Elimination of hepatitis C

Sarah Barber

Hepatitis C

Hepatitis C is the most common type of viral hepatitis in the UK. It is spread by contact with infected blood and is commonly transmitted through sharing needles and other drug equipment in the UK; it is thought that about half of the people in the UK who inject drugs have the infection. Hepatitis C can also be transmitted through unprotected sex, by sharing toothbrushes or razors and through tattooing and body piercing equipment that has not been sterilised.

In a lot of cases, the virus will not present with any symptoms initially and one in four people will fight off the infection without treatment. However, those who do not will go on to develop chronic hepatitis C infection which can lead to cirrhosis (liver scarring), liver failure and liver cancer.

It is thought that around 215,000 people in the UK have hepatitis C, many of whom are unaware they are infected. The condition disproportionately affects marginalised groups who are likely to have less access to healthcare and poorer health outcomes. The Hepatitis C Trust reports that almost half of people who go to hospital for Hepatitis C are from the poorest fifth of society.

Anti-viral medicines can effectively treat the virus in most cases. New medications have made treatment more effective and reduced the side effects associated with it. It is thought that by using these new medicines, 90% of individuals with hepatitis C may be cured.

Eliminating hepatitis

In 2016, the UK signed up to the World Health Organization (WHO) Global Health Sector Strategy (GHSS) on Viral Hepatitis. This included a commitment to the elimination of hepatitis C (HCV) as a major public health threat by 2030, with global targets of an 80% reduction in incidence of chronic hepatitis C infections and a 65% reduction in mortality from hepatitis C.

There have been some concerns expressed that the UK may not be on target to meet the commitment set out in the WHO strategy. In November 2017, international data on hepatitis C presented by the Polaris observatory (a US public health research firm) at the World Hepatitis Summit showed that the UK was not one of the nine countries on course to meet the target of eliminating hepatitis C as a public health threat by 2030. It was described as one of the countries ‘working towards elimination.’ This concern was raised in a March 2018 All Party Parliamentary Group on Liver Health report, Eliminating Hepatitis C in England. The report welcomed progress in treating Hepatitis C in England but called for new measures to ensure people living with hepatitis C can be identified and offered treatment, and urged the Government to ensure that ambitious national and regional targets are set to monitor progress.

In January 2018, NHS England announced that it would aim to eliminate hepatitis C by 2025, 5 years ahead of the WHO target. It called on the pharmaceutical industry to work with it to ensure the best value for treatments to achieve this aim. It highlighted a new round of procurement for hepatitis C treatments and collaboration to identify more patients living with hepatitis C who need to be treated. NHS England reported that earlier deals with industry for access to new drugs for this condition had led to reductions in number of deaths from the condition and those needing a liver transplant:

England is one of few countries in Europe where numbers of patients receiving new oral treatments for Hepatitis C are already increasing year on year, enabled by deals previously agreed with industry. The deals, including ‘pay per cure’ where the NHS only pays when a patient is cured and a focus on prioritising the sickest patients, have led to a 10% reduction in the number of deaths and the numbers of patients needing a liver transplant have reduced by 50%.

Stakeholders have expressed concern about the international data on progress published in 2017 but welcomed NHS England’s plans to eliminate hepatitis C earlier than the WHO targets.

A March 2018 Public Health England (PHE) report, Hepatitis C in England and the UK sets out progress so far on action to meet WHO targets on hepatitis C. It reported that work is ongoing to ensure that more individuals with hepatitis C are diagnosed, and that those who have been diagnosed in the past can access new treatments. The report concludes that whilst much work has been done, in order to eliminate hepatitis C as a public health threat by 2030, more work in collaboration with stakeholders is required.

A PHE infographic provides information on progress against targets on hepatitis C in England:

A June 2018 Parliamentary Question response sets out what steps the Government is taking to meet the target of eliminating hepatitis C by 2025:

NHS England has embarked on a new procurement exercise that invites industry to support the plans to tackle hepatitis C as part of a longer term drug procurement contract. This procurement exercise was officially launched in March 2018. The conclusion of assessment of proposals is planned for September 2018 and NHS England anticipates the new procurement approach will be implemented from 1 October 2018. The aim of the strategic procurement is to accelerate whole systems action to reduce hepatitis C prevalence and incidence. If successful, the ambition is to support the elimination of hepatitis C as a public health threat earlier than the World Health Organization (WHO) goal of 2030 and as soon as 2025.

Public Health England who lead on hepatitis C surveillance will ensure that achievements against the WHO targets in England are tracked. The National Strategic Group for Viral Hepatitis will continue to bring together stakeholders to discuss and share individual and collective actions underway to contribute to these goals.

Useful links for further reading are listed below.

World Health Organization fact sheet – Hepatitis C

NHS Choices – Hepatitis C

Public Health England – Latest Hepatitis C Virus (HCV) reports, slide sets and infographics for England and the UK

NHS England press release – NHS England sets out plans to be first in the world to eliminate Hepatitis C

NHS England – Hepatitis C in London: Annual Review

Public Health England – Shooting Up: Infections among people who inject drugs in the UK

World Health Organization – Global health sector strategy on viral hepatitis 2016-2021

Public Health Matters blog – Eliminating Hepatitis C as a major public health threat – the challenges ahead

The Hepatitis C Trust

The British Liver Trust

All-Party Parliamentary Group on Liver Health Inquiry Report – Eliminating Hepatitis C in England