What can the pandemic teach us about eliminating viral epidemics?

Learning from treatment successes could help better manage other infectious diseases

We have seen some silver linings from our response to COVID-19, such as the implementation of mRNA vaccine technology. But there are other successes in the COVID-19 response that can also be credited with slowing or reversing the course of the pandemic. And we could leverage them to eliminate other epidemics.

One of the most burdensome infectious diseases in Canada is hepatitis C. Fortunately, there is a cure. Unfortunately, many people live with this infection for years before being diagnosed, with the virus wreaking havoc on the liver in the meantime — leading to liver cancer, cirrhosis and even death. The only way to eliminate hepatitis C is to ensure everyone at risk has access to testing and curative treatments. But how would people know to get tested if hepatitis C often shows no symptoms?

Offer testing more broadly

Historically, hepatitis C testing has been offered when a health-care provider believes a patient is currently at risk of infection. The problem is that health care providers don’t always know their patients’ past or present risk factors. The patients themselves may have overlooked a potential exposure decades ago, such as sharing drug, tattoo or piercing equipment in their youth, or receiving medical care in another country with less rigorous sterilization practices.

Similarly, initial COVID-19 screening practices recommended testing only those who met specific and obvious criteria, such as people with symptoms who had travelled to high-prevalence countries or regions. Now that we know more about the role of asymptomatic spread of COVID-19, a broader offer of testing has helped to stop some outbreaks in their tracks.

Liver experts have also advocated for a broader approach to hepatitis C testing, recommending a onetime test for everyone born between 1945 and 1975 in addition to people with current risk factors. This could help diagnose those with asymptomatic infection, and could destigmatize the offer and request of a hepatitis C test.

Focus on priority populations

At the same time that COVID-19 testing criteria have been broadened, public health measures have become targeted. Recognizing the underlying inequities that create health disparities, some public health authorities have scaled up vaccine clinics and outreach in the neighbourhoods, workplaces and communities hardest hit by the pandemic. The strategy has paid off by focusing resources where they will have the most impact.

Similarly, advocates have been calling on governments to adopt a “priority population” approach to eliminate hepatitis C: acknowledging the communities most affected by hepatitis C — including older adults, Indigenous communities, immigrants from countries where it is common, and people who inject drugs — and prioritizing them for awareness-raising, testing and culturally relevant information in the languages they speak.

Tackle social risk factors

Another welcome development in the pandemic was the decisive action taken by some governments to address the social determinants of health. Concerned that homeless people may be more vulnerable, some jurisdictions proactively offered temporary housing for people living in shelters, on streets and in parks.

Decades of research have shown that a lack of stable housing is also associated with a greater risk of hepatitis C. We now know that we have the collective resources to house people when we want to prevent and eliminate a respiratory infection. Why can’t we muster the resources for housing and other social determinants of health when we know they can prevent and eliminate other infectious diseases?

Act now, save later

Looking forward, could the next ticking viral time bomb be hepatitis C? In Canada, the virus costs us $160 million per year, and this number is expected to increase to $260 million by 2032.

But if we changed our approaches now — broadening our testing strategies, focusing prevention efforts on priority populations, and ensuring everyone gets access to curative treatments — epidemiologists project that Canada could actually eliminate hepatitis C as a public health threat by 2030, saving millions of dollars in averted health care costs every year.

COVID-19 has shown us what can go wrong when we don’t take action, and what we can achieve when we do. Whether decisionmakers learn these lessons remains to be seen.