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Punjab’s hepatitis crisis

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by Ajoy Bose

In an unprecedented move to tackle the growing epidemic of Hepatitis C in the north Indian state of Punjab, free treatment is being made available by the local administration. This initiative has been strengthened by the recent sharp drop in the price of Hep C super drug Sofosbuvir, after global pharma company Gilead awarded voluntary licences to 11 local firms to make inexpensive generic versions.Taken together, these two events have significantly boosted the fight against the killer disease in the state. The growing numbers of hepatitis C patients across India will also benefit from Gilead’s new partnerships. With less expensive medicines, hopes for poor needy patients to get better access to this previously unaffordable and innovative medicine have been raised.


The state government of Punjab the first state in India to offer free treatment for hepatitis C. It has assigned three medical colleges in the major towns of Amritsar, Faridkot and Patiala, along with 23 district government run hospitals, to provide medicines without payment in two different treatment regimens for all confirmed cases of the disease. Patients who are bona fide residents of the state suffering from Hepatitis C have been asked to register themselves at these 25 centres. Here they will be issued the medicines for the course of treatment decided by medical specialists after examination and testing. This unprecedented initiative has been launched amidst growing alarm over the mounting incidence of hepatitis C in Punjab. The epidemic has been fuelled by the spiralling numbers of drug addicts, most of them sharing and reusing unsterilized injectable syringes.

Archana Shukla , Assistant Editor, Rural Affairs and Pharmaceuticals in the leading Indian business television channel CNBC 18 recently travelled across villages in Punjab. In her series on the hepatitis C epidemic in the state, she described the situation as grim.

“I came across a village Lande Rode where people said that as much as ninety percent of the population was suffering from early to late stages of hepatitis C. The village has acquired the reputation of being the Hep C capital of India” she said.

Despite the government scheme to provide free treatment to hepatitis C patients Shukla feels that the public healthcare machinery in the state was not up to the task of meeting the challenge.

“Most of the district hospitals and medical colleges providing free treatment are far from the worst affected villages in remote areas. Besides private quacks and agents of local drug manufacturers are already running a flourishing rackets at the village level, fleecing people by offering cheap diagnostic tests and tools if they bought the Hep C drugs from them”, the television correspondent said.

Significantly, while the government has promised free drugs for certified hepatitis C cases, the diagnostic tests that can cost up to twenty thousand rupees — an astronomical amount many times the monthly salary of a villager — is a huge barrier. The dual treatment regimens prescribed for the free drug drive by the government, instead of delivering just one pan genotypic regimen, could also raise the cost burden for patients.

“This dual treatment regimen will force patients to undergo a needless genotype test costing between seven and ten thousand rupees. Most importantly the absence of a public health approach and the absence of community based testing, means the government programme will only reach patients who have symptomatic liver disease because of HCV — not those who are unaware they are carrying the silent virus”, lamented Leena Menghaney, South Asia head of Medecins Sans Frontieres (MSF).

The drop in the price of Sofosbuvir, the highly effective drug against hepatitis C, is seen as a major step forward in bringing down prices of other innovative medicines, not only hep C. It offers a possible model that other pharmaceutical majors could follow in partnership with local generic companies.

However, despite this welcome progress, a bitter controversy is brewing over the surprising decision by the Indian Patents Office to grant a patent to Gilead for Sofosbuvir in May this year, even though the same office had rejected the patent application just last year. The decision has been challenged in the Delhi High Court by the US-based Initiative for Medicines, Access & Knowledge (I-MAK) along with the Delhi Network of Positive People.

“The curious decision by the Indian government to reverse its own decision refusing Gilead a patent for Sofosbuvir will not only stop the possibility of export of active pharmaceutical ingredient (API) to other countries but also undermine its own efforts to revive and boost the domestic API industry” said Ms. Menghaney.

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