SEVENTH MOST LETHAL

As of today, there are 400 million people in the world who have hepatitis B and C viruses. This disease kills 1.4 million people every year. The daily figure is 4,000! Hepatitis is the world's seventh most lethal disease. The hepatitis virus is dangerous and treacherous because of its long incubation period. When it gets inside the human body, the person feels nothing and may live on for many years without knowing that their liver is practically destroyed. Almost the saddest thing is that, in 95 per cent of cases, the virus is spotted by chance, when undergoing unrelated testing and examination. 

Free treatment

There is no exact statistics on hepatitis in Azerbaijan. This is a result of the absence of compulsory medical insurance. In addition, our people do not like very much regular full preventive diagnostic checkups. His is why, as was said above, the detection of hepatitis is a random process. 

Today Azerbaijan has a commission at its Health Ministry in charge of virus hepatitis B and C diagnostics and treatment. Its head Prof Murad Mammadov said in an interview with R+ that major efforts to prevent hepatitis in this country should go along two lines: timely vaccination and preventive education work because, unfortunately, the number of people infected with hepatitis in this country is steadily growing. The first contributing factor is the "anti-vaccination" hysteria that has spread over the post-Soviet space lately. Second, many people just do not know where and how they can catch the hepatitis virus which is mostly conveyed through blood and only in five per cent of cases through unprotected sexual contacts. So, the most frequent way of contagion is through the operating room if the surgeon is using improperly sterilized instruments, during tooth treatment, in beauty parlours, tattoo salons and other places involving the risk of direct contact with blood. Quite frequent are cases of innate hepatitis where babies are infected from their mothers who may be even unaware of the disease. 

For her part, a member of the commission, Haqiqat Qadirova has said that there is general statistics on patients having hepatitis virus supplied on a centralized basis from municipal and national clinics. But those are cases of acute forms of hepatitis A, B and C. "As regards our commission, we keep records on patients checked in with a chronic form of hepatitis," Haqigqt xanim commented. According to her, there were 2,900 patients registered by 10 September 2015 and 70 per cent of them had hepatitis C. "Most of them have lived with the disease for a few years and have obvious lesions in the liver," the doctor said. 

A case of hepatitis D (delta) virus was recently revealed in Azerbaijan. The agent of the disease has a defect disables it to multiply independently in the human body. It needs a helper virus for this purpose. Serving as such an helper is the hepatitis B virus. The resultant tandem of hepatitis D combined with hepatitis B causes a rather serious disease. 

It is definitely important to reveal hepatitis. But it is only part of the problem. As is known, medicines for its treatment are very expensive. This is why the World Health Organization (WHO) is currently implementing a programme in Azerbaijan to stamp out hepatitis under which free treatment is offered. Under this state programme, H.Qadirova said, treatment is provided with the use of Ukraferon and Ribavirin interferon medicines supplied from Ukraine. The commission representative could not say for sure whether Azerbaijan is planning to import generic medicines that should be prescribed along with interferons. "Relevant structures at the Health Ministry are dealing with this issue. I am not in charge of it," she said hoping that the Health Ministry would keep abreast with global processes in the domain of hepatitis treatment. At the same time, specialists believe that the hepatitis B situation has improved in Azerbaijan since compulsory vaccination was introduced for all children to undergo immediately after birth. 

Generics of originals?

So what kind of thing are generics? Why do specialists unanimously say that, in the treatment of hepatitides all over the world, preference is given just to them? Moreover, support for the production of generics and their use in medical practice is one of the WHO's strategic objectives in providing access to medical aid. 

The thing is that generics are remedies sold under international patented or unpatented names which differ from the brand name given to the medicines by their developers. As a rule, generics do not differ from the original medications in terms of efficiency but are much cheaper because their producers do not spend money on research and efforts to develop the medications, to obtain certificates confirming their safety and efficiency and on their advertising and promotion. 

Advocates of the use of generics in the treatment of hepatitides argue that such synthesized medicines can cure hepatitis completely in just 12 weeks and the curability rate increases to 95 per cent. In other words, hepatitis cannot be cured with interferons alone. So a number of countries where the problem of hepatitis spreading has become nationwide have assumed to provide people with such medications and treatment and they cover the cost in part or in full. 

Proponents of this group of medicines say that the use of generics is of much social medical importance because it makes quality treatment available for the broad public. For example, generics account for more than 60 per cent of all remedies being currently prescribed in the USA. A similar situation can be seen in countries of Western Europe, such as Germany, Austria, Switzerland and others. 

The wide application of generics make it possible to use national budget funds allocated for health care more reasonably and thus create a financial reserve to pay for expensive medical products, procedures and services. For its part, price competition from generics producers urges innovative companies to create basically new, more up-to-date medications and treatment methods. 

Opponents of generics see the stumbling block in the quality of the reproduced medications and their clinical efficiency compared to the original. For quite clear reasons, companies making duplicates (generics) do not invest enough funds in clinical trials of their medications, unlike those producers who are the first to bring a new remedy to market. This is why, in their opinion, generics are not always efficient in the treatment of one disease or another, especially the liver. 

As regards the Ukraferon immunomodulator which is provided for hepatitis patients in Azerbaijan, therapist and hepatologist Zaur Orucev says that it cures five to 10 per cent of mild cases and zero per cent of severe cases. It would be advisable for the state to find the funds to provide hepatitis patients also with generic medications which are prescribed together with interferons and are many times cheaper than the original medications, specialists say. But the very fact that interferons are now handed out free of charge is quite an achievement. 

They need protection

According to Rauf Hasanli, the head of the only educational organization for hepatitis patients in this country, despite the fact that Azerbaijan has a state programme offering free treatment to hepatitis patients, a lot of them still rush to private clinics. "Everything related to the treatment of hepatitis virus is very expensive," the expert comments. "Not everyone can afford it. General diagnostics of all hepatitides including diagnostics using the PCR (polymerase chain reaction) method costs about 800 manats. Given that the spread of hepatitides is in no way confined to the capital, treatment become too costly for residents of the regions who are infected with this virus: one interferon injection costs 180-250 manats while it is necessary to do them every week during half a year or even the whole year in advanced cases," the specialist emphasized. At the same time, interferons are very strong medicines. They suppress other body functions, too. So, one has to take a lot of other medicines simultaneously for rehabilitation of the body. 

Interestingly enough, the expert regrets, very few patients know today that Azerbaijan is running a free treatment programme for diseases caused by hepatitis viruses. 

In some forms of hepatitis, depending on the genotype, one can do without interferons. It is good news that the cost of treatment has dropped from 25,000-30,000 manats to 3,500-4,000 manats. The price of one package of an original medicine may reach 15,000 manats, Hasanli says. 

At the same time, hepatitis patients in Azerbaijan are faced with other problems, too. Their rights are often broken: they are sacked when their employers learn about their disease. They also suffer from other types of discrimination. All this is due to the lack of information about contagion and transmission of the disease. 

It is a pleasant fact that the global community is now close to total victory over the cunning, treacherous and fatal virus. According to information from the WHO, it is planned to ultimately stamp out the hepatitis virus by 2030 and governments are going to spend 11.5bn dollars on this programme. Such impressive an amount will not really seem so if we recall that 4,000 people die of hepatitis every day. It appears that Azerbaijan will not stand back from these processes, given that interferons are already being handed out free of charge here. But it is time to go over to other medicines - generics, as well.