THE PROBLEM

Unlike HIV, tuberculosis, and malaria, there is no multilateral or bilateral financing mechanism for hepatitis C (HCV). Domestic financing is currently the only means for raising substantial funds for national HCV programs. With a host of other pressing health issues, the task of mobilizing these resources can be overwhelming for the health budgets of some countries, especially the poorest countries. Very few countries have launched national large-scale or elimination HCV programs, and those that have are almost exclusively middle-income countries who have financed these efforts independently. Financing is a key bottleneck preventing a wider range of countries from increasing access to HCV drugs.

Unitaid is one of the sole donors for HCV. Over the past few years, Unitaid has been funding catalytic activities meant to lay the foundation for large-scale national HCV elimination efforts, including advocacy campaigns, investment cases, drug pricing, and technological breakthroughs in diagnostics.

Unitaid requested assistance from Pharos to identify potential countries that could be ready to rapidly initiate an HCV elimination program, estimate the potential costs of these elimination programs, and lastly outline some approaches that Unitaid could use to catalyze financing for elimination.

THE PHAROS SOLUTION

Pharos led a comprehensive synthesis and analysis of the needs and possible solutions in HCV financing and the development of strategic recommendations for Unitaid. The project was split in three key phases:

Country Assessment:
The scope of suitable financing solutions is ultimately determined by country context. We developed a readiness assessment tool to gain a more comprehensive, comparative understanding which countries are on the verge of launching national programs. For example, the tool evaluated countries on having established nascent treatment programs, on whether a national strategy existed, and what the fiscal space is in these countries to ultimately finance these programs at scale.

Cost of Elimination
Financing solutions also depend on the magnitude of the resources that are required, driven by the size of the HCV burden in terms of prevalent infections and incidence. Different mechanisms are best suited for mobilizing USD 50 million vs USD 1 billion. Pharos developed an elimination costing tool to estimate the magnitude of resources that will be needed for HCV treatment, screening, and supporting activity costs to achieve elimination by 2030. We partnered with the University of Bristol who adapted their full epidemiological model to a “coverage calculator” to inform treatment coverage levels in the tool.

Financing Options
We then evaluated the potential of a range of financing options based on their suitability for mobilizing the level of required resources, the risk to Unitiad, and the feasibility in terms of simplicity and appetite of would-be involved financiers, intermediaries, and country governments.

Technical analyses and final recommendations were submitted to the Unitaid senior team.

Status: Closed; Completed March- September 2018
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Team Members Involved: Rob Hecht, Shan Soe-Lin, Lindsey Hiebert, Adam Trickey (University of Bristol), and Peter Vickerman (University of Bristol)