Viral hepatitis – a silent, but preventable epidemic

Recent breakthroughs in available treatment options and the broader objectives of the health-related Sustainable Development Goals (SGDs) make the WHO target of eliminating viral hepatitis by 2030 feasible. Earlier this week, the WHO issued updated guidelines for the treatment of hepatitis C infection, to “promote the transition to newer, more effective medicines that have the potential to cure most persons living with hepatitis C infection”. This is a timely development, as this silent epidemic of hepatitis B and C affects 1 in 12 people worldwide. Like with other infectious diseases, low- and middle-income countries bear the biggest burden, where some regions experience high endemicity, precarious prevention of transmission and low access to treatment.

Exploring innovative financing to expand access to treatment

Investing today in hepatitis B (HBV) and hepatitis C (HCV) prevention and treatment means a fundamental alleviation of disease burden for individuals and their families, in addition to relieving pressure on national health systems. Nevertheless, these new treatments pose significant challenges in some countries. Like with other infectious diseases, a major question is how to make access affordable to a large number of patients, especially in low-and middle-income countries, where the burden of HBV/HCV and out-of-pocket payments for healthcare are significantly higher than in high income countries.

Early 2015, together with experts from IFPMA, we set ourselves the task of exploring how innovative funding mechanisms could help tackle this major public health issue. We reviewed over 20 different existing funding mechanisms and examined how these could be used to support health systems in LMICs deliver them. Almost to no surprise, we found that there is no panacea, as one single financing mechanism is unlikely to be feasible.

We found a number of financing mechanisms that offer considerable promise, including non-infrastructure public private partnerships that build on social impact bond funding, shared value projects, and micro-financing. A mixture of approaches which considers the local context may be most effective.

First a national plan, then a funded control of viral hepatitis

Mitigating financial barriers to prevention and treatment is only one element in a comprehensive public health approach to managing chronic viral hepatitis. Optimal conditions for financing mechanisms will require political support, and competence in selecting the mechanisms best adapted to country-specific challenges and that meet the needs of all the stages of the therapy cycle.

Furthermore, funders will only be convinced on the basis of a strategic plan that delineates its benefits. Can countries give a stronger signal to funders about their political will and commitment to control viral hepatitis by developing a national control programme?

We hope that the report gives stakeholders from regional banks, leaders both from a public health and a financing perspective, investors, patients, health professionals and services, pharmaceutical and diagnostics industries and independent assessors and evaluation advisors, each with potentially unique roles to play, a good basis for discussion on how to contribute to eliminating viral hepatitis in LMICs. A core characteristic of innovative finance lies in the collaboration between various stakeholders which traditionally do not consider themselves as business partners.

To view the full report, click here.

Author

• Pierre Van Damme