National hepatitis C programme has not had clinical lead for five months

The national hepatitis C programme, which has spent almost all its €30 million budget for 2017 in the first six months of this year, has not had a clinical head for the past five months, the HSE has confirmed.

Prof Suzanne Norris, who was clinical director of the programme up to last February, has yet to be replaced, according to a HSE spokeswoman.

Prof Norris was “not in a position” to continue as clinical lead after a one-year secondment to the programme, and returned to clinical duties, she said.

The HSE is in the process of recruiting a clinical lead, while Prof Aiden McCormack, a hepatologist at St Vincent’s hospital, is chairing an advisory group to the programme on an interim basis.

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The Irish Times reported the treatment of hundreds of patients with hepatitis C with potentially life-saving drugs has been abruptly halted due to the programme's funding problems. Doctors have been told not to treat any new patients until funding has been "realigned".

The programme aimed to treat up to 1,600 patients this year with increased funding from the Government, but fewer than 900 patients were treated prior to the imposition of the funding freeze.

Funding crisis

As well as the 600 registered patients whose treatment had not started, doctors say hundreds more have been diagnosed and are affected by the decision.

The funding crisis represents a setback for efforts to eliminate the disease, which the Government has promised to do within a decade.

According to the HSE, four companies – Abbvie, Gilead, Bristol Myers Squibb and MSD – supply drugs to the programme. Each supplier was invited to make submissions to the HSE last year on improved commercial terms for their drugs.

The HSE implemented a preferred regimen of supply for each genotype of the disease “based on which submission offered best value”, the spokeswoman said. “There were no winning/loser bidders as each supplier provided improved commercial terms which were subsequently accepted by the HSE.”

New figures from the European Centre for Disease Control (ECDC) show Ireland has one of the highest rates of hepatitis C infection in the EU, running at twice the international average. There were 14.5 cases of the disease per 100,000 of the populatioin reported in Ireland between 2011 and 2015, compared to 8.6 across the EU.

Rates of hepatitis B infection in Ireland were also about twice the EU average, according to the ECDC.

Infection

An estimated 4.7 million Europeans are living with chronic hepatitis B and almost 4 million with hepatitis C. However, large numbers are not aware of their infection as they have not yet been tested and diagnosed.

The prevalence of hepatitis B is an estimated 0.9 per cent, and that for hepatitis C is 1.1 per cent.

In 2015, almost 60,000 new cases of the two strains of the disease were reported in European Union countries. The past decade has seen a 26 per cent rise in hepatitis C cases, though some of this increase is due to better testing.

The ECDC says effective treatments are available, but the main bottleneck is causes by a failure to diagnose cases.

Ireland, along with other European countries, aims to eliminate hepatitis by 2026, but the centre says efforts need to be scaled up for this target to be achieved.

Hepatitis B and hepatitis C are infectious diseases that can cause severe liver damage. Transmission usually occurs via sexual or blood-to-blood contact.

At-risk groups include drug-users, people with multiple sexual partners and migrants from areas where the disease is endemic.