Hepatitis C deaths in India: With over a crore cases estimated, is India equipped to tackle the disease?

In a hall packed with doctors, last week in Chandigarh sat a few patients, old and young, male and female, on the fringes. They were shy and reticent, relegated to a corner in the air-conditioned room, until their names were called out. One by one they lined up and collected their certificates which declared them free of Hepatitis (Hep) C infection, but warned of a relapse, and also advised follow ups. Punjab is one of the two states in India, the other one being Haryana, which provides free Hep C, drugs to its patients. One may wonder, why such a big hullabaloo over this viral infection? Why single out Hep C for a discussion on access to free treatment? What is so unique about the virus?

After a patient’s immune system is attacked by the Hep C virus, the virus has an ability to lodge in the patient’s body silently, hibernating for many years, as many as twenty. It is a silent killer. The disease flares up without a signal or a sign and directly progresses to blow apart the liver, rendering it as much as 85% damaged, what we call ‘cirrhotic,’ in medical jargon.  Liver being the powerhouse of the human body, once damaged, leads to lethal repercussions for the patient. Such a patient dies within two years of Cirrhosis setting in.

In India, it is estimated that between 60 lakh to 1.1 crore persons are infected with Hep C annually. In 2015, an estimated 59,000 patients died. A faulty blood transfusion during an emergency surgery up to two decades ago, or a dental cleansing procedure using non-sterile equipment or an act of tattooing or indulging in unsafe sex can lead to infection. Yet, Central Bureau of Health Intelligence has recorded not more than 1, 42,148 cases of viral hepatitis (which includes both B and C types) and only 446 deaths during 2016.

After Punjab started meting out free Hep C drugs since last year at its government health set ups up to 32,000 patients have gotten registered in the state alone for free treatment in a single year.

This is a gross case of under-reporting. The disease is almost 60 to 100 times under-reported in India. Missed cases of Hep C and a large chunk of preventable deaths occur every year. More so, the blood boils at such a large amount of under-reporting because Hep C is a preventable and a curable disease.

While in the US, the cost of treatment is exorbitant, per pill costs $1000 and the treatment cost of Sofosbuvir regimen of 12-24 weeks can go up to a crore rupees, in India, the drugs are available at a much cheaper rate. The entire regimen of Sofosbuvir, Daclatasvir and Ledipasvir of six months can cost a patient up to Rs 30,000 in India.

While drugs cost Rs 30,000, there an entire battery of diagnostic tests – Hep C RNA tests to be done thrice over the course of treatment –a total of Rs 6500, a genotype test costing another Rs 3000, a haemogram or a complete blood count, a liver function test and a liver fibroscan all of which approximately add another Rs 5000 to the out-of –pocket expenditure for the patient. All in all, a Hep C patient if ever comes to a point of seeking treatment after realising the s/he has gotten infected with Hep C, much before the liver blows up to become cirrhotic, will end up spending close to Rs 50,000 in an attempt to undo the virus that has inflicted him or her.

It is not enough for the central government to gloat over making drug treatments cheaper in India, or for the respective state governments for making drugs available for free to patients in Punjab and Haryana. This because lakhs of patients who are infected with Hep C, that lies silent in their bodies, are unaware of their infection status.

India vouches to provide Universal Health Coverage being a signatory to World Health Organization (WHO) and the United Nations’ Sustainable Development Goals (SDGs) which entails providing all people with the health services they need without suffering financial hardship when paying for them by 2030. Is India really living up to the UHC promise? The case in point is the faltering treatment provision to Hep C patients and a complete lack of preventive screening mechanisms to pick up Hep C patients early in time.

A poor patient cannot afford to spend Rs 50,000 on a six-month treatment regimen in bigger hospitals let alone travel to bigger cities to seek treatment. In Delhi, activists have been pushing for free treatment of Hep C in major hospitals like GB Pant, All India Institute of Medical Sciences and Ram Manohar Lohia Hospital. Even after a year of promises and bringing drugs like Sofosbuvir and Daclatasvir under the National List of Essential Medicines (NLEM), which means that they are supposed to be available for free at all government hospitals, the drugs are unavailable. Patients have to buy Daclatasvir from private chemists, a pack size of 28 tablets costs Rs 6000. Up to 150 patients throng the Out Patient Department corridors of GB Pant Hospital every day. They come from all across India, mostly the northern parts, to seek treatment. And when they are asked to procure medicines from private chemists, which they obviously cannot afford, they drop out of treatment. Can India afford to let its poor patients suffering from Hep C die like this? Clearly not. It is high time the government gathers its act together to work on meting out free screening and treatment to Hep C patients across states. 

Maitri Porecha is a health correspondent with DNA and is currently pursuing the Universal Health Coverage Fellowship supported by the World Health Organization and Centre for Media Studies