I am really happy to be here with you, and so many friends, today! I still recall very lively the early days of the red ribbon forum during my previous tenure in China. It is great that this forum is still alive and strong, and offers a platform for open exchange and debate.
I am particularly happy that today we discuss issues around Hepatitis C. Almost 8 million people with HCV in China, including 2.5 million who are in need of treatment. And over 11 million Chinese will die of liver cancer (including hepatitis B) in the next 20 years if nothing is done.
These numbers are huge, even for Chinese standards. Something needs and must be done. The cost for individuals, families, and the society, in terms of pain, grief and economic loss with 11 million people dying of cancer is just not acceptable for the second largest economy of the world – with some of the world best and finest experts and researchers right here in China.
But what are the options? Traditional treatments including with interferon have a fairly low cure rate, and significant side effects. PEG interferon is a step forward, but still requires a year long treatment with a 2 out of three success rate – at cost of about 80,000 RMB.
Even with some level of reimbursement through health insurance, this unfortunately is not a good option for many who need it.
But there is also good news: there are new treatments which have been registered in the USA, for example. These drugs have cure rates of more than 90 percent, with just a three month cycle.
So, why don’t we use these new drugs? For two simple reasons:
- the cost of these drugs are currently too high;
- they are not registered in China, as registration requires separate clinical trials in China.
This is where we can – and must – learn from HIV! Just like in HIV in the early years, the best treatment of hepatitis is restricted to a comparatively small number of patients.
And because of the lack of large scale programmes we wont get a good deal. And because we don’t get a good deal, we don’t dare to even think about it.
But what if we got the treatment for 6,000 RMB for a full treatment cycle? A cure for 6,000 RMB!? No more cancer. No more transmission. This would be a really good deal, no? But believe it or not: this can become a reality if we shift to a public health programme, just as we have done in HIV.
And why do we have to wait for more clinical trials for a drug that has been registered by the toughest regulatory authorities and cured tens of thousands of people already?
I know that this is part of existing regulations. But why do we accept regulations that simply don’t make sense and cost millions of lives?
My friends: my plea is the following: the red ribbon forum was created as a platform for honest exchange and to provoke our own thinking. Let’s put our heads together and find the solutions, even if we have to challenge the existing approaches where they don’t make sense.
If we are to be successful, we need to have the better arguments. And be ready for pragmatic solutions. Let’s use the forum today to challenge our own thinking. Let’s follow the call of Dr Margaret Chan, DG of WHO, to fast track registration of the new Hep C drugs in China – based on the dossiers successfully submitted elsewhere. I am not naïve, and I am aware that we cannot change the system over night. But we must think bold, and be ready with a design of a public health programme that reaches all those many millions and put an end to Hepatitis in China.
Allow me to spend one last word on HIV. I am happy to see so many old friends who contributed to make access to HIV treatment in China a reality.
But let me be clear on this point: unless China moves on Fixed Dose Combination and possibly one-pill-a-day regimens, I do not see how access to HIV can be further improved.
In conclusion, we have the real opportunity to move towards the end of Hepatitis and HIV in China. This is not just words. We have to challenge ourselves and find the ways that bring us there. Simplification of treatment approaches with the most effective treatments must be a cornerstone in our strategies, for all those who need it. And there is no question that this will pay off. Sound public health approaches to treatment will be among the most cost effective interventions we have – if we do it right.
I wish to congratulate the leaders of the Red Ribbon Forum and the organizers of this meeting to the vison and foresight to address Hepatitis C as a public health threat. We look forward to working with all of you to overcome the challenges towards the end of Hepatitis and HIV in China.
Thank you!