Source: World Hepatitis Alliance
Day three kicked-off with a single message – financing does not need to be a barrier to elimination. Chaired by Dr. Amanda Kgomotso Vilakazi Nhlapo, National Department of Health, South Africa and Dr. John Ward, US Centers for Disease Control and Prevention, panelists took to the stage to discuss the various and often innovative ways for countries to finance their hepatitis response. Charles Gore, President of the World Hepatitis Alliance, opened the session highlighting that only 35% of national plans have funding strategies attached to them. WHO estimate that the hepatitis response will cost approx. $6 billion per year for all low-and middle-income countries. This was starkly compared to the 2010 World Cup in South Africa which cost $3 billion and the Commonwealth Games in India which cost $4 billion. The overall point being that money is available but not being used efficiently.
Efficiency was the topic of Dr. Jeremy Lauer’s, WHO, presentation. He highlighted the importance of integration of hepatitis within health systems. There is no reason to think about separating pooling and purchasing arrangement, if it’s already available. If we can build it into purchasing and health benefits, hepatitis can be the solution, not the problem.
Following these presentations, the session opened to a panel discussion chaired by Dr. Eduardo González Pier, Center for Global Development, with speakers from the World Bank, Center for Disease Analysis, Rwanda Biomedical Center and Colombian Ministry of Health. This session reiterated the previous points that domestic funding will be key and the most effective way to do this is through integration. Highlighting the differences between the HIV/AIDS response, panellists highlighted that the world has moved on from focusing on a single disease area and now we must work to develop sustainable universal health coverage systems.
Sustainable financing is intrinsically linked to political will which was another point shared by panellists. Dr. David Wilson, World Bank, highlighted that many countries don’t give enough of the national budget to health. In Pakistan, only 1% of GDP is given to the health budget. As Homie Razavi, Center for Disease Analysis Foundation, highlighted countries will spend less eliminating hepatitis C than doing nothing at all. One country highlighted for their commitment was Colombia. Over the last number of years they have procured hepatitis C treatment for lower costs through PAHO and now have committed to increasing treatment by 500 people each year until 2020.
After a short coffee break the second session of the day continued with "Strategic direction 4: different financing mechanisms for viral hepatitis programmes" which was chaired by Dr Adele Benzaken from the Ministry of Health of Brazil and Dr Philip Duneton of Unitaid. The session reaffirmed the main points from earlier in the day including reinforcing the importance of integration within health services and encouraging Ministers of Finance to invest.
One of the key issues raised was how to not only work with your Minister of Health but also involve the Ministry of Finance. For Ministers of Finance elimination is not always seen as cost effective; even though research has shown that while there are a lot of upfront costs in the long run, there will be healthcare savings as less people are hospitalised from complications of hepatitis. Homie Razavi likened the upfront costs involved in prevention and treatment to that of buying a house. When you buy a house, you pay more upfront but once the debt is paid off you save more in the long term. Therefore advocacy is critical to the elimination response.
The session ended with a debate between Dr Jeremy Lauer of WHO and Dr Chinburen Jigjidsuren from the Ministry of Health in Mongolia. They discussed the importance of civil society groups to lobby the government for funding. Dr Jigjiksuren stressed the importance of evidence-based research. All panellists agreed that there was no magic solution but that tools do exist for you to make a sustainable plan.
After lunch in the session “Innovation for Acceleration”, Dr Henry Cohen, ECHO Project, Uruguay explained how the project aims to scale up access to hepatitis care by linking expert specialist teams at an academic centre of excellence with primary care clinicians in local communities. He concluded: “Project ECHO is a cost-effective way to treat patients with HCV infection at scale, using existing primary care providers. This approach could substantially reduce the burden of chronic HCV infection in the United States”
Christian Trepo of INSERM, France, then discussed the outcome of an integrated HIV/hepatitis B research agenda in France, explaining that a lot of the work that created the new DAAs for hepatitis C was based on HIV research. “This common biology between hepatitis B and HIV commands for a combined eradication strategy,” he said, concluding that there are around 50 new drugs in the research pipeline for hepatitis B and several of them are likely to end up being approved.
The Innovation finalists (Freke Zuure, Emalie Huriaux, Anila Goswami, Lien Tran, Momoko Iwamoto, Ammal Metwally) discussed their innovative ways to tackle viral hepatitis. Emalie Huriaux from Project Infrom and CalHep discussed the elimination strategy being devised for San Francisco, based on including all those infected especially marginalised populations.
Anila Goswami, Institute of Liver & Biliary Sciences (ILBS), New Delhi, then discussed the hepatitis nurse coordinator treatment model, introduced at her institution, which remains the only one in India operating such a model. This task-shifting initiative from doctors to nurses has allowed these nurse coordinators to monitor the care for more than 1,500 patients with hepatitis C so far and if scaled up could allow huge treatment expansion in India.
Lien Tran of Hepatitis Victoria, Australia, then discussed the “Little HepB Hero” – the making of children ambassadors for hepatitis in families and the community, and this was followed by Ammal Metwally of Egypt discussing the screening and elimination of hepatitis C from entire villages in Egypt, a key pillar of that country’s elimination strategy.
Freke Zurre, of the Public Health Service of Amsterdam, then presented on home-based HCV-RNA testing for men who have sex with men (MSM) —part of an integrated approach to eliminate HCV infection among this population. Finally, Momoko Iwamoto of the Epicenter, Médecins Sans Frontières, Cambodia, discussed the optimal care model for hepatitis C in Cambodia.
The three-day event closed on a hopeful note with the launch of the São Paulo Declaration on Viral Hepatitis, which was negotiated by government representatives. The Declaration committed to taking a broad and coordinated approach to support implementation of the core interventions outlined in WHO’s Global Hepatitis Strategy. In response, the World Hepatitis Alliance and its 252 member organisations launched the São Paulo Community Declaration on Viral Hepatitis, demanding that governments give viral hepatitis the same priority as HIV/AIDS, malaria and TB, that stigma and discrimination is adequately addressed and that governments will fulfill the commitments of Sustainable Development Goals in so far as ‘that no-one will be left behind’ and that governments ‘will endeavour to reach the furthest behind first.’
“This is not just a piece of paper to us. This is a matter of life and death for more than 300 million people worldwide.” said Charles Gore. “It’s imperative that countries act immediately and decisively to stop the countless number of needless deaths each year”.
The event ended on a poignant note as Gottfried Hirnschall, WHO, and Dr Adele Benzaken, Government of Brazil, paid tribute to Charles’ leadership and vision. This comes ahead of his departure as President of World Hepatitis Alliance at the end of the year. The intense round of applause was testament to the level of support, inspiration and commitment that Charles has brought to people, organisations and governments across the world. Charles will continue his efforts as CEO of the Hepatitis C Trust in the UK.