related complications. Annually, three to four million are newly infected. Yet, only a small fraction of people with HCV is aware of their status. Due to the high price of PEG-IFN (up to US $20,000, even in lower middle-income countries (LMICs)), many countries have been unable to prioritize HCV testing, treatment and prevention programs, even where national prevalence is high.
Egypt, with the world’s highest HCV prevalence (15%), recently gained attention for its successful negotiation with PEG-IFN producers, Roche and Merck, for a price of US $2,000 per treatment course, a ten-fold price reduction. Egypt was able to achieve this price in part because a local company could produce a similar version of PEG-IFN cheaply. Roche and Merck wanted to maintain large shares of the Egyptian market, so they brought down their price.
“We want these new and coming HCV drugs as soon as people in rich countries can access them. Poor people’s lives count too, but obviously not in the eyes of these greedy pharmaceutical companies who care only about profit. None of the six companies we met with offered a plan that would help LMICs access affordable treatment,” said Jirasak Sripramong, an HCV educator and advocate with the Thai AIDS Treatment Action Group (TTAG) and participant at the HCV World CAB.
Eighty-five percent of people with HCV live in LMICs, but at current prices, there is no hope of treatment access for them --Gilead’s recently-approved sofosbuvir, which is expected to replace PEG-IFN as the new backbone of HCV treatment, for example, costs US $84,000 per treatment course in the U.S. and needs to be used in combination with other drugs. “Most people cannot afford HCV treatment—nor can their governments,” explains Paata Sabelashvili of the Georgian Harm Reduction Network. “My government, like others in the Eastern European region, is launching a national treatment program, but astronomically high prices will limit it. How can governments and donors effectively address HCV if Pharma refuses to drop drug prices?”
“All six companies claimed to have learned the lessons of the HIV/AIDS epidemic, but in fact refused to commit to price reductions or promote access to generic competition that will allow affordable access in LMICs. Abbvie, BMS, Gilead, Janssen, Roche, and Merck are holding people with HCV hostage to their corporate greed, and many will die waiting for treatment unless we fight back.” said Karyn Kaplan, an organizer of the meeting.
HepC activists continue to engage in numerous advocacy activities to increase access to affordable HCV treatment, including community education and mobilization, working with governments and pharmaceutical companies to negotiate lower drug prices, and lodging patent oppositions in courts to challenge the validity of new HCV drug patents where relevant (as in the recent I-MAK pre-grant patent opposition against sofosbuvir, in India – ruling still pending).
What can the general public do to support HepC activists?
The general public can participate in campaigns, such as our upcoming global advocacy campaign to get originator companies to bring down the price of new HCV DAAs, through signing onto petitions or joining solidarity actions in their cities. The price reduction campaigns are based on the right to health and recent studies that have shown true production costs of these new drugs are estimated at only a couple of hundred dollars per drug per treatment cost. We are questioning the methodology of how the companies decide on their final market price and their companies’ lack of a moral and ethical commitment to equitable access balanced with fair profit.
For further updates check out the Global HCV campaign website: www.hepcoalition.org
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