Treating hepatitis is cheaper than not

A researcher checks the vaccination against hepatitis B. [Photo/CFP]

The vaccination of babies against hepatitis B over the last quarter of a century has been one of China's greatest public health success stories. Hundreds of millions of children have been protected from being infected with hepatitis B, massively reducing their risk of developing liver cirrhosis and liver cancer later in life. This is China at its best - a problem was identified, and a determined, methodical, and evidence-based approach was deployed to fix the problem, with remarkable results.

It is now time to apply that same approach to the pressing issue of access to treatment for the tens of millions of people living with chronic hepatitis B or C in China who need treatment right now.

Viral hepatitis is a silent killer. Currently, there are about 100 million Chinese infected with chronic hepatitis B or C, but the majority of those infected are not aware they carry the virus. Up to 3 in 10 of these chronically infected people will go on to develop life-threatening illnesses such as cirrhosis and liver cancer if they do not receive treatment.

The good news is that effective treatments for hepatitis are now available. Hepatitis B cannot be cured, but it can be effectively managed with drugs like Tenofovir, which is also used to treat HIV. But currently, the same drug that is provided to people with HIV under China's successful public health program costs 10 times as much for hepatitis B, because there is no public health program for hepatitis B. Further, this drug is not reimbursed under most health insurance schemes for hepatitis B, which means it is out of reach for most. Yet there are around 28 million people who need hepatitis B treatment in China - and among them, 7 million who need treatment urgently because they already have advanced liver disease and at high risk of developing liver cancer.

Direct acting antiviral agents have now made it possible to cure hepatitis C completely. But for the 2.5 million people in China who have advanced liver disease caused by hepatitis C, these drugs are not yet available - because of the time it takes in China to have new drugs registered and approved for use.

The gravity of the hepatitis epidemic in China can no longer be ignored. Too many people are suffering, and millions are dying deaths that could be avoided. So why don't we just give all those in need the drugs that can save their lives?

The answer we hear is that it would be too expensive.

But the equation that produces this answer is wrong. Looking only at the current market price of the drugs and multiplying by the number of people in need only paints half the picture. The other half is people with advanced liver disease become sick, cannot work, and in the worst cases, die young. This comes at enormous cost to individuals, families, the economy and society. In other words: it is not the treatments which are too expensive, it is the lack of treatment.

The solution lies in adjusting the way funding for hepatitis treatment is distributed. In the absence of a public health program, individuals can only access hepatitis B treatment through the private sector, with very high out-of-pocket costs. This needs to change. And for hepatitis C, we must find a way to fast track the use of the world's best drugs in China to speed up access to cure.

China knows how to deliver successful, large-scale public health programs: the current generation of Chinese children, the first to be almost completely hepatitis B free, is testament to that. Now, it's time to act to ensure sure that, in the future, no-one in China dies a hepatitis-related death that could have been avoided.

The author is World Health Organization representative in China.