Egypt has eradicated Hepatitis C. Now it’s trying to help the rest of Africa.

For seven years, Sulemana Musah poured almost all the money he received into his war against hepatitis C.

His student loans for graduate school, his salary from his job as a high school teacher and the money he earned from a side job selling yams all went to tests and medicine to cure the virus that was weakening him. Mr Musah, 27, who lives in Accra, Ghana’s capital, put aside dreams of starting a business, building a house and getting married.

He collected enough money – $900, half his annual salary – to buy a course of medicine that revolutionized the treatment of hepatitis C in the United States and other high-income countries a decade ago.

He was the rare patient for whom that treatment wasn’t enough, so he tried for years, without success, to save enough for another. “I was just waiting for God to do his miracles,” he said.

In March, his doctor gave him extraordinary news: the Ghanaian government had donated medicine against hepatitis C. He could be treated for free. Within weeks, Mr. Musah had the pills. In October, a blood test showed that he had finally recovered.

He was broke, exhausted – and ready to dust off his ambitions.

The donation came from a most unlikely source: Egypt, which just a few years ago had the highest burden of hepatitis C in the world. An estimated one in ten people, approximately nine million Egyptians, were chronically infected. In a public health campaign extraordinary in both its scale and success, Egypt screened its entire population, struck a deal for heavily discounted drugs, and cured almost everyone with the virus.

“This is one of the greatest public health achievements ever,” said Dr. John W. Ward, director of the Coalition for Global Hepatitis Elimination at the Task Force for Global Health.

Egypt is on track to be the first country to achieve the World Health Organization’s goal of eradicating hepatitis C, and it is using that victory in a campaign of ‘health diplomacy’, pledging to donate medicines and provide expertise sharing, with the aim of treating a disease. million African patients. It is an unusual gesture in the world of global health, where largesse is typically extended to developing countries from high-income countries.

“The Egyptian government saw an opportunity to expand its expertise beyond its borders and contribute to global health efforts,” said Khaled Ghaffar, Egypt’s Minister of Health and Population. “This health diplomacy allows Egypt to leverage its success in treating hepatitis to the benefit of humanity while strengthening its position within the global community.”

Globally, approximately 58 million people are chronically infected with hepatitis C, according to the WHO, and the vast majority – 50 million – live in low- and middle-income countries. Four out of five people do not know they have the disease. About 300,000 people die every year from complications, mainly cirrhosis and liver cancer.

The virus is usually transmitted through blood; in high-income countries the disease is often spread through unsanitary needles used to inject drugs, while in developing countries transmission often occurs in healthcare settings, either through unsterilized needles and instruments or through cutting by traditional healers . About a third of people clear the infection on their own, but in most people the infection becomes chronic, slowly damaging the liver over time.

Yet few countries include the disease in their public health plans, or implement testing to track the number of people infected. Hepatitis C has not been the focus of major international programs, as HIV and malaria have been, and it has been such a low priority in low-income countries that governments rarely track how many people have the disease, let alone treat it to deal with. Until this year, in Ghana, like other African countries, only a handful of wealthy people had access to hepatitis C treatment, using drugs they bought privately.

Until 2007, the situation in Egypt was the same. A mass vaccination campaign that began in the 1950s and used improperly sterilized needles for 20 years had accidentally spread hepatitis among the population. Few people can afford private treatment. When the government decided to launch its national program, the virus was killing tens of thousands of people every year. Initially, Egypt used two ancient medicines that only cured about half of those treated with them. But in 2013, Gilead Sciences Inc. an antiviral drug on the market – the first cure for a viral infection in the history of medicine.

While the company was asking $1,000 for its once-a-day pill in the United States, Egypt negotiated to buy it for $10 per pill – and then arranged for Indian and Egyptian pharmaceutical companies to make an even cheaper generic version in exchange for royalties. Egypt has treated more than four million people and reduced the prevalence of hepatitis C to just 0.4 percent.

Other companies soon followed with more antiviral drugs; they are highly effective, safe and so far not plagued by the resistance problems that often plague antivirals.

“The news about the medicines was only good; the problem is that countries are not making the medicines available to the people in need,” said Dr. Ward, the coalition director.

Egypt chose Ghana as an early partner because the country is investing in building the national healthcare system. Dr. Yvonne Ayerki Nartey, a doctor at the Cape Coast Teaching Hospital, joined the Coalition for Global Hepatitis Elimination to create a plan for Ghana’s new response. She first had to find out how many Ghanaians were infected and where they were; A national screening found that one in 20 people in the north of the country, an area where poverty rates are higher and health care systems are weaker, had hepatitis C. She went on radio shows and spread the message via Facebook and WhatsApp that the treatment could take place soon. accessible.

Medicines were on their way from Egypt, but the next step was difficult: while in the United States a liver specialist would treat hepatitis, Ghana has fewer than twenty hepatologists. Dr. Nartey organized training for doctors in each district.

“Most have never been treated for hepatitis C because there is no treatment here,” she said.

Most of the new treatment sites were teaching hospitals in regional centers, but she pushed for a pilot project in a rural hospital in a remote region in the north, knowing that if Ghana really wants to eradicate the disease, frontline staff would need to be well prepared. those who carry out the treatment. At the national site, patients were screened, tested and enrolled within a week.

Testing remained a problem: Only private labs offered the viral load tests needed to monitor hepatitis treatment, and they charged several hundred dollars per test. Dr. Nartey has enrolled 340 patients for possible treatment, but only 290 of them have been able to raise the money for the viral load test they need to initiate. The new hepatitis program negotiated a lower rate, promising a steady stream of patients, but at about $80 per test, this remains the program’s biggest challenge.

For patients who not only lived with the financial costs of the disease, but also lived with fear and anxiety as they watched family members die from liver disease, the news of free treatment was almost unbelievable.

Mr. Musah first started feeling sick when he was a high school student living in a small town in the north. The hospital near his home couldn’t explain his back pain and feverish nights, and he tested for everything from a dairy allergy to syphilis to HIV. After hundreds of dollars in tests, he was finally diagnosed with hepatitis – but was told he needed a special hospital to help him. He traveled to Accra, where doctors said there was medicine, but he had to pay for it.

In March, he and other hepatitis patients attended a party at a hotel in the capital, where the Egyptian ambassador opened the free treatment program. But his challenges were not over. He needed expensive viral load tests to confirm the treatment was working; in September he was faced with the choice of using a new student loan he had taken out to pay for tuition for a master’s degree or for the test.

By scaling up the program across Ghana, Dr. Nartey to screen two million people with a cheaper antigen test, which costs about a dollar per patient, and then run the viral load for the 200,000 she says will have the antibodies, confirming an active infection. and end up with 46,000 patients who can be treated using the first tranche of medicines that Egypt has promised. Her prevalence research shows that another 300,000 people need to be treated.

“It’s a lot, but we are ambitious,” she said.

Egypt is working to set up parallel hepatitis C programs in other countries, including Chad and Sudan.

At the same time, Ghana is improving blood safety and injection practices, building on lessons from Egypt, and training traditional healers, reducing the number of new infections, said Dr. Ward.

He hopes that if Ghana succeeds in scaling up its hepatitis program, it will encourage neighboring countries to start their own.

“We need to get countries to realize that the drugs exist and are so effective,” he said. “We should be on the warpath to eradicate hepatitis C because it is so feasible.”

Mr Musah said when he got the news that he was finally virus-free, it was like the beginning of a whole new life: he no longer had to spend much of every day wondering how he could get medicines or tests. pay, or whether he could do so. before the virus killed him.

“Now I am free to plan a future,” he said.