Around the world, 150 million people are estimated to be chronically infected with hepatitis C, a virus which is transmitted through blood to blood contact and can inflame and cause significant — and potentially fatal — damage to the liver.

In this country, instances of the virus are on the increase; yet unlike other forms of hepatitis, there is no vaccination available, and the drugs that have traditionally been used to treat it (interferon/ribaviron) can cause harsh side-effects and need to be administered over a long period.

Recent drug discoveries have offered hopes of a treatment breakthrough, but these are by no means universally available, says Charles Gore, Chief Executive of the UK charity the Hepatitis C Trust. Yet if its elimination is to be achieved by 2030 — as the Trust believes is possible — Gore believes they should be. “Hepatitis C needs to be taken seriously as a public health issue, rather than an individual illness,” he says. “It is the only human virus that we can properly cure. Whereas interferon only offers a 50-60% chance of success over a prolonged timespan, new drugs offer a 90% chance of success over a shorter timespan – between eight and 12 weeks.”

One of the barriers to accessing new treatments is the lack of diagnosis. “In the UK, only around 50% of people with the virus are diagnosed,” says Gore. “So, obviously, if you remain undiagnosed, you are not going to receive treatment.

“Then there are problems with the referral pathway between diagnosis and receiving treatment because people can drop off it for a variety of reasons. For example, those who are referred can miss appointments; while others look at the medication available and decide they don't want treatment after all.”

Treatment costs

The cost of the new drugs is another barrier. “NHS England wants to restrict access to the medication because of cost,” maintains Gore, “even though NICE (the National Institute for Health and Care Excellence) says it is cost-effective.” In England, the Hepatitis C Trust has been “struggling” to get the Government to sign up to the concept of elimination; and yet, says Gore, if there were (virtually) no new cases and no-one dying from the effects of the virus, treatment costs would reduce to almost zero.

Scotland has a different take on things. “Half of all people with hepatitis C come from the bottom socio-economic quintile,” says Gore. “Broadly speaking, it's a deprived group. I think the Scottish government thought this was a good way of addressing that inequality, and saw the opportunity to do so logically and effectively. So it created one of the best hepatitis C action plans in the world — and, as a result, new infections have fallen significantly and treatment rates have increased. It's no accident that the World Hepatitis Summit is in Glasgow this coming September.”

Still, Gore remains optimistic, and notes that NHS England and Public Health England are working alongside a coalition of other organisations and patient groups to publish the Hepatitis C Improvement Framework (which has been delayed). To make services better in England, Gore advocates a number of measures. “Prevention is key, but we need to do more around treating the population — and we need to do more around messaging, too. Diagnosis needs to be stepped up and people need to be properly referred; and it's clear from work that the Trust has completed that screening needs to be considered. And because different parts of the pathway are commissioned by different people, we need joined up thinking on this issue.”