Mar 03, 2021

After five years of delays, Israel’s Health Ministry has just launched an expensive plan – first announced back in 2016 – to wipe out the potentially fatal disease hepatitis C. The viral disease becomes chronic and potentially fatal in 20% to 30% of all carriers. There are more than 100,000 carriers of hepatitis C virus (HCV) in the country, many of whom were infected when they lived in the former Soviet Union and came on aliya to Israel.  


The State of Israel has pledged to its residents to eradicate hepatitis C by 2030. The long delay in implementation apparently is the result of the high cost of the program. 


Years ago, the World Health Organization called for the wiping out of the virus around the globe; more than 180 million people around the world are carriers of the virus, and some four million are infected in an average year.


 About 80% of carriers are unaware of the infection, making them liable to infect others. It is spread mostly through blood-to-blood contact such as transfusions, blood transfusions or organ transplants before the virus was screened out of donor blood in 1992; intravenous drug use; and piercing, tattoos, razors without proper sterilization, among others. Numerous hemophiliacs became carriers decades ago before blood was screened, but there are still carriers who can develop liver fibrosis, liver failure and liver cancer 10 to 40 years after the infection. 


Those who were born and probably also received vaccines or underwent invasive treatments in countries where syringe replacement was not in effect – including Russia, Uzbekistan, Ukraine, Azerbaijan, Estonia, Armenia, Belarus, Georgia, Tajikistan, Turkmenistan, Latvia, Lithuania, Moldova, Kazakhstan, Kyrgyzstan and Romania – are more likely to be carriers. 


HCV infection from sexual contact is less common but at higher risk when those involved have a sexually transmitted disease (including HIV) or have multiple partners without strict condom use.


Many people with HCV are asymptomatic (without symptoms); if they do occur, they may include fever, fatigue, loss of appetite, abdominal pain, vomiting, dark urine, light-gray stools, joint pain and jaundice in the skin and eyes. If they suffer from an acute illness, the symptoms can appear at any time from two weeks to six months after infection, the Health Ministry said. 


Patients with chronic disease can develop various complications such as cirrhosis, bleeding from the esophagus or stomach, the accumulation of fluid in the body, liver cancer, the need for a liver transplant and even death.


There is no vaccine against HCV, and the infection is a major cause for the need of liver transplants. Chronic infection can be cured about 95% of the time with a variety of oral medications. Initially, these drugs cost a fortune to treat each patient, but their price has dropped significantly due to competition among pharmaceutical companies. That made it possible for the Health Ministry to commit itself to the campaign. 


“The AIDS cocktail keeps that viral disease on a back burner but does not eradicate it; the HCV drugs do wipe the virus out,” said liver specialist Prof. Jonathan Halevy in 2016, when he was chairman of the Health Basket Committee for adding new drugs for supply by the four health funds. “They are the next best thing to vaccines. HCV drugs will save the lives of tens of thousands of Israelis,” said Halevy, who is president of Jerusalem’s Shaare Zedek Medical Center


The newly announced Israeli program includes setting clinical guidelines, identifying carriers, setting up a national registry of carriers, , processing and treating them and raising public awareness of HCV. The government will allocate money to the four health maintenance organizations to ensure that every Israeli undergoes the necessary tests to identify carriers and provide treatment until their recovery.