Costly medicines mean debt or death for people with hepatitis C
October 24, 2011
People living with hepatitis C, International Treatment Preparedness Coalition - India (ITPC-India), and treatment
activists at a press conference held recently in Delhi, questioned the silence maintained by the Indian Health Ministry
on its response to the Hepatitis C virus (HCV) which is emerging as a growing public health threat, and in the absence
of effective prevention programmes, millions are at risk of this deadly infection.
According to the World Health Organization, hepatitis C virus (HCV) is a major cause of acute hepatitis and chronic
liver disease. Globally, 3 to 4 million persons are newly infected each year. The Viral Hepatitis resolution adopted by
the member states of the World Health Organisation on 23 January 2010 at the Sixty-third World Health Assembly,
recognises Hepatitis C as a public health issue. The burden of the disease in India is expected to continue rising in
the absence of prevention and harm reduction measures with vulnerable communities. According to the health
organisations, there are two main obstacles to an effective HCV response in the country. First is the absence of
prevention efforts; second is the lack of political will to treat HCV-among policymakers in the Health Ministry.
"HIV and hepatitis viruses are transmitted in similar ways and it makes public health sense to link HCV prevention
efforts to HIV programme" said Eldred Tellis, Director of Sankalp Rehabilitation Trust. "In addition to HCV screening in
blood banks, prevention and harm reduction efforts for HIV and HCV with vulnerable communities should go hand in hand.
Unless this is done, HCV infections will rise in India even though HIV transmission rates reduce, particularly among
injecting drug users (IDU), the most vulnerable community," adds Tellis.
Currently, HCV treatment is a combination of two drugs, pegylated interferon and ribavirin. For people who develop
chronic forms of the disease, treatment is currently unavailable in the public healthcare system and unaffordable in the
private sector. The high cost of HCV treatment in India (cost ranges from Rs. 14,000 to 18,000 per dose) is attributed
to the absence of generic competition due to patent barriers. India, as part of its obligations under World Trade
Organization's (WTO) international trade rules, had to introduce product patents on medicines in 2005. Pegylated
interferon alpha 2a and alpha 2b, used in the treatment of Hepatitis C, were among the first set of drugs to come under
patent monopoly in India, blocking the development of its more affordable generic versions.
"I had to use all my savings and borrow heavily to pay over seven lakhs rupees for my 48 week HCV treatment," said Nanao
Haobam.
Neini Wanda E. Pakma, who underwent HCV treatment this year, adds, "my family had to pay Rs.5, 78,000 over 24 weeks for
just pegylated interferon. I am one of the lucky ones to have been successfully treated in India. The high cost of drugs
makes it impossible for patients in India with chronic HCV to get the treatment they need."
The participants felt that the government has been moving far too slowly on addressing the problems of patients who need
HCV treatment. "When drugs are patented, and pharmaceutical companies fail to fulfil their obligation to make patented
medicines available and affordable to patients, the only way to bring prices down is through examining the validity of
the patent granted or compulsory licensing which allows generic production of more affordable versions," said Loon
Gangte, of the Delhi Network of Positive People (DNP+).
According to Dr.Tokugha Yepthomi, of ITPC – India, "As a physician I have gone through the frustration of watching
people die of AIDS even when effective anti retrovirals existed. But things changed with domestic production of
affordable generic antiretroviral medicines. People are now dying because the price of the HCV drug that can save them
is too high. Prohibitive pricing of lifesaving medicines by pharma companies is unethical and unacceptable."
Compulsory licensing (CL) could be a way out to effectively reduce the prices of Hepatitis C medicines. The case of the
CL issued by Thailand for the AIDS drug lopinavir/ritonavir in January 2007 clearly illustrates this. Over the course of
one year, the price decreased by as much as 75%. India's Patents Act too allows it to implement a progressive compulsory
licensing policy in accordance with international trade rules. The situation, although brushed aside under the carpet,
is already bad. It is high time for the Indian government to take immediate action.
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Shobha Shukla is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation
(NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto
Convent. http://www.citizen-news.org