Wales set to miss 2030 target to eliminate Hepatitis C without a renewed focus

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Health Committee
Hepatitis C: Progress towards achieving elimination in Wales (pdf)
Published: 27th June 2019

“We agree with witnesses that the elimination of Hepatitis C is achievable, but only with a commitment from the Welsh Government to produce a clear elimination strategy without delay….However, it is disappointing that we are not currently on track to meet the 2030 elimination target, and it is very concerning to hear about the uncertainty post 2020/21 in terms of strategy and funding, particularly for dedicated posts.”
– Committee Chair, Dr Dai Lloyd AM (Plaid, South Wales West)

1. Hepatitis C disproportionately affects vulnerable groups

Hepatitis C is a blood-borne virus affecting the liver, which can eventually lead to cirrhosis and liver cancer. Almost all cases are spread through drug users sharing needles, but it can also also be transmitted through poorly sterilised piercings – however, sex isn’t one of the main ways to transmit it. While there’s no vaccine, it can be successfully treated in 90% of cases if caught early.

Around 12-14,000 people in Wales have chronic hepatitis C. Due to how it’s caught, it’s far more prevalent amongst poorer communities, with more than half of people going to hospital with the disease coming from the most disadvantaged 20% in society (including the homeless), while the report says more than half of injecting drug users in Wales have antibodies which show they’ve come into contact with the virus.

Low levels of awareness amongst some health professionals was raised as an ongoing issue. Some patients said they had been visiting their GPs for several years with hepatitis C symptoms, but were never offered a test. There’s also a stigma attached to the virus due to how it’s transmitted.

2. Hepatitis C can be eliminated, but targets are set to be missed in Wales

The World Health Organisation (WHO) has set a target for Hepatitis B and C to no longer be a serious public health threat by 2030, which in practical terms means a 90% reduction in incidence and 65% reduction in deaths caused by the viruses. Wales signed up to this.

Public Health Wales said they were “optimistic” the target could be reached, but many witnesses said health boards were failing to meet treatment targets. Anecdotal evidence was also provided where health boards have told clinicians to avoid exceeding the treatment target due to finances.

The Welsh Government issued a new notice in October 2017 requesting that a number of measures are put in place by health boards, but no targets, specific delivery plan or additional funding accompanied it.

3. The long-term future of treatment programmes has been brought into question

Many witnesses said it was important to be able to go out into communities and actively track down people who are at risk, but drug users were said to be “notoriously poor” at seeking out health and social care services. Suggestions were made that more frequent testing can be undertaken in places like pharmacies, prisons, homeless shelters and mosques (Pakistan has a high hepatitis C infection rate).

The cost of hepatitis C treatments has significantly reduced, but there were calls for the Welsh Government to put funding on a longer-term footing; some national leadership roles for hepatitis don’t have funding certainty beyond 2020.

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