Georgia: Debate on Hepatitis C

An IWPR article on the high incidence of hepatitis C in Georgia prompted health officials, pharmaceutical industry representatives and pressure groups to meet and discuss strategies for combating the disease.

In an article called Hepatitis Unchecked in Georgia, reporter Manana Vardiashvili found that just one in ten people with hepatitis C were receiving treatment as the drugs were so expensive.

This important issue has often been passed over by local media, and is championed only the NGOs that work on it. In the course of interviews for the IWPR, it emerged that the different players – government officials, pharmaceutical companies, and pressure groups – felt left in the dark about what others were doing. IWPR’s Tbilisi office decided it would be a good idea to get them together in the same room to discuss some of the challenges and see whether they could be overcome.

According to the most recent data available, around 200,000 people in Georgia are infected with this particularly virulent form of hepatitis. That is 6.7 per cent of the population. The National Centre for Disease Control and Public Health recorded 1,847 new cases last year.

Georgia is shifting from the free healthcare system of the Soviet era to one based on private insurance. But despite the risk the hepatitis C poses to the nation’s health, neither the government nor the new health insurance companies are prepared to cover the high costs of testing and treatment. Only HIV-positive patients receive free medication for hepatitis C.

A 24-week course of drug treatment costs 6,000 US dollars, a huge sum in a country where the average monthly wage is just over 400 dollars and the unemployment rate is 15 per cent.

In the article, Health Minister David Sergeenko was quoted as saying that even if the government’s entire healthcare budget was given over to treating this one disease, “it still wouldn’t be enough”.

Apart from the funding need, one of the problems with dealing with hepatitis C is the widespread perception that it spreads mainly among drug users sharing infected needles, so it is their own fault. But as Maia Zhamutashvili, a doctor from the Infectious Diseases, AIDS and Clinical Immunology Research Centre , said blood transfusions carried out in past years have been a common source of transmission. Tattoo parlours and acupuncture are also possible routes.

At IWPR’s March 15 discussion event, Konstantin Rukhadze, executive director of the Hepa+ pressure group, said, “According to the only research that’s been done, which was nine years ago, only one in five [40,000 out of 200,000] infected people acquired the virus via the injection of narcotics.”

Paata Sabelashvili of the Georgian Harm Reduction Network warns that the country is one step away from an epidemic, and he placed the blame squarely on the health ministry.

“The Georgian health ministry says that the treatment of hepatitis C patients will cost the government 800 million laris [500 million dollars] and that they can’t afford to cover such high costs, because the ministry’s overall budget is only 650 million laris,” he said. “I think that reflects an irresponsible and uncaring attitude towards the thousands of people infected with hepatitis C.”

During their discussion, participants looked at cases where the governments of developing countries have succeeded in significantly reducing the costs of treatment.

“We have researched several international cases that could be applied to Georgia,” Rukhadze said. “All we need is the government to show the will. “We will continue advocating for increased public awareness and we’ll keep pushing until a national policy is developed.”

As in other former Soviet states, Georgia’s prison system shows a particularly high incidence of hepatitis C, and other infectious diseases.

In 2007, several prisoners filed a case at the European Court of Human Rights demanding that the state fully cover the costs of diagnosis and treatment. They won the case, and the government had to pay up.

The prisons ministry does not have accurate statistics on infection rates, but it insists it has included treatment programmes in its plan for 2013.

“Experts are working on a policy paper which will need to be backed up by comprehensive research in order to determine the right areas for intervention,” deputy minister Archil Talakvadze said at the meeting. “There’s a need to define what treatment systems are needed, and what funds will be required to implement the programme.”

The IWPR event was covered by leading media outlets Radio Liberty (a report in Georgian is available here), and Radio Imedi, which ran a special programme on hepatitis C, with factual input and interviewees provided by IWPR’s Tbilisi office. In a later talk show (audio in Georgian here), Radio Imedi interviewed Sabelashvili from the Harm Reduction Network.

After the meeting, Mariana Chokheli, harm reduction coordinator with the Open Society Georgia Foundation, said it had been valuable.

“The pharmaceutical companies, government representatives, and journalists received some new information from one another, so such meetings must carry on,” she said. “In future, I’d like to see representatives from the Georgian drug agency and health ministry attending such meetings, although I know IWPR did invite them.”