one part of president Biden's
budget focuses on attacking a
disease that is almost
completely curable with drugs,
hepatitis C.
Roughly 2.4 million Americans
still have hepatitis C, a viral
liver infection.
Untreated, it can lead to
chronic illness, liver cancer,
and death.
But drugs made available since
2013 cure hep C in 95 percent of
patients.
Yet all kinds of barriers remain
over cost and access.
The president is asking for $5
billion to expand rapid testing,
access, and treatment.
Dr. Francis Collins, the former
director of the nih, is now a
special projects adviser to the
president on this, and I spoke
to him earlier this week, before
the budget was released.
>> Welcome back to the newshour.
>> Glad to be here with you.
Amna: We do not often get to
talk about hepatitis C, but it
does disproportionately affect
certain populations.
Who is most at risk and why?
>> Hepatitis C is permitted to
the blood.
There were baby boomers who got
the transfusions back before we
knew how to test for the virus
and they are infected and do not
know it.
More recently it is often times
people who share needles or a
tattoo needle could be the way
this passes, and it can be
passed from mother to child.
It is a mix of folks.
Many of them in it marginalized
communities who do not have
great access to health care,
which is one of the reasons we
need a program if we are going
to take advantage of this
historical moment.
We can hear these people.
Amna: When you talk about
testing, you noted 40% of people
do not know they are infected.
Why the barriers to testing?
>> It is complicated and
expensive and the logistics are
not great.
The test requires going in one
time to see if you have
antibodies against the virus.
Some people cure themselves.
Then you have to come back for
the test.
Do you have the virus now?
That is an rna test, then you
have to come back at their time
and start on the bills.
Most people who are in difficult
circumstances have trouble with
revisits, and our medical care
system does not do so well
either on making that easy.
You have to see a specialist.
I do not think in this
circumstance a specialist as
needed, but that is the way a
lot of systems are.
A lot of things are getting in
the way of what she did be an
easier process -- what should be
an easier process.
Come in, you have a simple
figure stick.
You have hepatitis C, 30 minutes
later here are your pills.
Amna: In one visit.
There is a cure.
Most cases are terrible.
Is cost one of the reasons cure
has been out of reach for some
people?
>> That is a big part of it but
not the whole thing.
The cost has been high, but the
cure has been available for
about seven or eight years.
It is one of the most major
dramatic achievements of medical
research for the last decade.
It knocks at the virus but does
not knock out anything in the
host.
One pill a day, 12 weeks, 95%
cured and virtually no side
effects.
It is almost miraculous for a
disease that has taken so many
lives.
It was priced very high, $90,000
per patient.
It is still high at $24,000 per
patient.
If you are trying to run a
medicaid clinic or a clinic for
people who have no insurance or
people in prison the incidence
is pretty high because of the
interaction with the drug trade,
you cannot figure out how to pay
for it.
Amna: You mentioned overcoming
barriers to testing and getting
treatment into more people's
hands.
There was this investigation to
look into the prison system and
found state governments were
failing to care for people in
their custody, not testing them
because they did not want to
have to treat them and in some
cases refusing to treat people
they knew were infected.
How do you overcome barriers?
>> Talking to people who read
those prisons.
They feel terrible about this
but they cannot afford to
actually offer the treatment.
So they try not to even test,
because if they tested and they
are not doing anything that
makes you feel worse.
They are looking for a way
forward.
That is what this proposal is
from the Biden administration
being rolled out now.
A five-year plan to make the
drug available essentially for
free to prisons, medicaid
clinics, community health
centers that deal with the
uninsured to people on the
reservation, people in opioid
treatment centers, but we have
to come up with a way to make
that happen, which is a pretty
creative model some would call a
subscription model.
I think it is the way to solve
this, and it has already been
successfully done.
Amna: It is a five-year plan
based on a subscription model.
How does that work at the
community model?
>> Louisiana piloted this.
The idea is Netflix.
When you sign up for Netflix, I
am not advertising for them, you
pay one payment and you can
binge all you want with whatever
they have to author -- offer.
You pay the drug company a lump
sum, and they have to agree to
make the drug available for free
from that point on two people
imprisoned, people in community
health centers uninsured, people
in medicaid, people on the
reservation and you end up
driving the cost down
dramatically, and everybody wins
because the company right now
are not making any money selling
those drugs to those groups
because nobody can afford it.
More importantly all of those
people get treatment.
It will work.
Amna: You have had success for
-- successful pilot programs.
It is also a $5 billion plan at
a time when there is a brewing
debate over spending cuts in
congress.
How likely are they to practice?
>> I hope people will look at it
carefully and see that although
you have to pay upfront for
testing and deliver the drugs,
if you look downstream in terms
of dollars you save for people
who will not need a liver
transplant, that treatment for
liver cancer, over the course of
15 or 20 years you more than or
make up for what you had to pay.
This is actually deficit
reduction.
You just have to scale it out
over time.
Amna: I hope you do not mind my
asking, you come to this work
with your own personal
experience informing it?
>> My brother-in-law, Rick, just
a wonderful human being,
wonderful husband to his wife,
he had hepatitis C.
It never was quite clear how he
got it and he developed liver
failure, ended up having a liver
transplant, and then he turned
out to have liver cancer and he
died a terribly awful and
difficult death.
This was just a couple of years
before the cure became
available.
I do not want anybody to go
through what Rick went through
or Rick's family went through
including me, my wife, his wife.
It is totally preventable now.
If we are a country that cares
about all of our people, even
those who have had a rough times
, how can we look at this and
walk away?
Amna: Dr. Francis Collins, thank
you for being here.
>> Glad to be with you.