Source: New Zealand Government
Tēnā koutou katoa.
Thank you Anglesea Pharmacy and Te Manawa Taki for hosting this event.
As a doctor, I saw first hand the impact of hepatitis C. I met Moana in 2019; she came to the infectious diseases outpatient clinic at Wellington Hospital having tested positive for hepatitis C. Like most people early in their illness, Moana felt fine. She was busy working as a bus driver and re-connecting with her whānau, especially her grandchildren.
Moana traced her infection back to more than a decade earlier when she had used IV drugs, and spent some time in prison. She was the first person I treated with the then newly funded, highly-effective Hep C drug Miravret. I remember her clearly because she was so proud of the progress she’d made, to rebuild her life after prison. And I was proud too, to be able to cure her hepatitis C – so she could face the future without the threat of worsening liver disease, and maybe a liver transplant.
I’m really pleased to be here in Hamilton to launch the National Hepatitis C Action Plan for Aotearoa New Zealand. This sets out exactly how we will eliminate hepatitis C as a major public health threat by 2030. It will help more people get on with living healthy lives, and avoid deaths and the need for costly liver transplants.
A major collaborative effort has gone into this Plan, by a working group from across the health system. Crucially, this has included people with lived experience of hepatitis C, NGOs, frontline workers, and community representatives with valuable insights into how to best reach the estimated 45,000 New Zealanders living with chronic hepatitis C.
I want to take a moment to acknowledge the dedication of so many of you involved in the delivery of hepatitis services. In particular, nurses and regional coordinators, hospital specialists, pharmacists, GPs, consumer representatives, peer workers and other health professionals.
It’s also important to pay tribute to the work of Professor Ed Gane who’s here today, and who over many years has provided such strong leadership and innovation in the drive towards elimination of hepatitis C in this country.
My thanks also go to the many people who contributed their time and expertise to developing the Action Plan.
Hep C Action Plan
As many of you will know, the patients we see in clinic are likely only half of those who are out there. This might be because people with hepatitis C feel well initially, and when symptoms develop they are non-specific, such as tiredness or nausea. This might mean they don’t go to the doctor, or their doctor might not think to do the test.
At the same time, many of those with hepatitis C are members of our most marginalised communities, and the stigma associated with the virus presents a barrier to people receiving diagnosis and treatment. In other words, even with highly effective treatments, we won’t make progress against Hep C unless we have a new approach to finding people and linking them to care.
Aiming to eliminate hepatitis C is an ambitious goal. But until we set that goal, we won’t see the necessary rearrangements in our health system – to reach those who’ve not been diagnosed.
As a result, this Action Plan does not merely seek to raise awareness or scale-up existing prevention and harm reduction activities; rather, it transforms our approach to delivering hepatitis C services to people and places in the community at increased risk of infection.
New and innovative services within the Plan include using nurse-led clinics, point-of-care testing, pop-up clinics, one-stop-shops, and mobile services to increase equity of access to ground-breaking treatments that can now cure people with hepatitis C.
These services will be delivered by DHBs in partnership with needle exchange programmes and other integrated services, to bring together expertise and knowledge.
Our efforts must particularly focus on helping Māori, because emerging data suggests hepatitis C is more prevalent amongst Māori than other population groups, and they may be at higher risk of the long-term complications of chronic infection. Other priority groups in the Action Plan include people who inject drugs, and others who are living with hepatitis C.
World Hepatitis Day
It’s no coincidence I’m launching this Plan today. It’s World Hepatitis Day, and this year’s message is “Hepatitis can’t wait”. A real urgency is needed in efforts to eliminate hepatitis C as a public health threat within the next eight and a half years.
“Hepatitis can’t wait” is a particularly relevant theme in New Zealand, as it reminds us that people who are unaware they’re living with viral hepatitis cannot wait for testing; people affected by hepatitis cannot wait for stigma and discrimination to end; and decision makers cannot wait – and must act now – to make hepatitis elimination a reality.
So how do we eliminate hepatitis C? A detailed road map is being prepared for the first phase of the Action Plan, which will run from this year to 2025. Half of the activities within this phase are already being developed or rolled out.
Initial funding of $2.2 million has been allocated in the past year to start on key priorities in raising awareness, prevention, testing, surveillance – and improving access. This is on top of around $7 million per year in ongoing funding to support hepatitis C services delivered in DHB regions, and prevention and harm reduction services delivered by needle exchanges.
The biggest challenge we face in eliminating Hep C is that many affected people don’t know they have a health issue, because they’re not experiencing symptoms until their liver has been damaged.
To succeed we need to call the community to action just like we did to stamp out Covid-19. The Ministry of Health is working with Te Hiringa Hauora – the Health Promotion Agency – and a stakeholder advisory group, to develop a national awareness campaign on the need to get tested and treated. We expect it will be ready to ‘go live’ within the next year.
As access to both testing and treatment is often inequitable, the campaign will be tailored to priority populations.
Prevention and harm reduction
Prevention and harm reduction is a critical focus area in the Action Plan. This includes addressing discrimination against people who inject drugs and have hepatitis C, and promoting approaches and activities that reduce stigma.
In order to reduce infection and harm amongst drug users, the Ministry of Health is funding the procurement and cost-free distribution of extra sterile equipment in a new community-based partnership model between DHBs and needle exchange programmes.
Testing and screening
We have had a valuable weapon against hepatitis C since February 2019, when Pharmac began funding Maviret to treat the virus. This can cure almost everyone with chronic hepatitis C infection. More than 4,400 people had been treated with Maviret, by April this year.
We want to increase the uptake of new treatments such as this, alongside promoting early diagnosis, and linking people to treatment and care.
Surveillance and monitoring
It’s important we can track and report on our progress against the elimination target, so we’re developing a new surveillance system.
The Ministry of Health and ESR are already working on expanding a national clinical data repository known as Éclair. Originally set up for COVID-19, this growth will allow data to be collected for other diseases – with hepatitis C to be the first.
And to make sure any future surveillance mechanism for hepatitis C also links up with care planning and treatment – a virtual registry is also being developed.
Increasing integration and access to care
We need to reach into communities, to ensure they can access testing and treatment. Nurse-led clinics are being set up in many areas as mobile clinics, such as the van parked outside. Taking services to people in this way is a key part of transforming our approach to hepatitis C.
We’ll also be investigating the feasibility of widening who can prescribe hepatitis C treatments, to include nurses and pharmacists.
Prisons are one of the areas we want to prioritise for improving access and uptake of hepatitis C testing and treatment. Misuse of drugs can often play a part in why people end up in prison, and we know hepatitis C can be spread by injecting drugs. On top of this, sharing non-sterile tattooing equipment in prison puts people at risk of infection.
This Action Plan includes efforts to improve access to hepatitis C clinics in prisons which provide education, testing, assessment and treatment. Currently hepatitis C tests are offered to people in prison who ask for a test, or who may be at risk of infection. The Department of Corrections will investigate the feasibility of testing being offered to everyone – meaning people would have to make a deliberate choice not to participate.
Work will explore ways to boost follow-up offers of hepatitis C tests and timely access to further re-testing; improving the availability and promotion of hepatitis C information in prisons; and looking at how to improve prevention and harm reduction for people in prisons and transitioning into the community.
What next? Work is already well underway to develop and roll out activities for the first phase of this plan. A cross-agency Oversight Group is in place to guide the work, track progress and assess the impact. This will inform how we prioritise activities for phase two, from 2026 to 2030.
Hepatitis truly can’t wait. In New Zealand, each year around 1,000 people still contract hepatitis C, and more than 200 people die from it. But with an effective treatment now available, an Action Plan in place, and work underway, I have every confidence we will eliminate hepatitis C as a major health threat by 2030.
Nō reira, tēnā koutou, tēnā koutou, tēnā koutou katoa.