“When you first find out that you are a liver patient and that you may have liver fibrosis that could lead to cancer, you feel scared. I wanted to be armed with courage by knowing all I could about this disease and how it changes the lives of people with it,” commented one African patient from Senegal who has been cured of infection with the Hepatitis B virus.
“There are still many people who suffer from this disease without knowing they have it. I first discovered that I had Hepatitis B when I was recruited to the army. I learnt the causes and symptoms of the disease. There were medical tests that I had to take that were extremely expensive, and it was a difficult moment when I went for more tests only to discover that I was in an advanced stage and the medication was very expensive.”
“However, with the help of the African Liver Patients Association [ALPA] and some family members, I was able to complete my medication. Now that I am cured, I am here in Cairo to share my experiences because I must help others suffering from the same disease and because many people helped me,” he said, adding that it was essential that information about the virus is shared in order to help prevent future infections.
Some 20 per cent of Egyptians are also struggling with liver disease, mostly caused by the Hepatitis C virus.
A national initiative launched in September this year under the auspices of President Abdel-Fattah Al-Sisi called “100 Million Seha” (100 Million Healthy People) offers all Egyptians the chance of free tests, especially for infection with one or other of the Hepatitis viruses that can cause liver disease.
These tests are usually expensive and not everyone can afford them. Those who are found to be positive for infection with the Hepatitis B or C viruses are then offered free treatment.
This is possible because in 2012 a new medicine was developed for Hepatitis C called Sovaldi. It has been made available for free to patients testing positive for the virus through a screening process supervised by the government.
Today, Egypt has been sharing its medical expertise in this field with its African neighbours at a conference on 19-21 November entitled “Capacity Building Workshop for African Union [AU] Member States on Viral Hepatitis” held in Cairo by the ALPA and the African Union Scientific, Technical and Research Commission (AU-STRC).
It was attended by delegations from African countries, MPs, representatives from pharmaceutical companies, academics, civil society representatives and doctors.
The event featured a case study about how Egypt has been successful in combating the disease once and for all in the village of Al-Othmaneya in Gharbiya governorate.
It also pointed to the problems faced by many African countries in protecting their citizens from liver diseases and the role of Egypt in assisting them in doing so.
“We are working according to the African Union Agenda for Development 2063, including by capacity building in improving the health of the African peoples. This has resulted in the establishment of the AU Centre for Disease Control, a step forward in ending the plague of infectious diseases on the continent. Africa is full of resources that could help tackle disease, resources that have been inherited from our forefathers. We need to do more to capitalise on these, as too often the international pharmaceutical companies take our resources and then bring them back to us in the form of expensive medicines,” said AU-STRC Director Ahmed Hamdi.
“Some 34 per cent of all scientific research is in the field of health in Egypt, while 40 per cent of research in a country like Burkina Faso is also in health. In other countries like Uganda, it is only 10 per cent, but 33 per cent of the publications coming out of Africa are in medical research. We have no problem in terms of medical capacities, but we are not able to produce our own medicines despite our internationally recognised research,” Hamdi added.
“We have to ask ourselves why. Fifty-five per cent of medical practitioners in Africa are looking to work outside the continent in search of higher salaries, even as 70 million Africans are suffering from Hepatitis viruses. Some states in Africa do not have the know-how or the capacity to understand diagnoses and medications. However, Egypt has been successful in doing so, and we would like to build on that success,” he said.
“Egypt has a complete strategy for ending infection with the Hepatitis C virus, and the testing of 50 million citizens has been ongoing. It is vital that this expertise is now transferred via the ALPA to other African nations,” ALPA Chairman Gamal Shiha said.
According to a presentation by Shiha, a model for the elimination of the virus has been applied in 100 villages in Egypt, which has seven per cent of the world’s patients with the Hepatitis C virus.
Egypt negotiated with an international pharmaceutical company to produce the medicine for the disease at a low price and established a large treatment programme.
The number of patients treated in Egypt has now exceeded two million at more than 72 treatment sites in fewer than four years.
About four million people have been estimated to be in need of treatment, most of them living in rural areas. Out of the 1,800 people living in the village Al-Othmaneya, for example, 17 per cent were found to be antibody positive.
The strategy of screening and staging possible liver fibrosis in 50 million Egyptians as a result of possible viral infection started last October preceded by an awareness campaign including lectures about the disease through local promoters in villages.
Patients were then treated, with those who could not afford medicine being given it free of charge, usually in the two hours following diagnosis.
“We want to see the scientific community and the World Health Organisation [WHO] apply rapid diagnostic tests. These take one hour and cost less than $1.6, while other tests usually cost $3,” Shiha said, adding that there were also now machines that could scan for the disease.
One agency that is working hard to spread Egyptian expertise in Africa is the Egyptian Agency for Partnership for Development (EAPD) announced by President Al-Sisi in 2014
. Its secretary-general, Ahmed Shahin, said he agreed with Shiha on the need to spread Egyptian expertise in the field of combating the Hepatitis viruses.
“On all fronts we need to unite and implement this important initiative as Egypt’s contribution to South-South co-operation assisting the African countries in achieving development, including medical development,” Shahin said.
To do so, the EAPD is working on four main pillars, including capacity building through 70 training courses, with 8,000 Africans so far having benefited.
The second pillar is dispatching experts to other African countries, with there now being more than 45 Egyptian experts in 32 African countries, most of them working in the medical sector.
The third is humanitarian assistance through supplying medical equipment, logistical assistance, and humanitarian assistance when needed.
The last pillar is encouraging greater integration between Egypt and Africa in trade.
“We want to encourage NGOs to take part in dealing with the medical problems faced by Africa. 10 per cent of deaths in Africa are caused by liver viruses. The AU must put these at the top of its list of priorities for this reason, and the National Committee for Ending Liver Viruses, which started in Egypt in 2006, gives the clearest example of how to fight the Hepatitis C virus in the world today, meaning that we are duty bound to share our expertise with brotherly African nations,” said Gamal Esmat, a representative of the Ministry of Health who attended the Cairo conference.
According to Esmat, Egypt examined previous experiences in other countries before starting work and has been successful in producing its own model. It has also depended on locally manufactured medicine for the virus since 2015.
“We have built 170 centres in the different governorates and have been training doctors in different specialties and GPs on combating liver viruses. This conference is a great chance for capacity building in the field,” Esmat said.
He listed the efforts Egypt has made to combat the virus, starting with the prescription of interferon, which was not suitable for some patients, and then the introduction of Sovaldi and widespread screening.
“We want to transfer this experience to other African nations. Our aim is to have a world that is free of the Hepatitis C virus by the year 2030. We want an Egypt that is free of the virus by 2020,” he said.
Member of parliament’s Africa Committee Mona Mounir gave a summary of how the committee is keen to meet with the ambassadors of different African countries to listen to their problems and to help to solve them.
Meanwhile, at the Cairo conference ALPA Vice President Kenneth Kabagambe gave a presentation on the extent of viral hepatitis in Africa.
“In Africa today, we have 60 million people living with Hepatitis B, while only three in every 1,000 have been diagnosed with it. There are 10 million people with chronic Hepatitis C infection.Nine out of 10 people are living with liver cancer, but they do not discover it until it is in an advanced stage, and by that time little can be done to help them live longer,” Kabagambe said.
He said that 100 African governments were now committed to ending viral Hepatitis on the continent, adding that the priorities of the African Hepatitis programme included a 90 per cent reduction in new cases of Hepatitis B and C and a six per cent reduction in virus-related deaths.
“The WHO should support countries concerned by the ownership of clinics, in partnership with other countries that can help cure the disease and provide medical cooperation. By 2020, all the concerned countries should have their own national plans in place for ending liver diseases on the continent. But this will not happen unless we put civil society at the heart of the process,” Kabagambe commented.
“I call on governments to include screening for Hepatitis B as well as Hepatitis C in their campaigns,” Shiha said, adding that each country should decide for itself what type of screening method is best.
“We can fight this disease in my country and in all of Africa. I want to see African governments hand-in-hand in fighting this disease,” commented the former liver patient from Senegal, adding that people must also be given access to the information that can help halt the spread of this disease and others.
* A version of this article appears in print in the 29 November, 2018 edition of Al-Ahram Weekly under the headline: Ending Hepatitis in Africa