Price is a game changer. Just look at the effects caused by the advent of low-cost airlines. Flying has never been cheaper and people who could not afford boarding a plane can now travel to places they had only dreamed of. In other words, it has brought changes to the industry and to people’s lifestyle. The same applies to health. Cheaper health products change people’s lives. Ukraine has the highest prevalence in Europe of hepatitis C, a chronic liver disease that can be especially deadly when it strikes HIV patients.
The number of people infected is estimated at 1.2 million for a population of 44 million. Yet the high cost of medication has been a serious impediment to treatment. A near monopoly in the pharmaceutical market by Merck (MSD) and Roche, the two companies that manufacture Pegylated Interferon, has kept prices stubbornly high. But thanks to the support of the Global Fund, Alliance Ukraine recently negotiated a steep discount with a pharmaceutical manufacturer for medication, enabling treatment to be significantly expanded for highly vulnerable patients co-infected with HIV and hepatitis C. This news is of little relief for the 300,000 people who died of hepatitis C since the beginning of the year, but could save the lives of 150 million people infected with the virus.
Hepatitis C is often called “the hidden or the silent epidemic,” as very little is known about the risks and spread of hepatitis C. But this is not an excuse for international and national decision-makers to remain silent. The hepatitis C epidemic knows no borders and has no war-chest to combat it. No global targets have been set by global health stakeholders to improve access to hepatitis C treatment, as has been the case in the treatment of HIV/AIDS, tuberculosis and malaria. Despite efforts by patients, civil society, doctors’ associations and many governments across the world, treatment worldwide for hepatitis C continues to be beyond reach for most patients.
In my country, however, we recently scored an important victory. Since the beginning of 2011, only 80 courses for treating adults infected with hepatitis C were procured, in addition to some for children. The situation resembled that of HIV antiretroviral therapy (ART) 10 years ago, when the treatment per person cost $10,000, compared to $150 now. Before the Global Fund began providing funds to International HIV/AIDS Alliance in Ukraine, there were only 250 patients receiving ART in the entire country. Today, there are nearly 50,000 people, and 83% out of them are getting treated with drugs procured from Ukraine’s national budget.
The hepatitis C treatment initiative allows Alliance Ukraine to acquire drugs at a cost of US$5,000 for a single 48-week course of treatment, a reduction from the previous price of US$13,200. It is the first time the treatment, combining Pegylated Interferon and Ribavarin, will be available in a Global Fund-supported program in Ukraine. The initiative has stimulated action by the government and has become a catalyst for change. On 17 September, a decision by the cabinet of ministers to set up a national program for hepatitis with US$4.2 million came into effect. The Health Ministry has acknowledged that the US$5,000 price would now be considered by the Ministry as a benchmark for governmental procurement of the medication. With Global Fund support, Alliance Ukraine has procured 100 courses totaling US$500,000. Using this price benchmark, the government has committed itself to procuring at least 13,000 courses totaling US$ 65 million by the end of 2015.
This is a victory for patients and for public health in Ukraine, and one that will have an enormous market impact. Hopefully, the Ukrainian example will change the minds of donors, politicians and pharmaceutical manufacturers, making treatment of hepatitis C treatment not only affordable in Ukraine, but worldwide.