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Fighting Egypt's 'Silent Epidemic' - Hepatitis C

Egypt has the highest prevalence of HCV in the world
Egypt has the highest prevalence of HCV in the world
Leyla Doss

CAIRO — After being unemployed for three years, 26-year-old Emad Hassan was offered a job at a local bank on the condition that he take a blood test. It was then that he discovered he had been infected with the hepatitis C virus (HCV), which can cause liver disease and eventually hepatocellular carcinoma — better known as liver cancer.

The bank consequently withdrew its offer, and Hassan fell victim to the social stigma associated with hepatitis C and other chronic diseases.

In fact, Egypt has the highest prevalence of HCV in the world with 10-14% (8 to 10 million people) infected with HCV, and an approximate 1.5 million in need of treatment. Of these, Gamal Esmat, professor of liver disease at Cairo, notes the vast majority are in the Nile Delta region. HCV’s high prevalence in Egypt is in part due to a mass state campaign in the 1960s and 1970s to treat schistosomiasis using improperly sterilized glass syringes and needles.

But a new treatment for HCV could radically change the situation. In collaboration with the Ministry of Health and other global organizations, the National Hepatology and Tropical Medicine Research Institute (NHTMRI) plans to introduce a new HCV treatment in 2014.

Unlike previous treatments — antiviral drugs that treat HCV by boosting the immune system — the new treatment cures the virus within 12 weeks at a 97% effectiveness rate and with no side effects. Known as “direct acting antiviral agents,” the new HCV treatment combats the disease by targeting the infected liver cells and destroying the virus’ replication machinery.

Raymond Schinazi, an American research scientist of Italian-Egyptian descent at Atlanta’s Emory University, was the founder of Pharmasset Inc., the company that originally developed the drug. Schinazi’s team of researchers worked for over six years, finding what they consider to be the cure: the PSI-7977 molecule, now named “sofosbuvir,” which the U.S. Food and Drug Administration (FDA) approved Dec. 8.

The “silent epidemic”

Born and raised in Alexandria, Schinazi and his family left Egypt during the large-scale Jewish exodus that took place in the 1950s and 1960s. Schinazi says he still has a close relationship with Egypt and hopes his collaborative research will eventually help cure those infected in his country of birth.

“When I first heard of HCV, I thought to myself: This is my next target,” he says. “My dream was to one day find a cure for it and help my mother country,” says Schinazi, who sold his company and the drug patent to U.S. company Gilead Sciences for $11.4 billion.

There are currently over six drug companies competing for the production of a HCV cure. But unlike the other drugs in the market, sofosbuvir is also pan-genotypic, which means that it can be used to treat infected people with all genotypes worldwide — including genotype 4, which is most common in Egypt.

Dubbed the “silent epidemic,” hepatitis C has infected approximately 170 million people worldwide and has caused about 350,000 deaths per year from HCV-related diseases.

“Our aim is to provide a treatment for HCV which is safe, effective and with minimal side effects,” says Manal al-Sayed, professor of pediatrics at Ain Shams University and a member of the National Committee for the Control of Viral Hepatitis. “Our challenge will be to have it at affordable prices for all,” she adds.

With prospects of the cure costing as much as $100,000 in the U.S., many are concerned it would be unaffordable for most Egyptians. Egyptian authorities, doctors, Ministry of Health members and others are currently negotiating with major pharmaceutical companies producing this and other treatments to reduce costs.

Nevertheless, Egyptian authorities and doctors remain hopeful of bringing HCV treatment to Egypt at 5% of the global price, with the rest subsidized by government authorities.

What is HCV and how is it contracted?

Hepatitis C is blood-borne, and symptoms are often not visible until 20 years after infection. It can range in severity from a mild illness lasting for a few weeks to a serious, lifelong condition that can lead to cirrhosis of the liver or liver cancer.

Hepatitis C virus — Photo: TimVickers

Despite treatment and the likelihood of a total cure looking promising in the near future, authorities and researchers admit that more attention should be focused on preventing the infection stage of hepatitis C.

Dina Iskander, a researcher for the Right to Health Program, applauds the prospects for new treatment, but believes that more attention and expenditure should be directed at the inefficiency of the Egyptian health care system.

According to the U.S. Centers for Disease Control and Prevention (CDC), almost 20% of the Health Ministry’s budget has been allocated to care and treatment and just a 1% expenditure on infection control.

In Egypt, there are approximately 165,000 new cases of infection each year, and a staggering 70% of them are related to the health care system. Equipment is often not sterilized according to acceptable standards, and infection is very often transmitted through improperly screened blood transfusions of infected patients.

Other modes of infection include the sharing of unsterilized needles and unsterilized tools for pedicures, manicures and tattoos. In rare cases, HCV can also be transmitted from mother to fetus or through sexual intercourse.

There are, therefore, plans to implement a comprehensive national registry system and screening programs for the disease, Pr. Sayed says. Over the past six years, there have also been extensive campaigns to raise awareness about infection and treat large numbers of patients for free.

WHO says Egypt is one of only two developing countries that provide free universal treatment for HCV. With over 23 centers in Egypt developed over the past six years for treating patients, approximately 300,000 infected individuals have been received free care.

Sayed hopes eventually to get more assistance for training and research in the field in order to produce new safe and effective products in Egypt. “This would make it markedly cheaper and easily accessible for all,” she says. “It would be a huge turning point in our history.”

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Protests against gasoline price hikes in Lebanon

Anne-Sophie Goninet, Jane Herbelin and Bertrand Hauger

👋 Wai!*

Welcome to Thursday, where leaked documents show how some countries are lobbying to change a key report on climate change, Moscow announces new full lockdown and the world's first robot artist is arrested over spying allegations. Meanwhile, German daily Die Welt looks at the rapprochement between two leaders currently at odds with Europe: UK's BoJo and Turkey's Erdogan.

[*Bodo - India, Nepal and Bengal]


🌎  7 THINGS TO KNOW RIGHT NOW

• Documents reveal countries lobbying against climate action: Leaked documents have revealed that some of the world's biggest fossil fuel and meat producing countries, including Australia, Japan and Saudi Arabia, are trying to water down a UN scientific report on climate change and pushing back on its recommendations for action, less than one month before the COP26 climate summit.

• COVID update: The city of Moscow plans to reintroduce lockdown measures next week, closing nearly all shops, bars and restaurants, after Russian President Vladimir Putin announced a nationwide seven-day workplace shutdown from Oct. 30 to combat the country's record surge in coronavirus cases and deaths. Meanwhile, India has crossed the 1 billion vaccinations milestone.

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• Human remains found in hunt for Gabby Petito's fiance: Suspected human remains and items belonging to Brian Laundrie were found in a Florida park, more than one month after his disappearance. Laundrie was a person of interest in the murder of his fiancee Gabby Petito, who was found dead by strangulation last month.

• Artist robot detained in Egypt over spying fear: Ai-Da, the world's ultra-realistic robot artist, was detained for 10 days by authorities in Egypt where it was due to present its latest art works, over fears the robot was part of an espionage plot. Ai-Da was eventually cleared through customs, hours before the exhibition was due to start.

🗞️  FRONT PAGE

"Nine crimes and a tragedy," titles Brazilian daily Extra, after a report from Brazil's Senate concluded that President Jair Bolsonaro and his government had failed to act quickly to stop the deadly coronavirus pandemic, accusing them of crimes against humanity.


📰  STORY OF THE DAY

Erdogan and Boris Johnson: A new global power duo?

As Turkey fears the EU closing ranks over defense, Turkish President Erdogan is looking to Boris Johnson as a post-Brexit ally, especially as Angela Merkel steps aside. This could undermine the deal where Ankara limits refugee entry into Europe, and other dossiers too, write Carolina Drüten and Gregor Schwung in German daily Die Welt.

🇹🇷🇬🇧 According to the Elysée Palace, the French presidency "can't understand" why Turkey would overreact, since the defense pact that France recently signed in Paris with Greece is not aimed at Ankara. Although Paris denies this, it is difficult to see the agreement as anything other than a message, perhaps even a provocation, targeted at Turkey. The country has long felt left out in the cold, at odds with the European Union over a number of issues. Yet now President Recep Tayyip Erdogan is setting his sights on another country, which also wants to become more independent from Europe: the UK.

⚠️ Outgoing German Chancellor Angela Merkel always argued for closer collaboration with Turkey. She never supported French President Emmanuel Macron's ideas about greater strategic autonomy for countries within the EU. But now that she's leaving office, Macron is keen to make the most of the power vacuum Merkel will leave behind. The prospect of France's growing influence is "not especially good news for Turkey," says Ian Lesser, vice president of the think tank German Marshall Fund.

🤝 At the UN summit in September, Erdogan had a meeting with British Prime Minister Boris Johnson at the recently opened Turkish House in New York. Kalin says it was a "very good meeting" and that the two countries are "closely allied strategic partners." He says they plan to work together more closely on trade, but with a particular focus on defense. The groundwork for collaboration was already in place. Britain consistently supported Turkey's ambition to join the EU, and gave an ultimate proof of friendship after the failed coup in 2016.


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📣 VERBATIM

"He has fought tirelessly against the corruption of Vladimir Putin's regime. This cost him his liberty and nearly his life."

— David Sassoli, president of the European Parliament, wrote on Twitter, following the announcement that imprisoned Russian opposition leader Alexei Navalny was awarded the 2021 Sakharov Prize for Freedom of Thought, the European Union's highest tribute to human rights defenders. Navalny, who survived a poisoning that he blames on the Kremlin, is praised for his "immense personal bravery" in fighting Putin's regime. The European Parliament called for his immediate release from jail, as Russian authorities opened a new criminal case against the activist that could see him stay in jail for another decade.

💬  LEXICON

魷魚的勝利

Chinese video platform Youku is under fire after announcing it is launching a new variety show called in Mandarin Squid's Victory (Yóuyú de shènglì) on social media, through a poster that also bears striking similarities with the visual identity of Netflix's current South Korean hit series Squid Game. Youku apologized by saying it was just a "draft" poster.

✍️ Newsletter by Anne-Sophie Goninet, Jane Herbelin and Bertrand Hauger

Anyone want to guess Trump's first post on his upcoming social media platform...? Let us know how the news look in your corner of the world — drop us a note at info@worldcrunch.com!

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