Russia's silent epidemic : Hepatitis C
"I don't know where to get the money from, treatment is too expensive," says Sergei, who lives in Saint Petersburg. He has been newly diagnosed with hepatitis C and is in need of treatment to reduce the risk of developing liver cancer and cirrhosis. "But the money for medication isn't available to normal people."
At least 5 million people in Russia are infected with hepatitis C (approximately 4.4% of the whole adult population), of which, according to various estimates, 1–2 million people urgently need treatment. While drugs have been available to cure hepatitis C for some time, patent barriers and sky-high prices of oral treatments have priced many out of treatment. The most vulnerable groups susceptible to the virus – the poor and those injecting drugs – are left to await their fate.
Hepatitis C in Russia mostly affects people who inject drugs (PWID), among which, according to the most conservative estimates, as much as 1.3 million people are infected. Both hepatitis C and HIV – Russia's other epidemic – are fuelled by the country's high number of injection drug users. While HIV rates have declined globally, they have increased in Russia: from 170,000 a decade ago to around 1.2 million today. Experts place much of the blame on the Kremlin, pointing to its long-standing ban on methadone used globally in heroin addiction treatment.
Russia doesn’t have an integrated registry of patients in need of hepatitis C treatment.
Until now, full clinical examination has not been offered to patients registered in infectious clinics, regardless of the region. As a result, treatment needs have not been assessed on the basis of clinical indications. Russia’s system of epidemiological monitoring and surveillance is underdeveloped, which makes it near impossible to realistically evaluate the total number of chronic hepatitis C (CHCV) cases and treatment needs in this respect.
Injecting drug users are excluded from treatment programs.
Low treatment coverage of patients with HIV/HCV co-infection is related to the fact that people who use injecting drugs are often refused treatment. In all the surveyed regions, internal regulations prohibited AIDS Centers from enrolling people with drug dependency into treatment programs.
Legal ban on methadone and buprenorphine substitution therapy programs leads to exclusion of people who use drugs from treatment programs.
All over the world, opioid substitution treatment programs involve people with drug addiction in hepatitis C treatment programs and help encourage adherence to treatment. In Russia, OST programs are officially prohibited. As a result, doctors fail to prescribe antiviral treatment to CHCV patients who use drugs, on the grounds that they won’t be able to follow their treatment regime.
High cost is the main barrier to the expansion of CHCV treatment.
If the body is unable to fight off the virus, hepatitis C is normally treated with a six-month course of pegylated interferon, a class of medication that can successfully cure around 85% of cases. But it is very expensive due to its patent, because of an oligopoly of two original-brand drugs.For chronic hepatitis C infection, treatment usually involves a combination of pegylated interferon and antiviral drugs – one of which, simeprevir, costs around $45,000 for 12 weeks of treatment, according to Doctors Without Borders. In a country where 22.9 million live below the poverty line, access to such expensive treatment is likely to be limited.
Health facilities in Russia are not ready for expanded hepatitis C treatment.
Within the Priority National ‘Health’ Program, people living with HIV/HCV are usually treated by AIDS Centers, although in some cases patients are referred to local polyclinics. Regional activities aimed at strengthening and maintaining human resource capacities are basically non-existent, which results in the health system failing to address HCV treatment burden even in the context of minimal access to treatment.
One of the patients landed in Chennai and apart from his $2000 traveling and hotel expense, he paid $1000 for the treatment and saved US$80,000.
The cost of treating Hepatitis C is very high in the U.S. and other parts of the world. Health programs have raised an outcry against the hefty price of Harvoni (It is a combination pill containing sofosbuvir plus ledipasvir). However, Gilead Sciences gave license to produce generic versions of Harvoni to several Indian generic pharmaceutical companies. Since majority of Indian population earns much less than the US population, India has been treated as a special case and the Indian government has negotiated a deal with Gilead to produce Sovaldi at $300 per bottle and $900 for 12 weeks course, costing just 1% of what the treatment cost in U.S. In part this happened because India failed to recognize the innovation by Gilead that went into discovering the miracle Hepatitis C treatment.
Here is how much Harvoni costs around the world.