TCS Daily

Treatment from Boston to Beijing

By Steve Haynes - March 18, 2005 12:00 AM

Picking and playing favourites when it comes to the devastating effects of global epidemics is foolhardy, yet it is interesting to note the amount of medical and media attention given in recent times to bird flu (and to whether or not it may become a global epidemic), while at the same time other catastrophic global epidemics -- comparable in scope to HIV/AIDS -- are already with us. Hepatitis B is one example.

Globally two billion people have been infected with Hepatitis B and 400 million people are chronically infected. Each year 10 to 30 million become infected with the virus with, on average, two people dying every minute.

Chronic Hepatitis B virus infection is endemic in Aboriginal and Torres Strait Islander communities. Studies in the 1980s and early 1990s showed that 46.9% of Aboriginal schoolchildren in rural and urban areas of the Northern Territory had markers of infection. During the decade that ended in 1997, primary liver cancer was the third most common cancer and the second-highest cause of cancer death in Aboriginal men.

In Asia, liver cancer is in the top three causes of cancer death and 80% of these deaths are due to Hepatitis B. The risk of death from liver cancer for someone who was chronically infected in childhood is 25%.

The good news is that recently the Antiviral Drugs Advisory Committee of the FDA in the US recommended approval of a new treatment for chronic Hepatitis B. This gives hope for millions throughout the world, including many here in Australia and significant numbers in neighbouring Asian countries. It is another fine example of the global pharmaceutical industry meeting the unmet treatment needs of communities in resource poor countries -- treatments for malaria, sleeping sickness, polio, smallpox, HIV/AIDS and river blindness being just some examples of the many others.

A lengthy process

The fight against Hepatitis B started forty years ago and with an interesting Australian connection. Researchers found that the blood serum of an indigenous Australian reacted in a particular way to the blood of patients with leukaemia and haemophilia; adding further to the knowledge of why some patients who received blood transfusions developed fevers, chills, or rashes.

The protein or antigen responsible for the reaction became known as the Australian Antigen. As research continued, scientists became aware of a significant link between the Australian Antigen and Hepatitis: the antigen was a part of the Hepatitis virus. This Hepatitis B virus is 50 to 100 times more infectious than the HIV virus.

And the response?

With a new chronic Hepatitis B treatment just around the corner, are there any lessons that can be learnt from treating the HIV/AIDS global epidemic? Will the pharmaceutical industry receive the accolade it deserves, for its high risk investment in producing another life-saving medicine -- a process that takes on average takes 12 years, at cost of more than A$1 billion? Or will the industry be subject to the same unwarranted, politically-motivated attacks levelled at last year's World AIDS conference in Bangkok, despite having developed a host of retroviral treatments for HIV?

In dealing with chronic Hepatitis B, there must be a vigorous emphasis on access to treatment, particularly in those communities at significant risk. Using the hackneyed price or patent argument as an excuse for non-treatment -- when the problem is often lack of will, inadequate health care infrastructure and lack of qualified medical and paramedical expertise -- is no longer acceptable.

When it comes to Hepatitis B-induced liver cancer, there will be three choices: death, transplant or pill. If you live in Boston, Bristol or Brisbane, you will want and will likely get access to the pill. Those who live in Beijing, Bagan or Bathurst Island deserve the same.

Steve Haynes is Senior Manager, Communications & Strategic Relations, Medicines Australia.


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