Hepatitis C drug access: Europe is the new Africa
Simon Collins, HIV i-Base
Leading doctors, researchers and community activists involved in the Five Nations meeting collaborated on a joint public statement that called for “governments, the pharmaceutical industry and the medical profession to co-operate to make the latest and most effective hepatitis C drugs affordable and accessible to all patients”. 
The statement was important, as treatment access and cost were repeated themes throughout the conference. As the meeting progressed, it become increasingly clear that the remarkably high cure rates being reported with the newest hepatitis C drugs were only likely to be used by a tiny percentage of people who needed them.
The current arrival of new HCV treatment is often historically compared to the availability of ART to treat HIV in the mid 1990s from the standpoint of new drugs and the dramatic impact they had on mortality and morbidity. But just as HIV drug pricing limited access to people in rich countries, without concerted public health campaigns, the new HCV drugs will similarly be denied to most people in need. The surprise for many is that this disparity is occurring within rich European countries. For many people, Europe is the new Africa. Many of the European activists speaking in the programme reported little prospect of access to treatment, despite long-term HIV/HCV coinfection and progression to cirrhosis.
As EATG activist Diego Garcia Morcillo explained in a plenary session on access: “People are dying, it is that simple. We have forgotten the lessons we learned from HIV. In South Africa, pharmaceutical companies blocked access to generic medicines. Now it is happening in Europe.” 
This session highlighted disparities in access in different European countries – with Germany and France having broader access to new treatments, but with Spain, Italy and the UK planning to limit access to those with the most advanced disease. The exorbitant prices set for these drugs is holding public health systems to ransom. Individual patients who are diagnosed and within care will have to let their liver function progressively decline until this is judged sufficiently serious to warrant tolerable treatment with best standard of care.
Dr Edmund Wilkins, one of the senior HIV and HCV consultants involved in the BHIVA coinfection guidelines noted in the Janssen satellite meeting before the first plenary: “For the next year we are still going to be using interferon-based treatment, and interferon is not a drug that anyone wants to be taking”. 
- Conference statement. European experts call for reduction in treatment costs to ‘eliminate Hep C within our lifetimes. (08 December, 2104).
- Diego Garcia Morcillo. Plenary Session 6 HIV/hepatitis in Europe: who, when and where. Five Nations Conference on HIV and Hepatitis 8-9 December 2014, London.
- Wilkins E. HIV and hepatitis C: the patient’s journey through a clinical setting. Five Nations Conference on HIV and Hepatitis 8-9 December 2014, London. Session not available online.