Pakistan needs urgent measures to tackle this dreaded disease
Lt. Gen. (Retd) Mahmud Ahmad Akhtar
Pakistan has the highest Hepatitis-C burden in the world with approximately ten million patients, according to World Health Organisation statistics. A decade earlier, Egypt had the highest burden of Hepatitis-C, about 9 million patients, with about 1 in 10 chronically infected. In a public health campaign, extraordinary for both its scale and its success, Egypt screened its entire population and cured almost everyone with the virus. Egypt also helped Ghana, who is completing universal healthcare coverage, also Sudan, Chad and other African countries.
Lt. Gen. (Retd)
Mahmud Ahmad Akhtar
This is one of the greatest accomplishments in public health said Dr John W. Ward, the director of the Coalition for Global Hepatitis Elimination at the Taskforce Global Health. Egypt is on track to be the first country to achieve the World Health Organisation goal of eliminating Hepatitis-C and is following that victory with a campaign of “health diplomacy” pledging to donate drugs and share its expertise with a goal of treating a million African patients. The Egyptian government saw an opportunity to extend its expertise beyond its borders and contribute to global health efforts, said Khalid Ghaffar, Egypt’s Minister of Health and Population. The health diplomacy allows Egypt to leverage its success with Hepatitis treatment for the greater benefit of humanity while simultaneously enhancing its standing among the global community.
By adopting rational public health measures, Egypt saved a lot of money, thus spending earlier on Hepatitis-C complications of cirrhosis, cancer, liver transplant etc. Globally, about 58 million people are chronically infected with Hepatitis-C according to WHO and the vast majority of 50 million live in low and middle-income countries. Four out of five patients do not know they have the disease. It is a silent killer. About 300,000 die due to complications. To identify the ones having the virus, Pakistan needs to screen the whole population above 12 years of age as a priority followed by children 3-12 years of age. Pakistan is a low / middle income country, having a poor public healthcare system. The virus typically spreads through injections while reusing the infected syringes, the general medical practitioners and even quacks use injection indiscriminately. Of course, elite public health facilities dubbed as “Disease Palaces” and luxurious private health facilities are exceptions. These are beyond the reach of general public.
In the province of Sindh, the children got infected with AIDS virus due to use of infected syringes by the medical practitioners. Rationally, the injections should be used rarely. There should be restrictions on sales of injections. Barbers spread the disease by using / reusing infected razors. Disposable razors should be used. Using infected surgical / dental instruments not properly sterilized, using unscreened blood transfusions and having intimate contact with an infected person are among other reasons of spread of Hepatitis-C virus. In developed countries, it is spread by needles used in injecting addiction drugs. Infected persons with Hepatitis-C virus needs to be diagnosed early and promptly treated as the virus can silently cause liver damage leading to complications and affecting other organs. The financial burden on the public sector having the lowest financial allocation, already in great strain, have to bear burden beyond their capacity. Liver transplant costs over four million rupees plus costly immune-suppressive drugs beyond the means of over 80 percent of population.
Despite experiencing significant expenditure, about 36,000 Pakistanis lose their lives each year due to Hepatitis-C virus related complications. The cost of treating an infected patient in advanced stage with multiple admissions and procedures costs approximately US$ 10,000 whereas the cost of screening and modern effective treatment is US$ 130, not to mention the pain, suffering and economic losses experienced by the patients and their families.
The screening test is simple; the result is available within one hour. Now the highly effective inexpensive oral Hepatitis-C medicines are developed which can cure the ailment within 12 weeks. It is a low-hanging fruit. Studies from India, Agarwal et al, have indicated that within two years, funds invested in Hepatitis-C prevention and treatment could start yielding results, aside from preventing immense suffering for patients and families.
Universal healthcare system practiced in many low-middle income countries has solved these problems. In this region, since long, Sri Lanka has universal healthcare system, also providing free education, same for a common person and the President’s son. Pakistan is having over 25 million children out of school due to lack of facilities jeopardizing their future and of the country. In India, many states have reached 100% universal healthcare system. Others over 60% to 70% percent like wise. Bangladesh and other countries in the region are on the way to full universal healthcare system. The advanced / progressive countries are having universal healthcare system since long with the exception of USA, a capitalist country having large number of billionaires.
Unfortunately, Pakistan, a poor country following the American Capitalist healthcare system, calling itself the Islamic Republic, is totally un-islamic and against the wish of its founder who envisaged Pakistan to harness an “Islamic Welfare System”. Dr Francis Collins, the former director of National Institute of Health, now appointed as President Biden’s advisor on Hepatitis-C Lamarck, while writing in the New York Time, highlighted the urgency to eliminate Hepatitis-C across the globe saying “Many countries have taken greatest strides toward wiping it out (hepatitis). Egypt is now essentially there. Will the USA be the last? It appears Pakistan will be like polio, still lingering on. It should be kept in mind that a cured person cannot pass on to others, as a result every case treated today results in multiple cases averted in the future. An expert group has estimated that a national initiative to end Hepatitis-C would save society more than US$ 18 billion on healthcare over the next decade. Eliminating Hepatitis-C is one compassionate response for a nation that cares about all of its people, but it is also deficit reduction. It costs much taxpayers to live with Hepatitis-C than to cure it. Without action, we will doom many more families to go through the pain, says Dr Francis Collins.
Prevention is not only better than cure, it is the real cure. Rapid diagnosis with the modern techniques and soft treatment with the new drugs recommended by the WHO Expert Committee on Drugs is the answer, not only in solving the problem of Hepatitis-C, but also to other problems confronting Pakistan. In Pakistan universal healthcare system should be enforced to solve its health problems. In it ties, salvation of the people and country. People should be educated through media, education, curriculum, prayer leaders etc. about the diseases and their eradication.
*The author did a pioneering study on viral Hepatitis in Pakistan by doing needle liver biopsies, correlating with liver function tests for the Doctor of Medicine Thesis written in early 1960s, in collaboration with Prof Helmuth Sprinz of AFIP Washington USA also doing studies on Nigeria Armed Forces while working there.
