How Egypt is tackling Hepatitis C
gypt is believed to have the largest prevalence of the Hepatitis C Virus (HCV) in the world, with 7% of the population - approximately eight million people - infected.
The causes of this rampantly widespread disease originated primarily from a massive government-led medical campaign launched in the 1960s to treat Egyptians suffering from schistosomiasis, better known locally as bilharzia. Unsterilised needles were used to inject millions of villagers across the country. These were likely contaminated with the blood-borne HCV and resulted in the current epidemic.
Hepatitis C is a liver disease caused by the HCV. The infection may clear up in a few weeks, but in many patients, it lies dormant and asymptomatic for decades, surfacing later as a precursor for many fatal liver diseases including liver cancer, cirrhosis, and liver failure.
"Hepatitis C is a liver disease caused by the Hepatitis C virus. The infection may clear up in a few weeks, but in many patients, it lies dormant and asymptomatic for decades, surfacing later as a precursor for many fatal liver diseases including liver cancer, cirrhosis, and liver failure."
Dr Wagida Anwar, member of the National Committee for the Control of Viral Hepatitis and Professor of Public Health at Ain Shams University, says millions of Egyptians were injected with the bilharzia treatment, reducing bilharzia infections to about 3%, but allowing the HCV to spread.
She adds that contaminated blood transfusion methods, unsafe injection practices, poorly sterilised surgical and dental equipment, and poor health standards and medical care may have compounded the infections even further.
The World Health Organisation (WHO) recognises HCV as a global challenge that necessitates an urgent response: 325 million people worldwide are living with chronic HBV or Hepatitis C virus (HCV) infection, and the majority of them lack access to life-saving testing and treatment. This scenario was evident in Egypt until recently.
The WHO noted in 2014 that just about every family in Egypt was touched by Hepatitis C with approximately 165 000 new infections occurring each year. Around 40 000 patients died of the epidemic on a yearly basis. According to Egypt’s Central Agency for Public Mobilisation and Statistics, the economic burden of HCV in Egypt was estimated at $3.81 billion, equivalent to 1.4% of total Gross Domestic Product (GDP).
Cognisant of the scale of the epidemic and the urgent need to scale up efforts at addressing it, the ministry of health developed the “The Plan of Action for the Prevention, Care, and Treatment of Viral Hepatitis 2014–2018”. It focuses on seven main components of viral hepatitis prevention and control: surveillance, infection control, blood safety, HBV vaccination, care and treatment, communication, and research.
According to Anwar, since the treatment programme began, about 1.8 million HCV patients have been treated with an efficacy rate of about 98%.
To reach all those infected, the programme established facilities to combat HCV infection within 100 kilometres of every Egyptian city and village, says Anwar. Each facility was overseen by trained hepatologists. Patients were tested to confirm HCV infection, were screened for eligibility for subsidised treatment, and then provided care and treatment services, including medication and testing.
In 2014, Egypt reached an agreement with the San-Francisco-based pharmaceutical company, Gilead Sciences, to purchase a new course of medication to treat HCV at a greatly discounted price. Sovaldi, a direct-acting antiviral treatment with high cure rates, became available in Egypt for $900, a fraction of the $84 000 it is sold for elsewhere. This was a 99% reduction in price.
Simultaneously, since the epidemic is largely prevalent in rural, poverty stricken areas more than urban ones, the Ministry of Health offered the treatment for free or through medical insurance.
That was the start. Today, Egypt relies on much cheaper and locally produced generic medication that sells for approximately $83 while phasing out the manufactured-abroad Sovaldi.
Other players were involved in the campaign to eradicate HCV in Egypt, in particular civil society organisations and the WHO.
The success of Egypt’s HCV programme has inspired a turn to medical tourism. A local drug maker that manufactures the HCV treatment, in collaboration with Egypt’s Health, and Tourism and Aviation Ministries, initiated the Tour n’ Cure campaign in June 2016. It is aimed at attracting HCV patients from countries where treatment remains expensive, promising an affordable cure with no waiting lists and attractive tourist perks.
For approximately $6 200, Tour ‘n Cure offers flights, a week’s stay at a five-star hotel in Cairo or Sharm el Sheikh, blood tests, three months’ worth of treatment and tours to Egypt’s historic landmarks. The treatment is completed upon the patients’ return to their own country.
Egypt has solicited the support of celebrities to promote its Tour n’ Cure campaign. Football stars Lionel Messi, Ronaldinho, and Dani Alves, and squash champion Ramy Ashour, are among ambassadors of the campaign. According to the website, over one million patients have been treated since 2016.
More importantly, what the National Committee on HCV hopes to achieve is reduce the HCV prevalence to about 1%, which is the rate existing in developed countries, says Dr Anwar. This is quite the challenge since newly infected cases will take between 20 to 40 years to bloom into full-fledged HCV cases.
On a positive note, researchers have found that there is less ignorance and lack of awareness of the need to properly sterilise equipment and medical instruments than in the past. Egyptians are cognisant of the implications of needle sharing and blood transfusion methods are well controlled today, says Anwar. In fact, since 1994, all blood bank donors are HCV screened.
Egypt’s efforts were duly acknowledged as a “tremendous success story for public health” by former WHO director-general Margaret Chan in 2016. While the country is on track to winning the battle against Hepatitis C, experts have correctly recommended that a commitment to ongoing investment in research and development of medication, adequate government funding and public awareness campaigns remains crucial.
(Main image: DFID/ Flickr)