In 2006, when Egypt formed a national committee to control the spread of Hepatitis, the country was known to have the highest burden of the disease globally. India, at the time, had still not acknowledged its growing Hepatitis numbers, while focusing on HIV and Tuberculosis.
Over the past decade, Egypt has come a long way, reducing Hepatitis prevalence from 4.5 per cent then to 1 per cent now, and, in the process, has provided a roadmap for the World Health Organisation (WHO) and countries like India, which is grappling with an estimated 6 million Hepatitis C (HCV) and 40 million Hepatitis B (HBV) cases.
“The syringe culture is similar in Egypt and India. People take less oral medication and prefer injections. Syringe safety is necessary to prevent new cases,” says Manal El Sayed, a member of the Egyptian national hepatitis committee since its inception in 2006. She says her country raised awareness on the use of sterile razors in barber shops, use of new instruments for pedicure and manicure and on the use of disposable syringes for patients. “It’s all about advocacy. There should be multiple stakeholders like the government, politicians, the media and individuals from different sectors who wish to bring this health problem into the limelight,” Sayed, a paediatrician, explains.
The Egyptian government, she says, also urged Hepatitis drug manufacturing companies to lower costs. Direct cost of hepatitis treatment there was estimated at $ 670 million and the country was able to treat its patients, Sayed says, at 1/10 the global price of the drugs. “We decided to treat at least 30,000- 40,000 patients a year, but there ended up being 65,000 patients. Companies were willing to lower costs,” Sayed says.
The Hepatitis pool grew in Egypt in the 1950s and 1960s due to the reuse of glass syringes after boiling. It is believed that similar unsafe syringe practices have led to the increased cases in India. According to Razia Pendse, South East Regional adviser to WHO, India accounts for 60 per cent of Hepatitis cases in South East Asia. But the country has not conducted a single survey to determine its Hepatitis load. Egypt, on other hand, carried out its first survey in 1996 and its latest in 2015.
Egypt has now introduced a birth-dose policy to prevent new infections. “Our aim is to reach most isolated and rural areas,” Sayed says. The prevalence of HCV in Egyptian children has dropped to 0.8 percent from the 1.5 percent a decade ago. India, Sayed believes, needs a similar approach.
The Union Ministry of Health and Family Welfare has begun a vaccination drive for newborns against HBV under Mission Indradhanush, that is aimed to prevent seven diseases in infants. Since 2014, over 40 lakh children have been covered under the scheme. But there still stands no active diagnosis or free treatment programme for Hepatitis adult patients unlike AIDS or Tuberculosis.
The Health ministry has also roped in Bollywood actor Amitabh Bachchan to become the face of the campaign. Although delayed, the government is slowly moving towards disposable syringes with Maharashtra becoming one of first states to embrace one-time usable syringes. “The cost will be high but we are looking at local syringe manufacturers,” Maharashtra’s principal health secretary Sujata Saunik said.
A national survey, under the aegis of the health ministry and WHO, is also scheduled to kick off in Punjab on the impact of disposable syringe usage. India has also joined WHO’s Global Campaign for Safe Injection Practice. WHO’s Dr Henk Bekedam says that for India, the initial cost of the Hepatitis programme will be high due to high prevalence: “But what is the cost of a human life? The cost will come down once enough awareness is created.” He advocates a system to track down infected blood donors from mass blood donation camps, who, he adds, should then be brought in for treatment.