The Biden administration's fiscal year 2024 budget proposal aims to eliminate hepatitis C from the United States by creating a nationwide program to fight the disease.
“The field has been waiting for this for a long time,” says transplant hepatologist David Kaplan of the University of Pennsylvania Perelman School of Medicine. Eliminating the disease “is possible and feasible,” he says, noting that other countries are on their way to meeting that goal. But that doesn’t mean the effort will be easy, adds pediatric hepatologist James Squires of the UPMC Children’s Hospital of Pittsburgh. “It will be a challenge.
Despite the lack of a vaccine, researchers can talk seriously about eliminating hepatitis C because the drugs known as direct-acting antivirals , first approved in the United States in 2013, are so effective. These drugs, such as the combination of sofosbuvir and ledipasvir sold as Harvoni, can oust the virus from more than 95% of patients with only an 8- to 12-week course of treatment.
For example, estimates suggest about 10% of the roughly 2 million people in the United States who are in jail or prison carry the virus, but they often go without testing and treatment. For this group, “We need more resources for testing and a cultural shift in availability of treatment,” says Matthew Akiyama, a clinician-investigator at the Albert Einstein College of Medicine.
The initiative would also tackle one of the biggest treatment obstacles—drug costs. Although the price of DAAs has fallen by about 75% since they were introduced, a full course still runs about $20,000. To improve treatment for incarcerated people and other underserved populations, the program would adopt the so-called subscription, or Netflix, model, first tested by Louisiana, in which the government pays drug companies a set amount for as much drug as it needs, rather than paying per dose.
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