health and tech institute (hti)
strategy for continuous health transformation
Joaquim Cardoso MSc
Founder and Chief Researcher & Editor
February 17, 2023
EXECUTIVE SUMMARY
Egypt’s successful effort to nearly eliminate hepatitis C provides an important case study for the United States (and other countries), where rates of the disease are rising, particularly among people who inject drugs.
- Egypt was able to achieve this remarkable feat by
(1) negotiating with drug manufacturers to lower the cost of treatment and producing medications locally, while also
(2) establishing a nationwide screening program and
(3) training community workers to conduct door-to-door screenings.
- The U.S. [and other countries] can learn from this experience by prioritizing affordable and accessible preventive care programs, investing in targeted policy action, and considering price negotiations with drug manufacturers.
- With the right policies in place, the U.S. [and other countries] can make significant strides in reducing the spread of preventable diseases like hepatitis C.
DEEP DIVE
How Egypt Has Nearly Eliminated Hepatitis C Even as Rates Rise in the U.S.
Commonwealth Fund
Munira Z. Gunja
February, 2023
Just a decade and a half ago, Egypt had the world’s highest prevalence of hepatitis C.
Roughly 170,000 Egyptians became infected annually with the serious, usually chronic viral illness, which can lead to cirrhosis, liver failure, and cancer.
But last year, Egypt nearly eliminated the disease as a public health threat, preventing millions of deaths in the process.
With the opioid crisis driving an increase in hepatitis C infection rates in the United States over the past five years, Egypt’s experience is worth closer study.
It’s a success story that proves with concerted political action, nations can slow or stop the spread of acute and chronic illnesses.
How did Egypt eliminate hepatitis C?
When Egypt was at the peak of its hepatitis C crisis, treatment was expensive and largely ineffective.
The introduction of new, highly effective treatments in 2014 gave everyone, from public health managers to patients, hope.
But the cost kept it out of reach for most: a 12-week course of treatment retailed for USD 84,000 per patient.
The Egyptian government took action by slashing the price of hepatitis C treatment through negotiations with drug manufacturers and by producing medications locally.
Within six years, more than 4 million Egyptians were able to sign up for treatment.
To stop the spread of the disease, the government also established a nationwide screening program.
Community workers were trained and funded to go door-to-door in villages and visit religious centers and offices, and screening centers like hospitals and rural health clinics were opened.
In just a few years, more than 50 million people had been screened, slowing the virus’s spread and likely preventing countless future outbreaks.
The goal was to eliminate hepatitis C from Egypt by 2030. The government did it eight years early.
The goal was to eliminate hepatitis C from Egypt by 2030. The government did it eight years early.
What are the takeaways for the U.S.?
Hepatitis C is on the rise in the United States, particularly among people who inject drugs.
But it’s far from the only disease that can be prevented and treated with the right polices.
Drug prices are a key part of the puzzle. In the U.S., 14 percent of insured patients skip doses or prescriptions because of their cost, a number that jumps to 33 percent for people who are uninsured. Just one pill can cost as much as $1,000.
Drug prices are a key part of the puzzle. In the U.S., 14 percent of insured patients skip doses or prescriptions because of their cost, a number that jumps to 33 percent for people who are uninsured. Just one pill can cost as much as $1,000.
While Egypt and the United States have different tools available for determining drug prices, Egypt’s example highlights the potential of price negotiations.
In the U.S., the Inflation Reduction Act authorizes the federal government, for the first time, to negotiate with pharmaceutical manufacturers to set prices for certain drugs covered by the Medicare program.
While this is a step toward lowering health care costs for Americans, this provision of the law is limited to the Medicare population, and initially to only 10 drugs.
Egypt’s experience also illustrates the importance of investing in affordable and accessible preventive care programs.
With 8 percent of the population uninsured, millions of Americans can’t afford basic preventive care.
And with the future of free preventive services for those with insurance in question in several states, access to screenings for cancer, diabetes, and hepatitis C may soon be financially out of reach for even more people.
Finally, Egypt demonstrated the value of targeted policy action.
Fewer than one in three Americans diagnosed with hepatitis C get timely treatment, with Medicaid recipients being the least likely to receive treatment.
The rates are even lower among Black and other nonwhite Medicaid patients.
While the cost of treatment has decreased over the years, there remain eligibility restrictions and insurance preauthorization requirements, among other barriers.
Egypt was able to prove that coordinated, concerted actions could reduce the risk of a preventable disease.
With its vastly greater resources, the United States could certainly do the same.
* The author would like to thank Ane-Kristine Finbråten, a 2021–22 Norway Harkness Fellow, for her input on this International Insight.
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