Egypt becomes first country to achieve WHO validation on path to elimination of hepatitis C

Egypt has made unprecedented progress towards eliminating hepatitis C and became the first country to achieve "gold tier" status on the path to elimination of hepatitis C as per the World Health Organization (WHO) criteria. 

Achieving the gold tier means that Egypt has fulfilled the programmatic requirements that facilitate the reduction of new hepatitis C infections and deaths to levels that position the country to end the hepatitis C epidemic, the WHO said in a statement on Monday (9 October).

Globally, 58 million people are living with chronic hepatitis C infection. While there is no vaccine, the disease can be cured with highly effective and curative short-course treatments that last eight to 12 weeks. Globally, however, four out of five people living with hepatitis C do not know that they are infected. Unless treated or cured, the infection can cause liver disease and cancer.

Egypt has diagnosed 87% of people living with hepatitis C and provided 93% of those diagnosed with curative treatment, exceeding the WHO gold tier targets of diagnosing at least 80% of people living with hepatitis C and providing treatment to at least 70% of diagnosed people. 

"Egypt's journey from having one of the world's highest rates of hepatitis C infection to being on the path to elimination in less than 10 years is nothing short of astounding," said WHO Director-General Dr Tedros Adhanom Ghebreyesus. 

"Egypt is an example to the world of what can be achieved with modern tools, and political commitment at the highest level to use those tools to prevent infections and save lives. Egypt's success must give all of us hope and motivation to eliminate hepatitis C everywhere."

Egypt has successfully transitioned from having one of the highest rates of hepatitis C in the world to one of the lowest by reducing the prevalence of hepatitis C from 10% to 0.38% in just over a decade.  

Since the early 2000s, Egypt has been strengthening its national preventive and treatment programmes. In 2006, the country established the National Committee for Control of Viral Hepatitis, a governance structure to oversee and lead the national hepatitis response.

Starting in 2014 and reinforced in 2018, the President of Egypt introduced a countrywide campaign to eliminate hepatitis C that offered free testing and treatment for hepatitis C. The "100 million seha" (100 million healthy lives) campaign resulted in the testing of over 60 million people and treatment of more than 4.1 million people. 

Locally manufactured direct-acting antiviral treatments were a key factor in the campaign's remarkable success – a 99% hepatitis C cure rate among people who received treatment.

Through a patient-centred approach, Egypt has also significantly improved its patient safety practices and embraced the concept of "doing no harm" by implementing universal injection safety, blood safety procedures, and harm reduction. 

Dr Ahmed Al-Mandhari, WHO regional director for the Eastern Mediterranean, praised Egypt's unprecedented success: "It is a testament that success is unstoppable when there is commitment, even when faced with daunting challenges and difficult times, including the Covid-19 pandemic. 

With its commitment to eliminate hepatitis C, Egypt has succeeded in testing virtually the whole of the eligible population and has treated almost all those who are living with the virus. This represents one third of the 12 million people living with hepatitis C in the Eastern Mediterranean Region. This reflects the essence of our regional vision and the call for solidarity and action."

Through close cooperation with the WHO Country Office in Egypt, and with support from all three levels of the organisation, the Ministry of Health and Population has successfully expanded its financial and technical resources over the years to realise the vision to eliminate hepatitis C as a public health problem.    

"I am filled with pride and joy as I witness the historic moment of having Egypt recognised internationally as the first country to have achieved this remarkable progress towards eliminating the disease," said WHO Representative in Egypt, Dr Naeema Al Gasseer. 

"I have witnessed first-hand the extraordinary efforts that the Ministry of Health and Population has undertaken during the past decade to eliminate this public health threat. The Ministry has been driven by the highest political commitment and by solidarity, equity and inclusion to provide services to everyone living in Egypt, without discrimination and as a universal human right."

"This milestone coincides with the 75th anniversary of WHO this year and is a clear embodiment of its vision: improving public health and achieving health for all," she added. 

WHO supports the Ministry with technical guidelines and tools outlining a human rights-based approach to hepatitis C diagnosis and treatment, and it advocated for the inclusion of vulnerable groups such as refugees and migrants in the campaign. WHO continues to support the Ministry with the capacity-building of health workers and reaching out to communities with awareness campaigns.

According to the 2023 WHO Guidance for country validation of viral hepatitis elimination and path to elimination, countries can apply for full validation of gold, silver or bronze tiers on the path to elimination based on achieving relevant targets. 

Egypt is the first country that applied for validation and achieved gold tier status on the path to elimination, meaning that it is well on its way towards reaching all elimination targets before 2030.