In an earlier blog I mentioned that in addition to failings around mental health dual diagnosis there was another subject where lack of action made me angry. In truth on occasion it has also brought me to something approaching despair. The issue in question was Hepatitis C (HCV), a virus I have seen afflict friends and colleagues and let’s not forget the well over 100 million people worldwide living with the infection. It is a major contributor to the rising toll of liver related death.
One of the very first meetings I ever attended when I started work in substance misuse was about this Blood Borne Virus (BBV). There was a sense of urgency and I left the meeting with a sense of optimism. Over the next 15 years or so this would be eroded as there was always another priority or lack of agreement on what should be done. The successes achieved in preventing HIV within populations who injected drugs was not being replicated with HCV.
Recent years have seen great progress made in terms of treatment. Big pharma and research have provided drugs which offer the tantalising prospect of effectively eradicating this virus. Gone is the horrendous treatment and its uncertain outcomes. However, there remain huge challenges in creating the systems that can reach those with the virus, finding the funds to pay for treatment, plus the need to educate policymakers, medical professionals and the public on why HCV matters. My frustration, was if anything, growing.
It is therefore with a sense of relief that I have recently discovered what appears to be an international competition to start making real progress. This is not a formal competition, not a world cup of public health, but there is a real sense of cities and countries wanting to be first in eradicating HCV. Now I was aware of some fraternal rivalry between Scottish colleagues and those in England on who was doing best in this area (Scotland being able to claim some early leads), but it was the surprising figure of Barcelona FC striker Lionel Messi who introduced me to a much broader competition. He has helped promote Egypt’s health tourism offer to treat HCV. This programme has attracted some criticism but the domestic goal of eradicating the virus by 2020 doesn’t lack ambition.
This set me looking. The World Hepatitis Alliance identified nine countries on track to eradication by 2030, Australia (yet again leading the world in harm reduction), Brazil, Egypt, Georgia, Germany, Iceland, Japan, the Netherlands and Qatar. But there are other competitors, New York State, Hong Kong, Philadelphia, the State of South Australia, San Francisco are also looking to compete. Indeed, one city within South Australia is hoping to be the first HCV free City in the world (take a bow Murray Bridge). There are of course many more and there are many challenges to be overcome. Indeed, there is a risk if we don’t get this right we could end up in a cycle fighting drug resistant HCV but let’s remain upbeat. This is bold, optimistic and in the main, pragmatic stuff. Having read many of the strategies there is a clear understanding of the populations to be reached and acknowledgement of the importance of maintaining or improving needle exchange programmes, Opiate Substitute Treatment (OST) and engagement.
Its not a surprise to see Australia at the forefront here. One of the first countries to really deliver good harm reduction around drug use, they have a track record of innovation and getting on and doing it. The Kings Cross injecting room set up in the 1990’s by City Health veteran Dr Ingrid Van Beek has not just helped the people who use it. Its impact goes much further in terms of encouraging others all around the world to see what they can to help improve what can seem hopeless problems. I strongly suspect that Ingrid has directly inspired more work and action to reduce BBVs than Lionel Messi will but the idea of cities, regions and countries competing to tackle major health problems, with or without a superstar’s endorsement, has a strong appeal. I am also confident that there will be plenty of inspiration available in Odessa this September.