My View

How a Simple Test Can Save 120,000 Lives

Hepatitis C, the “silent epidemic” afflicting baby boomers, is twice as prevalent among African-Americans, but preventive measures may save $2.5 billion in health care costs, a CDC official says.

John Ward directs the CDC's Division of Viral Hepatitis. He earned his bachelor's from the University of Alabama in biology and history and his M.D. from UA-Birmingham.
National Journal
John Ward
Add to Briefcase
John Ward
Feb. 27, 2014, 5:36 a.m.

John Ward, 58, has spent his ca­reer at the Cen­ters for Dis­ease Con­trol and Pre­ven­tion, start­ing in 1984 work­ing on AIDS, then as ed­it­or of the Mor­bid­ity and Mor­tal­ity Weekly Re­port, and since 2005 as dir­ect­or of the vir­al hep­at­it­is di­vi­sion.

In this role, the Alabama nat­ive and his team lead an ef­fort to im­ple­ment a simple test to de­tect hep­at­it­is C, a vir­us iden­ti­fied 25 years ago that of­ten gives rise to liv­er dis­ease and is most pre­val­ent among Afric­an-Amer­ic­ans.

This in­ter­view, con­duc­ted by Jody Bran­non, has been ed­ited for length and clar­ity.

I’ve been in­ter­ested in com­mu­nic­able dis­eases throughout my ca­reer at CDC, and after the long-stand­ing di­vi­sion dir­ect­or left, I was for­tu­nate to be se­lec­ted to lead our work against a group of dis­eases trans­mit­ted in mul­tiple ways.

When we got here, we began to draw at­ten­tion to what’s been called a si­lent epi­dem­ic — 3.5 mil­lion to 5.3 mil­lion people liv­ing with hep­at­it­is, of B or C type — in­fec­ted in dif­fer­ent ways and now liv­ing with it for dec­ades. We began to see a rising rate of liv­er can­cer — a great ma­jor­ity caused by hep­at­it­is — and rising num­bers of deaths from it.

It af­fects Afric­an-Amer­ic­ans dis­pro­por­tion­ately. They have twice the rate of death from hep­at­it­is C as white Amer­ic­ans, and they have twice as high a rate of in­fec­tion. So we have called at­ten­tion to test­ing the baby-boomer gen­er­a­tion for hep­at­it­is C — people born from 1945 to 1965 — be­cause that pop­u­la­tion were young adults be­fore this vir­us was found in 1989 and be­fore pre­ven­tion meas­ures were put in place. They may have been ex­posed to hep­at­it­is through blood trans­fu­sions, ex­pos­ures in the health care set­tings, or through drug use, or oth­er ex­pos­ures.

This pop­u­la­tion has an in­creased rate of hav­ing hep­at­it­is C, and you re­main in­fec­ted for life. As years go by, the vir­us eats away si­lently at the liv­er and causes late symp­toms. So our big fo­cus is get­ting more people tested and aware of their in­fec­tion status, and, if they’re in­fec­ted, dir­ec­ted to prop­er treat­ment.

Ad­dress­ing health dis­par­it­ies and people with high pre­val­ence, the pre­val­ence is at least two times as high in black Amer­ic­ans as in white. So we want to be care­ful to share the right mes­sage to pro­viders and the com­munity it­self. There’s a simple blood test, and the very ex­cit­ing news is there are safe, short-act­ing cur­at­ive treat­ments for hep­at­it­is C.

If you test and cure them for C, you lower their rate for mor­tal­ity by 50 per­cent and for liv­er can­cer by 70 per­cent, so there’s a huge health pay­off through test­ing and treat­ment.

This wave of treat­ments is very new — only li­censed in Novem­ber or Decem­ber. It al­lows you to have an or­al treat­ment re­gi­men that can be a hand­ful of pills for 12 weeks — maybe 24 — of treat­ment. Be­fore that, and even now, some pa­tients re­quire in­jec­tions of in­ter­fer­on every week with side ef­fects that are quite no­tice­able.

The old treat­ment had a bad repu­ta­tion if you had to live with liv­er dis­eases. To get rid of your in­fec­tion, we have to cor­rect a lot of in­ac­cur­ate im­pres­sions — how they make you feel, what’s in­volved — and we’re at a dif­fer­ent place now.

It comes at an im­port­ant time with rising dis­ease and mor­tal­ity, which is totally pre­vent­able if we can get people tested and treated. We want all people born in that era to be tested for hep­at­it­is, re­ferred for care, and to re­ceive the treat­ments that are in­dic­ated.

In our eco­nom­ic stud­ies, when we look at the cost of avert­ing death and ex­tend­ing lives, we es­tim­ate that it costs about $32,000 to ex­tend a per­son’s life for one year. That’s the tra­di­tion­al way in­ter­ven­tions are eval­u­ated. That fol­lows well in the range of oth­er pre­vent­ive ser­vices for check­ing blood pres­sure, cho­les­ter­ol, and flu vac­cin­a­tions for older adults. It shows it­self to be a very reas­on­able in­ter­ven­tion that has a pay­off in avert­ing death for a reas­on­able amount of money.

We es­tim­ate that if we fully im­ple­ment this birth-co­hort strategy, we can identi­fy 800,000 people not aware they’re in­fec­ted, and avert 120,000 deaths and save $2.5 bil­lion in health care costs.

The obstacles are get­ting clini­cians aware of our re­com­mend­a­tions and help­ing them make it part of their routine prac­tice. The more that can be handled by your nurse or mid-level pro­vider rather than a doc­tor means it can be im­ple­men­ted more quickly. So we’re look­ing to in­sert an elec­tron­ic re­mind­er in­to a pa­tient’s re­cord, like for pa­tients whose birth­days are between 1945 and ‘65, auto­mat­ic­ally you’re offered this test. So we’re look­ing to get that in place.

The U.S. Pre­vent­ive Ser­vices Task Force also made a sim­il­ar re­com­mend­a­tion for test­ing for this group. The be­ne­fit of that is the USP­STF re­com­mend­a­tions are covered as a no-co-pay pre­vent­ive ser­vice. That means, for most private health care ser­vices, the pa­tient won’t have ex­penses, so that re­duces one bar­ri­er. Some­times pro­viders will listen to their pat­ents, and that re­in­forces our mes­sage. They draw blood and add the test on without ad­di­tion­al cost to the pa­tient more of­ten than not since it’s covered by in­sur­ance.

We’re also edu­cat­ing the pub­lic, so the pa­tient knows the im­port­ance, and then we’re gath­er­ing data to see where it’s work­ing and where it’s not and to im­prove it, with par­tic­u­lar at­ten­tion to Afric­an-Amer­ic­ans and com­munit­ies where pre­val­ence is highest.

I’ve had friends in my own com­munity and ac­quaint­ances who un­for­tu­nately have waited too late to be tested and treated, so they’d already de­veloped liv­er dis­ease so ad­vanced they could no longer be­ne­fit from treat­ment. The reas­on is that there are so few symp­toms un­til the ad­vanced stage that a pa­tient can­not rely on how they’re feel­ing. Only through test­ing is that pos­sible. The drugs work bet­ter when the liv­er dis­ease is milder, so the earli­er the test and treat­ment, the bet­ter.

Most pa­tients, when they learn of the reas­ons for test­ing, they read­ily ac­cept it, and I have ex­amples of people say­ing, “Thank you for catch­ing this in time.” In fact, CDC-sup­por­ted test­ing pro­grams get thank-you notes from people who pre­vi­ously didn’t know of their con­di­tion.

So pro­viders and doc­tors will provide a ser­vice that’s ap­pre­ci­ated by pa­tients. Among those people tested and treated and for­tu­nate to clear their in­fec­tion, they say, “I didn’t really know how bad I felt un­til I got rid of this in­fec­tion.” The days of feel­ing slug­gish, out of sorts, los­ing their get-up-and-go, they at­trib­ute to just get­ting older, when it was really hep­at­it­is C that was caus­ing symp­toms. They’re so mild and non­spe­cif­ic no one really seeks med­ic­al care, but ac­tu­ally they have it.

The pro­spect of sav­ing 120,000 lives — well, you don’t get those op­por­tun­it­ies in pub­lic health very of­ten. As­sem­bling at­ten­tion that this de­serves and get­ting pro­viders and the health com­munity on board is mak­ing a dif­fer­ence.

For more in­form­a­tion about the CDC’s Hep­at­it­is C pub­lic edu­ca­tion cam­paign, Know More Hep­at­it­is, please vis­it: ht­tp://­more­hep­at­it­is/



Are you part of the demo­graph­ic that is the Next Amer­ica? Are you a cata­lyst who fosters change for the next gen­er­a­tion? Or do you know someone who is? The Next Amer­ica wel­comes first-per­son per­spect­ives from act­iv­ists, thought lead­ers, and people rep­res­ent­at­ive of a di­verse na­tion. Email us. And please fol­low us on Twit­ter and Face­book.

Jody Brannon contributed to this article.
What We're Following See More »
Military Parade Delayed Until 2019
8 hours ago
Manafort Case Moves to Closing Arguments
1 days ago
Manafort Defense Rests
2 days ago
Judge Holds Witness in Contempt in Manafort Case
6 days ago

"A federal judge has found a witness in contempt for refusing to testify before the grand jury hearing evidence in special counsel Robert S. Mueller III’s investigation of Russian interference in the 2016 presidential election. U.S. District Chief Judge Beryl Howell made the ruling Friday after a sealed hearing to discuss Andrew Miller’s refusal to appear before the grand jury. Miller is a former aide to longtime Trump confidant Roger Stone."

Gates Says He Committed Crimes with Manafort
1 weeks ago

Paul Manafort's former business partner Rick Gates said in court today that "he conspired with Manafort to falsify Manafort’s tax returns. Gates said he and Manafort knowingly failed to report foreign bank accounts and had failed to register Manafort as a foreign agent."


Welcome to National Journal!

You are currently accessing National Journal from IP access. Please login to access this feature. If you have any questions, please contact your Dedicated Advisor.