Pakistan has highest hepatitis C burden in world: PKLI BoG chairman

ISLAMABAD: Pakistan has the highest hepatitis C burden in the world with approximately 9.8 million cases with the disease. To identify the ones having the virus, the country needs to screen the whole population (over 12 years of age as a priority followed by children between 3-12 years), says Dr Saeed Akhtar.

Talking to The News, Chairman Board of Governors (BoG) of PKLI said that on August 6, 2023, the then prime minister Shehbaz Sharif had officially launched the “National hepatitis Elimination Programme and there is a need to expand it countrywide”.

He said the hepatitis typically spreads through barbers, using the same razor, used previously by an infected person, reusing syringes from infected individuals (note that boiling the syringe does not eliminate the virus), using infected surgical and dental instruments not properly sterilised, receiving unscreened blood transfusions, and having intimate contact with an infected person.

About the testing and treatment process, Dr Saeed said individuals infected with hepatitis C need to be tested early and treated promptly, as the virus can silently cause liver damage, leading to complications and even liver cancer. These patients often require multiple hospitalizations for managing their health issues.

“The financial burden on public sector hospitals can be immense, and patients’ out-of-pocket expenses can drive them into poverty. Liver transplants, costing around Rs4 million per case in Pakistan, are needed for 2,000-3,000 cases annually. Despite experiencing significant expenditures, about 36,000 Pakistanis lose their lives each year due to HCV-related complications. The cost of treating an infected patient through multiple admissions and procedures amounts to approximately $100,000, whereas the cost of screening and treatment is $130, not to mention the pain, suffering, and economic losses experienced by the patient and their families,” he added.

“Fortunately, Pakistan has developed highly cost-effective oral hepatitis C medicines that can cure the disease in just 12 weeks. Economic analysis shows that investing in testing and treating hepatitis C cases using locally produced medications in Pakistan would be highly feasible. Such an investment would not only save lives but also prove financially beneficial in the long run. Studies from India, Agarwaal et al have indicated that within two years, the funds invested in hepatitis prevention and treatment would start yielding returns, aside from preventing immense suffering for individuals and families,” says Dr Saeed Akhtar.

To effectively address hepatitis C, Pakistan can learn from Egypt’s experience. Egypt, which was once the global leader in hepatitis C cases, has come close to achieving a hepatitis-free status within seven years through strong political commitment and coordinated efforts. Pakistan’s leaders must display similar determination and allocate the necessary resources. A comprehensive approach is crucial, involving media, public campaigns, scholars, artists, educational institutions, and governmental bodies, all working together to screen the population and provide treatment.

“In the Eastern Mediterranean Region (EMRO) of WHO, Egypt and Pakistan were contributing to the largest burden of hepatitis C, over the last decade. However, Egypt has eliminated hepatitis C by testing the whole population and treating over 3.5 million cases. Now, Pakistan has the highest hepatitis C burden in the world with approximately 9.8 million cases with the disease. To identify the ones having the virus, we need to screen the whole population,” commented Dr Saeed.

According to the expert, globally, nearly 58 million people are living with chronic hepatitis C virus infection, with 90pc of them unaware of their condition. The virus silently takes lives, causing over 3,000 deaths due to hepatitis C every day. Recognising the enormity of the problem, the World Health Organisation has set a goal for all countries to eliminate hepatitis C from their territories by 2030. Pakistan is also a signatory to this agreement.

About PKLI performance, Dr Saeed claimed the institution began clinical services in 2018 and, despite serving as a COVID centre for two years, has successfully conducted its first 1,000 transplants (436 livers and 564 kidneys). It has also initiated a hepatitis prevention and treatment programme across 23 districts in Punjab, even before launching clinical services. Over five years, in collaboration with the Punjab hepatitis control programme, the PKLI screened 3.3 million people and treated 600,000 patients. Efforts are underway in Sindh as well. Thanks to the collective efforts of PKLI, the government, WHO, and other professionals, a budget of Rs35 billion was approved for a five-year national hepatitis elimination programme.

Dr Saeed claims that elimination of hepatitis C from Pakistan is achievable through his proposed model of “Drawing lessons from international experience”. However, he added the success requires a unified national mission driven by strong political will, commitment, and support at every level of execution and cooperation from the public. Establishing a successful elimination model could serve as the basis for early diagnosis, treatment, and surveillance programmes for other communicable and non-communicable diseases, thereby preventing epidemics. If Egypt can achieve this goal, Pakistan can too, with the help of Allah and a concerted effort.