Striving towards hepatitis C elimination in the era of COVID-19

Open letter

Since 2016, when the World Health Organisation (WHO) set the target to eliminate viral hepatitis as a public health threat by 2030, numerous countries made commitments and developed action plans to attain this goal (1-3). In 2019, the Canadian Network on Hepatitis C released a Blueprint to inform the hepatitis C elimination efforts in Canada (4), with a focus on priority populations who are most at risk from harm due to hepatitis C. These include people who use drugs, Indigenous peoples, people with experience in the prison system, gay, bisexual and other men who have sex with men living with HIV, and immigrants and newcomers from hepatitis C endemic countries. Recent work suggests that Canada could now be on track for hepatitis C elimination by 2030 (5); however, this will require an ongoing focus on increasing hepatitis C prevention, testing, and treatment among priority population groups. The 2020 COVID-19 pandemic has disproportionately affected members of these populations, and has aggravated existing challenges to hepatitis C control (6).

The COVID-19 pandemic has impacted all stages of the hepatitis C cascade of care and has resulted in reduced access to critical medical services (7, 8). While the current public health priority of controlling the transmission of SARS-CoV-2 is necessary, it is crucial to consider the direct and indirect harms felt by affected populations in our communities. Not only does the reduction in care directly hamper progress towards hepatitis C elimination, but the increased isolation experienced by priority populations may exacerbate the already substantial harms they face, including stigma and discrimination, overdose risk, comorbidities, precarious housing, poverty, and domestic violence. The recent increase in overdose-related deaths highlights this reality (9-11). Many people identified as priority populations for hepatitis C in Canada experience inequality at different levels of the public healthcare system. Now more than ever these populations require timely access to critical medical services including harm reduction, hepatitis C care, and COVID-19 surveillance. By providing these services to marginalized populations, we can simultaneously reduce the direct and indirect harms caused by the COVID-19 and the burden of hepatitis C in our communities.

The massive mobilization for COVID-19 testing has shown that population-level screening of priority groups is feasible and has demonstrated the multiple interactions between social justice and health. We can build on the lessons learned through the COVID-19 response to promote a holistic approach to care for people who bear a disproportionate share of the hepatitis C burden in Canada. This approach relies on three pillars: prevention, testing, and treatment. We must continue to improve access to vital harm reduction services such as needle and syringe programs and opioid agonist therapy, to prevent hepatitis C (re)-infection as well as other harms associated with injection drug use. Further, innovative strategies are needed to scale-up HCV testing and treatment in the context of COVID-19. For instance, by mirroring the models implemented to test for SARS-CoV-2, and by co-locating services for hepatitis C and COVID-19 surveillance and care, we have the potential to leverage the infrastructure newly dedicated to COVID-19 to the benefit of those most underserviced in our communities (6).

The WHO’s targets for hepatitis C elimination are ambitious and will require ongoing, concerted efforts by all committed governments to address the intersectional issues faced by priority populations in our community. The COVID-19 pandemic has spurred an increased interest in public health and has demonstrated the immense effects that concentrated and rapid action in the area of infectious disease can have. These lessons can and should be applied in the context of hepatitis C as we continue to strive towards elimination.

On behalf of the 2020-2021 trainees of the Canadian Network on Hepatitis C:
Andreea Adelina Artenie, Evan Cunningham, Simmone D’souza, Zoë Greenwald, Gillian Kolla, Dahn Jeong, Charlotte Lanièce Delaunay, Ching-Hsuan Liu, Gayatri Marathe, Alison Marshall, Sabrina Mazouz, Chisom Okwor, Adam Palayew, Catia Perciani, Marilyn Rheault, Hannah Wallace.

Also published in the Montreal Gazette on July 28, 2020.


  1. Maticic M, Zorman JV, Gregorcic S, Schatz E, Lazarus JV. Changes to the national strategies, plans and guidelines for the treatment of hepatitis C in people who inject drugs between 2013 and 2016: a cross-sectional survey of 34 European countries. Harm Reduction Journal. 2019;16(1):32.
  2. US Department of Health Human Services. National viral hepatitis action Plan: 2017-2020. 2018.
  3. Waked I, Esmat G, Elsharkawy A, El-Serafy M, Abdel-Razek W, Ghalab R, et al. Screening and treatment program to eliminate hepatitis C in Egypt. New England Journal of Medicine. 2020;382(12):1166-74.
  4. Canadian Network on Hepatitis C Blueprint Writing Committee Working Groups. Blueprint to inform hepatitis C elimination efforts in Canada. 2019.
  5. Binka M, Janjua NZ, Grebely J, Estes C, Schanzer D, Kwon JA, et al. Assessment of treatment strategies to achieve hepatitis C elimination in Canada using a validated model. JAMA Network Open. 2020;3(5):e204192-e.
  6. Canada's Source for HIV and Hepatitis C Information, Canadian Network on Hepatitis C. Hepatitis C elimination: Sustaining the Canadian response during and after COVID-19. 2020.
  7. Mignacca FG. Montreal’s CACTUS safe-injection community group sees more overdoses amid pandemic. CBC News. 2020.
  8. Lavoie J. Toronto group calls on government to do more to prevent drug overdose deaths: COVID-19 pandemic has exacerbated the problem, says Toronto Overdose Prevention Society. Torontocom. 2020.
  9. Public Health Agency of Canada. Statement from the Chief Public Health Officer of Canada on COVID-19. 2020.
  10. CBC News. Pandemic worsens Canada’s deadly opioid overdose epidemic. CBC News. 2020.
  11. Johnston J. June was the worst month for overdose deaths in B.C. history. CBC News. 2020.