I read the recent state Department of Health (DOH) report on premature deaths in Hawaii due to chronic hepatitis C, available online, with great concern and sadness.
As a treating physician for patients with this dreadful disease since 1991, I am not surprised to learn the results of this report. I saw an increasing number of patients dying from the long-term consequences of this chronic illness when undiagnosed and untreated. Hepatitis C was the number one cause for liver transplantation, liver cancer and death. Sadly, some patients passed away while waiting for that transplant.
Now this timely DOH report adds another dimension to the consequences of hepatitis C: early death. It is alarming that the rate is high among people who are younger than 65, the most productive period of a person’s life. The rate of infection has increased significantly among young adults due to the ongoing national opioid epidemic.
Treatment once consisted of interferon-based therapy of at least one year duration with significant side effects that were very difficult for a patient to bear. The treatment was sometimes worse than the disease itself. But thanks to scientific advancements, we now have curative therapy of a short duration and minimal side effects.
The cost of the treatment was very high initially, but the drug price has come down significantly in recent years. And the benefit has overly outweighed the cost of the treatment. The number of deaths and a patient’s need for liver transplant has decreased dramatically since the new antiviral drug became available. However, the people who could benefit from this treatment most has not been identified and link to treatment.
Hawaii must do more to tackle this curable illness head on. The World Health Organization recognized a paradigm shift for hepatitis C treatment in 2019 and with a detailed analysis of the situation found that it is feasible for us to work toward a world without hepatitis C. The federal Centers for Disease Control and Prevention (CDC) has declared hepatitis elimination a “winnable battle,” meaning that much progress can be made in a relatively short period of time. CDC also recommends that all persons over the age of 18 get screened for hepatitis C.
I’ve proudly worked with members of Hep Free Hawaii, including the state DOH and Hawaii Health & Harm Reduction Center and almost 200 other stakeholders, to raise awareness and increase access to medical care. The centerpiece of these efforts is the Hep Free 2030 elimination strategy, which has the support of Gov. Josh Green and all members of Hawaii’s congressional delegation.
However, there are still multiple barriers to be overcome in moving toward hepatitis C elimination in Hawaii by 2030. The barriers are as follows:
>> Lack of knowledge that this a grave disease and that there is a curable treatment, especially among front line health providers and patients.
>> Lack of resources to educate and implement timely screening and linkage to care.
>> Unmet needs and disparities among populations who are at high risk for chronic hepatitis C but uninsured or under insured.
Hawaii is well-positioned to overcome these barriers. I strongly urge the public, state legislators, insurance providers (private and public) and concerned residents to lend their support to a concerted effort to advocate and tackle this preventable, treatable and eradicable disease. Hepatitis C can then join smallpox and yellow fever as diseases for the medical history books.
This next legislative session will provide an opportunity to allocate funds that can move Hawaii toward hepatitis C elimination. Let’s raise our voices together as we embark on this winnable public health battle.
Naoky Tsai, M.D., specializes in hepatology and gastroenterology and marked his 50th year as a physician in 2024.
