MISSING leadership by WHO Director Dr Margaret Chan

Test and treat Hepatitis C now!

Director-General Chan, in 2010, the Executive Board of the World Health Assembly tasked you with mobilizing political will and adequate resources for an effective response to the global viral hepatitis pandemic.

New hepatitis C virus (HCV) drugs coming out of the pipeline have demonstrated cure rates of up to 100%; the hepatitis C virus could feasibly be eradicated from the planet. Without World Health Organization (WHO) at the helm, this prediction will remain unattainable.

Since 2010, more than a million people have died from HCV although it is treatable and curable. Three to four million people are newly infected each year, although HCV is preventable. Most new infections occur among people who inject drugs, yet less than 4% of them have sufficient access to clean injecting equipment. This shocking public health failure allows the epidemic to continue spreading.

Only a tiny fraction of the 185 million people who have HCV are aware of it. Most live in low and middle-income countries (LMICs) and have no access to diagnostics, care, or treatment. Pegylated interferon (PEG-IFN), backbone of the current standard of care for HCV, is priced cruelly out of reach. Where there is access to HCV treatment, people who inject drugs are often denied it: merely 2-4% of people who inject drugs access treatment.

People who inject drugs who want to be treated for HCV are often forced to stop their drug use or enter an opioid substitution therapy (OST) program. Neither of these stipulations are justifiable on clinical grounds, but are forms of discrimination that stem from the moral judgment of people who inject drugs. People who are currently injecting or in an OST program respond as well to HCV treatment as those who are not.

The World Health Organization must act to increase global access to HCV diagnostics and treatment, in particular for people who inject drugs, by:

  • Speaking out frequently on the need for rights-based harm reduction services including needle and syringe programs (NSP), OST and integrated hepatitis C treatment on a scale that will reverse the HCV epidemic among PWID as recommended by WHO/UNAIDS/UNODC.
  • Providing technical support to countries to create access to affordable, high quality, effective and safe biosimilar and alternative pegylated interferon products.
  • Creating clear guidance on HCV screening and testing that explicitly recommends screening for people living with HIV, in whom HCV progresses rapidly, and in people who inject drugs.

Many countries are prepared to address their HCV epidemics, and we, people living with HCV and our advocates, are ready to be actively involved in the development of national plans to prevent and control HCV. Countries are waiting for WHO guidance in key areas that will empower us all to move forward.

You must not fail your mandate. We implore you to demonstrate true leadership through the mobilization of political will and the necessary resources to combat the global HCV epidemic.

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