The Secretary of the 19th Expert Committee on the Selection and Use of Essential Medicines Medicine Access and Rational Use (MAR) Department of Essential Medicine and Health Products World Health Organization 20 Avenue Appia CH-1211 Geneva 27 SWITZERLAND E-mail: [email protected]

January 28, 2013

A Joint Support Letter Signed by ITPC- and Its Member NGOs for the MSF Application for Inclusion of Pegylated Interferon on the WHO EML Dear Sir or Madam:

ITPC-China is a national activist and NGO coalition on advocacy for people with HIV, TB and viral hepatitis. The Coalition hereby supports the application for the inclusion of pegylated interferon (PEG-IFN) alfa 2a 2b on the WHO Model List of Essential Medicines (EML).

In China, there are approximately 10 million people living with HCV. However, according to the Annual National Infectious Disease Reporting Incidence and Mortality Statistics published by the Chinese Ministry of Health, newly reported cases of HCV have shown a double digital growth between 2007 and 2011. Very few Chinese receive treatment for HCV, as the cost is prohibitively high.

While the overall HCV infection rate in China is relatively low, the total number of people needing treatment is still high, and the rate of co-infection among people living with HIV (PLHIV) is alarming. Among an estimated 780,000 PLHIV in China1, injecting drug users (IDU) account for 28.4% and former plasma donors and former contaminated blood or blood product recipients account for 6.6%.A recent survey of HIV-1 positive injection drug uses (IDU), former paid blood donors (FBD)2 and sexually transmitted cases from multiple provinces including the four most affected provinces in China found that IDU and FBD have extremely high rates of HCV infection (97% and 93%, respectively). Those who acquired HIV-1 through sexual contact also had a higher rate of HCV infection (20%) than the general population.

Even though hepatitis C can be cured with the standard of care for the treatment of HCV of pegylated interferon and ribavirin, such treatment in China costs more than USD11,000 for a course of 48 weeks treatment which is still not covered by local government health medical insurance in most places in China. In a country where the

1 2011 Estimates for the HIV/AIDS Epidemic in China published by China published by WHO, UNAIDS, China MoH 2 High Prevalence and Genetic Diversity of HCV among HIV-1 Infected People from Various High-Risk Groups in China, PLoS ONE;2010, Vol. 5 Issue 5, p1, May 2010

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average annual per capita income is less than $5,000,3 the cost of HCV treatment ensures that very few people can access treatment. Existing national insurance schemes cover only a fraction of treatment costs, with rural residents and many poor families (including those driven into poverty by HIV-related medical care) unable to afford even basic medical treatment.4

While treatment access needs to be addressed across the population, the emerging HIV-1 and HCV co-infection in China requires urgent well-established surveillance, prevention and treatment measures because people co-infected with HIV and HCV suffer poorer quality of life, and often experience a more rapid progression of liver disease and death compared to those infected with HIV or HCV alone.

All in all, we sincerely believe that the inclusion of PEG-IFN on the WHO EML will strongly accelerate the global efforts against hepatitis C and will particularly make an impact on the policy-making process among the health authorities for universal access at the national level in China.

Yours sincerely,

Jay Liu

Coordinator

Jointly signed by 1. International HIV/AIDS Alliance（UK）Kunming Division （国际艾滋病联盟（英国）昆明 办事处） 2. AIDS Care China (中国爱之关怀) 3. China Service Organizations Network for Drug Abuser (中国药物滥用者服务组织工作网 络) 4. China Grassroots Women's Rights Center (中国民间女权工作室)

3 http://www.worldbank.org/en/country/china/overview, accessed on 24 January 2013 4 "Missing the Target 10, Communities and the Treatment 2.0 Initiative: Delivering on the Next Treatment Scale-up," p.27. International Treatment Preparedness Coalition, October 2012 http://www.itpcglobal.org/atomic-documents/11057/2078TT10_web.pdf

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5. Women's Network against AIDS-China（女性抗艾网络-中国） 6. Beautiful Life (Shanghai) Health Service Agency (美丽人生（上海）健康服务社) 7. Dongjen Center for Human Rights Education(东珍人权教育中心) 8. Shanghai Supple Jasmine Women's Health Group (上海依依茉莉女性小组) 9. Shanghai Xuhui HOPE PLHIV Group(上海市徐汇 HOPE 感染者小组) 10. Shanghai Minhang Rainbow PLHIV Group(上海闵行雨后彩虹感染者小组) 11. Shanghai Jing'an District Youth Service Center of AIDS Prevention(上海青艾) 12. Tianjin Deep Blue Working Group(天津深蓝组织) 13. Tianjin Friendship and Love Homeland（support group）（天津友爱家园） 14. Guangxi Nanning Evergreen Mutual Support Group(绿城长青互助小组) 15. Guangxi Bagui Care Group(八桂关爱小组) 16. Guangxi Guilin Red Ribbon Center(桂林红丝带家园) 17. Guangxi Luzhai Red Ribbon Center(鹿寨红丝带家园) 18. Guangxi Liuzhou Mutual Support Group(柳州蓝天互助小组) 19. Guangxi Snow Lotus (support group) (广西雪莲花) 20. Doctor Li Xia, Yunnan Provincial Hospital for Infectious Disease(云南省传染病院/云南省 关爱中心 李侠 医生) 21. Dai Xiaoqin, Community Worker in Yunnan(社区工作人员 戴晓琴) 22. Yunnan Cangyuan Red Ribbon Center(沧源红丝带家园) 23. Yunnan Gejiu Sunshine Workstation(个旧阳光工作站) 24. Yunnan Kaiyuan the Plough Working Group(开远北斗工作室) 25. Yunnan Kaiyuan Red Ribbon Center(开远红丝) 26. Yunnan Mengzi Kangxin Home(蒙自康馨家园) 27. Yunnan Mangshi Red Ribbon Center(芒市红丝带) 28. Yunnan Gejiu Infectious Diseases Hospital Red Ribbon Center(个旧传染病院红丝带家园) 29. Yunnan Erhai Mingyue Group(大理洱海明月小组) 30. Yunnan Dali No.2 People’s Hospital Red Ribbon Center(大理市二院红丝带小组) 31. Yunnan Ruili Red Ribbon Center(瑞丽市红丝带家园) 32. Yunnan Jianshui Red Ribbon Center(建水红丝带) 33. Yunnan Kunming Yunling Zuzhiguang (support group) (昆明云岭竹之光) 34. Yunnan Pu’er Red Ribbon Center(普洱红丝带) 35. Yunnan Banna Red Ribbon Center(版纳红丝带之家) 36. Yunnan Baoshan Home of Love(保山爱之家园) 37. Yunnan Daytop Drug Abuse Treatment Rehabilitation Center(云南戴托普药物依赖治疗康 复中心)

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38. Heilongjiang Kangtong Working Group(黑龙江康同工作组) 39. Heilongjiang Home of True Love (support group) (黑龙江真爱家园) 40. Heilongjiang Zhen'ai Working Group (黑龙江珍爱工作组) 41. Heilongjiang Qiqihar Hecheng Brother Working Group (齐齐哈尔鹤城兄弟工作组) 42. Heilongjiang Qitaihe Aixin Home (support group) (七台河爱心家园) 43. Heilongjiang Qitaihe Tongxing Community (support group) (七台河同行社区) 44. Heilongjiang Daqing Rainbow Working Group (大庆彩虹工作组) 45. Heilongjiang Daqing Tianqing Working Group (大庆天晴工作组) 46. Heilongjiang Mudanjiang Zhi’ai Working Group (牡丹江挚爱工作组) 47. Heilongjiang Hegang Qingkong Working Group (鹤岗晴空工作组) 48. Heilongjiang Jiamusi Aixin Home (support group) (佳木斯爱心家园) 49. Heilongjiang Zhenqing PLHIV Mutual Support (哈尔滨真情感染者互助小组) 50. Heilongjiang Shuangyashan Lao Shao Qing Yi Working Group(双鸭山老少情谊工作组) 51. Hubei Zhiyuan Health Promotion Center(武汉馨缘工作组) 52. Chengdu AiRen Alliance PLWHA Mutual Support Group(成都爱仁同盟感染者互助小组) 53. Hunan Friend Love Home(湖南友爱之家) 54. Hunan Hemophiliac Association(湖南血友联谊会) 55. Hunan Changsha Zhongda Sunshine Community Service Center(长沙中大阳光社工服务 中心) 56. Hunan Zuo’an Rainbow Working Group (湖南左岸彩虹工作组) 57. Hunan Zhangjiajie Tongtian Working Group(张家界同天工作组) 58. Hunan Changsha Xingcheng Working Group(长沙星城工作组) 59. Hunan Yiyang Yincheng Working Group(益阳银城工作组) 60. Hunan Changsha Gay & Lesbian Culture Activity Center(长沙同志文化活动中心) 61. Hunan Changde Zuo’an Rainbo Working Group(常德左岸彩虹工作组) 62. Hunan Home of Aixin Volunteer Team(湖南爱心家园义工团队) 63. Hunan Huaihua Care Home (support group) (湖南怀化关爱之家) 64. Guangzhou Red Ribbon Center(广州红丝带之家) 65. Lingxia Sunshine Studio(宁夏阳光工作室) 66. Ningxia Blue Sky Working Group(宁夏蓝天工作组) 67. Fujian Futong Association(福建省福桐联合会) 68. Fujian Love Castle Organization(福建爱之城堡组织) 69. Fujian Sunshine Care Organization(福建省阳光关爱组织) 70. Shanxi Landian Working Group(山西蓝典工作组) 71. Jiangsu Sharing Sunshine Organization(江苏共享阳光组织)

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72. Jiangsu PLHIV Care Coalition(江苏省阳光关爱感染者联盟) 73. Jiangsu Care Home(江苏徐州关爱家园) 74. Jiangsu Yangzhou Sunshine Care (support group) (江苏扬州阳光关爱) 75. Zhejiang Aixin (support group) (浙江爱心) 76. Harmony Home(郑州关爱之家) 77. Henan Qingzhulin (support group) (河南信阳青竹林) 78. Henan Nanyang Red Group(河南南阳红小组) 79. Henan Jiudu Working Group (Aixin Home) (洛阳九都工作组(爱心之家）) 80. Henan 3 Working Group (Harmony Home) (河南三工作组（关爱之家）) 81. Henan Golden Sunshine Children Support/Care Association(河南金色阳光) 82. Henan Women's Network against AIDS (河南女性抗艾社区组织网络) 83. Henan Aibang (support group) (河南爱帮) 84. Henan Weishi Red Ribbon (support group) (河南尉氏红丝带) 85. Henan Tianzhong Charity(驻马店天中公益) 86. Henan Zhecheng Home of Red Willows(柘城县红柳之家) 87. Zhecheng Civic Association for AIDS Control(柘城县艾滋病防治民间促进会) 88. Henan Sui County Aixin Mutual Support Group(睢县爱心互助组) 89. Henan Sui County HIV Prevention and Control Association(睢县防治协会) 90. Henan Kangle Home(宁陵县康乐家) 91. Henan City Kangle Home in Huilang Town(巩义市回郭镇康乐家) 92. Henan Farmers’ Health Mutual Support Group(新蔡县农民健康互助组) 93. Henan City Sunshine Home(鹤壁市阳光家园) 94. Henan City PLHIV Mutual Support Group in (周口市沈丘县感染 者互助组) 95. Henan Shangshui County PLHIV Mutual Support Group(商水县感染者互助自救组织) 96. Hainan Xinhai Home PLHIV Support Group(海南心海家园感染者小组) 97. Shaanxi Tongkang Jianyi Home Working Group(陕西同康 “健怡之家” 工作组) 98. Xinjiang Urumchi Yaxin Oasis (support group) (乌鲁木齐亚心绿洲) 99. Chongqing Nanyu Working Group(重庆蓝宇工作组) 100. Hebei Qingniao Charity (河北青鸟公益) 101. Hebei Light of Love PLWHA Group (河北爱之光小组) 102. Hebei Tongxing (support group) (河北同行) 103. Shangdong Heze City Hemophiliac Home(菏泽市血友病之家) 104. Shandong Chengwu County PLHIV Group(鲁成感染者小组) 105. Shangdong Qingdao Aixinxing Organization(青岛爱心行组织)

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