New Zealand Listener – June 01, 2019

24 LISTENER JUNE 1 2019

were being sold privately by their maker,

Gilead Sciences, for up to $100,000 for an

eight-week course of treatment – became

available on the Pharmaceutical Benefits

Scheme at a cost of only $40 to patients.

The dream was becoming real. Or was it?

“It’s been woeful,” sighs Tasmanian GP

Dr James Freeman, who has built his profes-

sional life around battling the virus since

2014. “Hep C has had its 15 minutes of
      fame.”
      Australia’s treatment numbers are sagging.
      Forty thousand people were treated in 2016,
      only half that many in 2017, fewer again in


2015. “The monthly treatment uptake has
      tanked,” said the head of Hepatitis Australia,
      Helen Tyrrell, on the ABC last year.
      And yet, Australia is doing as well as any
      country in pushing back against hep C –
      which affects 71 million people worldwide

• and is still on track to meet the end goal
  that the World Health Organisation (WHO)
  set in 2016 of “global elimination” of the
  disease by 2030.
  But what the WHO means by “elimina-
  tion” is not what you might think. It doesn’t
  mean eradication. The target is officially an
  80% reduction in hepatitis C incidence and
  a 65% reduction in mortality.

“It’s a definition that only a bureaucrat

could love,” says Freeman. “It allows you to

declare success without actually completely

succeeding.”

This year, Pharmac funded Maviret, the

last and most powerful of a series of cura-

tive drugs for hep C (see “Vanquishing the

virus”, Listener, March 2). If previous anti-

virals, including those funded in Australia,

have been experienced as functionally a

miracle cure by patients, Maviret is a slightly

bigger miracle. Treatment takes eight weeks,

most people have no side effects, it treats all

genotypes of the virus and, according to a

recent German study, it’s 99.5% effective.

We have the means to cure the 50,000

New Zealanders infected with hepatitis C,

but do we have the plan? And what can we

learn from Australia’s experience?

The answer may lie in a butterfly.

BIG TROUBLE

In 2015, 51-year-old Hazel Heal was in

big trouble. Doctors said her liver was rap-

idly deteriorating. The hepatitis C-related

cirrhosis she’d borne for 18 years – and

through two punishing and unsuccessful

courses of interferon, the only available

treatment at the time – was on the verge

of decompensation, or failure, the point at

which a liver transplant is the only realistic

hope of survival. She needed urgent treat-

ment and the newly available antiviral drugs

would cost as much as $100,000 from the

manufacturer, Gilead.

She had already called a real-estate agent

about selling her Dunedin house to pay for

the treatment when she heard about the

FixHepC Buyers Club, which leveraged

Gilead’s pricing-to-the-market strategy by

importing the drugs from countries such

as India, where they were far cheaper. She

found a doctor willing to write a prescription

for the parallel-imported antivirals, flew to

Australia to pick up the drug, and was cured.

The doctor was James Freeman. And since

that first consultation in Tasmania, he and

Heal have established a remarkable partner-

ship. First, they worked to convince New

Zealand doctors that the generic drugs were

safe and effective and that they should write

prescriptions that would let their patients

use them and, second, they want to make

sure Maviret gets to the people whose lives

it can save.

In April, Heal travelled to the Inter-

national Liver Congress in Vienna with

Rachel Stace, a co-founder of the tiny local

advocacy group Hep C Action. They were

accompanied by Claire Newman, manager

of the charity Seed the Change, which has

been helping Hep C Action. But it was Free-

man, the doctor who saved Heal’s life, who

paid their travel costs.

“James knows we won’t disgrace him in

the world,” says Heal.

The Vienna conference is the liver-med-

icine world’s big event. More than 10,000

delegates attend and the accompanying

exhibition floor is dominated by the dis-

play stands of well-heeled pharmaceutical

companies. There, in a tiny corner allocated

to not-for-profit organisations, the New Zea-

landers set up their stand.

They did it with a cloth backdrop bought

R from Spotlight and held in place with gaffer
U
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HEPATITIS C CURE

We have the means to

cure the 50,000 New

Zealanders infected

with hepatitis C, but do

we have the plan? And

what can we learn from

Australia’s experience?

Dr James Freeman and

Hazel Heal, whom he

cured of hepatitis C:

working together to

make sure Maviret gets

to the sufferers whose

lives it can save.