It is "insane" that Canada continues to see a rise in transmissions of Hepatitis C, despite the fact that there is a cure, say health researchers.
But thanks to political inaction, and the prohibitive cost of the live-saving drugs, Canadians continue to contract the life-threatening virus.
By official estimates, the population carrying Hepatitis C in Canada is around 250,000, but experts speculate this number is tens to hundreds of thousands higher due to poor tracking of and testing for the virus. In America, the virus results in more deaths every year than HIV. And while Canada's range of Hepatitis C cases sits in the ballpark for most advanced nations, the disease is still ravaging the Canadian drug community.
It's currently hard to figure out just how many die from Hepatitis C — Canadian mortality statistics haven't been published since 2007, when 487 people died from virus. The problem with narrowing down deaths, however, is that the disease goes undiagnosed so often that its effects, including liver damage and overall deterioration of a person's health, can be, what experts call, a "silent killer."
In Canada, the virus disproportionately affects intravenous drug users. By 2011 estimates, around 66 percent of all current, and 28.5 percent of former injectable drug users tested positive for the virus. In some areas, that number is much higher: for example, when Insite, North America's only safe injection site, first opened in Vancouver's Downtown Eastside in 2003, 88 percent of its visitors tested positive for Hepatitis C.
Advocates and experts are warning the new Trudeau government that, if Canada wants to make a dent in its growing number of Hepatitis C cases, it needs to take a more comprehensive approach to combatting the virus — especially now that there are sure to be an influx of new cases as intravenous opioid use continues to grow.
In the past, treating Hepatitis C, with drugs like Interferon, was ineffective, agonizing and expensive.
"It was a really terrible, terrible thing. Being told you only have a 30, 40 percent chance of being cured and having to go through all [the side effects] is just not appealing to patients," said Don Crocock, a Hepatitis C survivor and outreach worker from the Niagara Health System.
But new medicines like Sofosbuvir-Velpatasvir — a drug that can eradicate the virus for 99 percent of patients through a 12-week treatment program — are being touted as the gold standard . The problem, of course, lies in its price point. The full treatment averages $60,000 per patient in Canada, and even higher in the US.
Not only are the drugs expensive, but they're also not covered by all provincial medicare plans, meaning patients are required to pay for the drugs out-of-pocket, or under private insurance. In Ontario, patients can apply to get special exemption to have the cost of the drugs covered by the provincial health plan, but in order to get the exemption, the patient must prove that their liver is already deteriorating.
Adam Cook, a policy researcher at the Canadian Treatment Action Council, says the lack of an aggressive national strategy on the disease is the real missing link in tying the fight against Hepatitis C together. He argues that the government's inaction — considering the virus is curable — is inexcusable.
"The Canadian healthcare system has a very counter-intuitive approach to it — and what I mean by that is that, first of all, there's a cure. We don't get to cure things in virology very often, we usually just figure out a way to control them," Cook told VICE News. "[Hepatitis C] has a cure, which is insane."
That approach isn't slated to change much.
The current strategy for beating Hepatitis C in Canada, originally detailed in a 2009 action plan released by the previous Harper government, was not been received well by those who work in the field.
"Canada does not have a national strategy," says Cook. "Countries that do have a strategy are those like Egypt, Georgia, Mongolia. We don't normally get lapped by countries like that, we just don't. When you think about Canadian heritage moments, the push for the best health care from people like [father of medicare] Tommy Douglas, the issue of Hep C tears that whole charade down. From a policy perspective, this is like Kryptonite for the Canadian healthcare system."
That 'action plan' doesn't detail a role for new medications will be used, or whether harm reduction will be involved in the strategy, and the Trudeau administration is currently basing its fight against Hepatitis C on the same plan.
"The Government of Canada is working with our provincial and territorial partners and national and community stakeholders to take concrete measures to strengthen Canada's response to Hepatitis C," a spokesperson from the Public Health Agency of Canada (PHAC) told VICE News, when pressed about what specific measures the new Trudeau government would take.
When asked whether the government planned on improving screening processes or improving access to the antiviral drugs that could curse the virus, a spokesperson for the Public Health Agency of Canada (PHAC) refused to say.
Requests by VICE News to secure an interview with a representative for the agency were refused.
Safe injection sites are often touted as the other half of the equation in fighting transmission rates. Logically, prevention and treatment should go hand in hand, and to many experts, that combination is the answer. But stretched resources have led to a discussion about which side of the equation ought to be prioritized.
Even at Vancouver Coastal Health (VCH), the agency responsible for overseeing Insite — North America's first and only safe injection site — there is skepticism about harm reduction initiatives as the one-true answer to curbing new infections.
Dr. Patricia Daly, VCH's Chief Medical Health Officer, says that despite Insite's effectiveness in Vancouver's Downtown Eastside, she doesn't believe a small number of safe injection sites will be able to make a significant impact on Hepatitis C transmissions by themselves.
"I would say [Insite has] a lower number of cases of Hep C reported, but I don't think we can directly attribute that to Insite," she told VICE News. "Hep C is harder to prevent than HIV because it requires much less of the virus to be infected, so if you're sharing needles even once you're going to be at risk.
"Insite and facilities like it are not going to control the spread of Hep C, let me put it that way."
Daly does say, however, that expanding access to safe injection sites — among other harm reduction initiatives such as methadone maintenance treatment (MMT) — is going to be necessary in helping to combat over Hepatitis C numbers.
"Addiction is a very, very challenging thing to treat and people respond better to some treatments than others. You can't look at it as a one-stop solution," she says.
Political opposition to safe injection sites like Daly's has been strong. Last year, the former Conservative government passed Bill C-2, a piece of legislation that made it difficult for new harm reduction facilities like safe injection sites to open by forcing them to obtain the approval from both medical authorities and the police. Experts say that this kind of legislation is one of the key reasons for why Hepatitis C is still such a problem in Canada.
The new Trudeau government has signaled a change on that front, and recently green lit a second safe injection that had been operating illegally for 14. It's unclear if the site will receive the same level of coordination as Insite.
Crocock, a Hepatitis C survivor who began using drugs in 1967 before quitting in 1993, only found out about his diagnosis in 2008 after he was forced into the hospital from chronic fatigue and weakness.
As an outreach worker, Crocock says harm reduction can only take you so far and that, at the end of the day, governments will need to pony up the money to treat the disease.
"For people who are injecting drugs, you can tell them not to inject or to do it safely, but when it's 3 in the morning, 4 in the morning, and they've been on a three-day run — bang, it just happens, and somebody else get infected," Crocock says. "The world isn't as clean cut as we'd like it to be unfortunately."
Follow Jake Kivanc on Twitter: @KivancJake