NHS England (NHSE) has announced that the country is set to eliminate hepatitis C in 3 years – "putting England in pole position to be among the first countries in the world to eliminate the virus as a public health concern". A ground-breaking NHS initiative on hepatitis C has resulted in 70,000 infected people being found and cured of the potentially fatal disease, resulting in a dramatically reduced death rate 5 years ahead of global targets, as well as drastically reducing the number of people seeking liver transplants due to hepatitis C.
As a result, the NHS is "on track to eliminate hepatitis C by 2025", NHSE said. The initiative, which involved the 'largest ever' drug procurement process, with a 5-year contract worth almost £1billion, was launched in April 2018 but delayed by 6 months due to legal action by AbbVie, manufacturer of what was called at the time 'the health service's most costly drug', adalimumab (Humira). The company's claim that the NHS's 'smart' procurement process for the supply of curative direct acting antiviral treatments was unfair, and that the NHS had breached its duty to treat all bidders fairly, was ultimately dismissed by the High Court.
Disease 'Successfully Cured in Weeks'
At the time NHSE estimated that around 160,00 people were infected with hepatitis C in England, and that around half of them were unaware of their infection. However, new oral antiviral treatments – produced by AbbVie as well as Gilead, Johnson & Johnson, and Merck & Co – meant that the disease could now be "successfully cured in weeks" in around 95% of patients, with minimal side effects.
In addition to the pioneering drug deal, in 2015, NHSE had established 22 testing and treatment networks across the country to support a "concerted effort" to find people at risk. As a result, the number of people seeking liver transplants due to hepatitis C-related diseases was reduced by two-thirds, with annual registrations for transplant dropping from over 140 per year to fewer than 50 per year in 2020.
Deaths Dropped by a Third
NHSE said that thanks to the drug deal and the 'find and treat' program, deaths from hepatitis C – including liver disease and cancer – had fallen by 35%. This means that the NHS has exceeded the World Health Organisation (WHO)'s target of a 10% drop in mortality by more than three-fold, and the target for disease elimination has been "dramatically cut" 5 years ahead of schedule.
The NHSE campaign against hepatitis C involved collaboration with Oxford homelessness charity St Mungo's: the NHS secured new treatments while St Mungo's partnered to deliver 'find and treat' programmes to vulnerable communities. Homeless people often do not have regular contact with health services, so suffer from worse health outcomes than the general population.
The outreach programmes provided same-day screenings for hepatitis C for people who have been historically hard to reach and treat. Patients who tested positive were then offered support to access and complete a full course of treatment.
Sara Hide, a hepatitis C co-ordinator at St Mungo's said: "People who've experienced homelessness are at a higher risk of contracting hepatitis C. This can be due to substance use but also sharing toothbrushes, razors and other general lifestyle factors associated with sleeping rough."
She added: "With treatment for hepatitis C now less invasive – a course of medication for 8 to 12 weeks – we've seen an [increase in] uptake in people responding to our screening services. We also screen for other conditions at the same time to identify clients that might need extra health support."
Programme Helping Vulnerable People
John Stewart, national director for specialised commissioning at NHSE, said: "The festive period and the cold weather often brings into greater focus the challenges for people experiencing homelessness, and we're pleased that our hepatitis C programme, working with incredible partners like St Mungo's, is helping to meet the healthcare needs of many of those individuals."
NHSE said it had worked with drug companies to identify and treat people who may be unaware they are living with the virus, including people experiencing homelessness and individuals with mental health problems. The initiatives – working with local health services, councils and voluntary groups – find potential patients, test for infection and provide treatment to those who need it.
Rachel Halford, CEO of the Hepatitis C Trust, said: "We are delighted to be a part of this unique elimination deal, and work alongside NHS England to find, test and treat people most at risk of contracting hepatitis C. Through our peer-led programmes of work, people who have had and recovered from hepatitis C have been empowered to lead the way and help save the lives of thousands of others by supporting them into treatment. No one needs to die today from hepatitis C; it's now so easy to get tested, get treated, and get cured.
'Astounding' Progress Towards Hepatitis C Elimination
"The progress that has been made towards elimination is truly astounding. We now need a final concerted effort to make sure we reach all those that may be affected and reach elimination. Investment in a national campaign to improve public awareness of hepatitis C to reduce stigma and encourage people who may have been at risk to get tested is paramount."
Professor Sir Stephen Powis, NHSE national medical director, said: "The NHS is leading the world in the drive to eliminate hepatitis C and save thousands of lives, while tackling a significant health inequality in the process. Thanks to targeted screening and because the NHS has a proven track record of striking medicine agreements that give patients access to the latest drugs, we are on track to beat global targets and become the first country to eliminate hepatitis C by 2030 – which will be a landmark achievement."
