A dramatic drop in the cost of revolutionary new hepatitis drugs could see Pakistan lead the way in stamping out one of the world's most prevalent infectious diseases.
Hepatitis C infects as many as seven million people in Pakistan, making it one of the worst affected countries on the planet.
The virus is responsible for a silent epidemic with most sufferers unaware they are infected until their livers have suffered years of irreversible damage, or they have cancer.
A sharp fall in the cost of powerful new drugs and screening kits now offers the chance to transform the way the infection is treated according to the aid group Doctors Without Borders (MSF).
The charity is running a pilot project in a Karachi slum which aims to use the new low cost drugs to cure people in small grass roots clinics rather than central hospitals.
“This could be a game changing, not only for public health, but it is a miracle waiting to happen. The day the government begins to put its weight behind it, it will be something which will be a revolution,” said MSF's Dr Hassan Zahid.
Hepatitis C treatment until recently relied on a year-long course of injections that only cured around half of patients and brought on gruelling side effects including depression and suicidal feelings. Different strains of the virus also had to be treated with different drugs.
A new generation of drugs called direct-acting antivirals (DAAs) went on the market earlier this decade transforming the chances of treatment. DAAs could be taken as tablets, most combinations worked on all strains and cured more than 95 per cent of patients in a few months.
But the new DAAs were hugely expensive. When Sofosbuvir, produced by pharmaceutical giant Gilead, became available in late 2013, it cost $1,000 per pill or $84,000 for a full course. The price made it 67 times more expensive gram-for-gram than gold.
It remains hugely expensive in the West, where politicians and organisations including MSF have campaigned for Gilead to either bring prices down or allow other manufacturers to make generic versions. The publicly listed price that the NHS currently pays is nearly £12,000 for a bottle of 24 tablets, though a new deal is understood to be under negotiation.
However in the developing world, where campaigners say drug giants make less money and defend their profit margins less fiercely, prices have tumbled. By using tactics learned in the long battle to make HIV drugs affordable, campaigners have opposed patents, challenged licensing agreements and bought in bulk.
Gilead and other drug companies have cut prices and allowed local manufacturers to make generic versions. MSF can now buy Indian-made treatment for $120 per course in Pakistan and expects the price to go down further.
The MSF project is in Machar Colony, one of Karachi's largest slums where around 150,000 mainly Bengali and Pashtun residents work largely in the fishing industry. If hepatitis C can be effectively treated in a small clinic here, then it shows it can be treated in a similar fashion almost anywhere, MSF argues.
Those who believe they have the disease, known locally as black jaundice, which has symptoms including tiredness, joint pain and nausea come in and are screened. New portable genetic testing machines mean viruses can be quickly screened for in the clinic.
Patients are also questioned on what risks they might have taken to end up with the infection. The blood-borne virus is often spread from patient-to-patient by unqualified doctors or dentists using dirty instruments or syringes.
Asif Ali, a 26-year-old gardener, found he had hepatitis C when he had a routine health check up when applying to work in Dubai. His joints had been painful for several years, but he had no idea why. He had regularly received injections from backstreet doctors and six years ago had dental work.
Curing people of the disease, before they need expensive hospital care and transplants, could save countries huge amounts of money. The World Health Organization says it wants to eliminate both hepatitis B and C by 2030.
But with no vaccine on the horizon, hepatitis C can only be stamped out by treating those who have it. With transmission so rife among unqualified and backstreet doctors and dentists, medics also fear people will be infected just as they are cured. Cleaning up healthcare is therefore vital to the chances of stamping out the disease.
The MSF clinic in Machor Colony has cured an estimated 2,000 people since work began and has hit the 95 per cent success rate found in larger hospitals. Yet the disease attracts far less funding that HIV or tuberculosis, said Jessica Burry, who works on MSF’s Access Campaign.
“We have got the option to cure people and we don't have the political will or the funding to do it,” she said.
patients awaiting screening and Marchor Colony slum.
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