Opinion: England and other nations are on the path toward eliminating hepatitis C. Why not the U.S.?

Oct. 8, 2026 Chan is the chief medical officer at the Rhode Island Public Health Institute and a consultant medical director with the Rhode Island Department of Health. Epstein is a gastroenterologist specializing in hepatology at the Rhode Island Public Health Institute’s Open Door Health clinic. Nunn is the chief executive officer of the Rhode Island Public Health Institute. In September, “Baywatch” star Pamela Anderson opened up about her hepatitis C diagnosis in the 1990s. “It was a death sentence,” she said while accepting the Award of Courage from amfAR, an organization supporting HIV/AIDS research and advocacy. When she was diagnosed, she said, her doctor told her that she might only live another 10 years. Her story is a good reminder of the amount of global progress that has been made in preventing and treating hepatitis C in just the last decade — and how far the U.S. has to go to catch up to our European neighbors. Hepatitis C is a serious, bloodborne infectious disease that primarily impacts the liver. While some people can clear the infection on their own, the majority are at major risk of developing chronic, potentially fatal conditions like cirrhosis and end-stage liver disease. Hepatitis C infections are among the most common causes of medically necessary liver transplantations, second only to alcohol-associated liver disease. When Anderson was first diagnosed in the late 1990s, the hepatitis C virus was still relatively novel. It had only been officially discovered in 1989, and there were few if any effective treatments available. One could argue she was lucky to have even been diagnosed. Since hepatitis C symptoms can often be delayed or “silent,” many patients — both then and today — go undiagnosed until more serious conditions present more obvious symptoms. Fortunately for Anderson and countless others, the landscape around hepatitis C quickly evolved. One of the more significant medical breakthroughs of the 2000s was the development and regulatory approval of hepatitis C medications that have minimal side effects and cure more than 95% of people with chronic disease in just eight to 12 weeks. It’s not an exaggeration to say these once-a-day pills have saved thousands of lives and created a realistic path toward eradicating hepatitis C on a global scale. Many countries around the world — notably, England, Egypt, and Norway — have made great strides down that path in recent years. Each country has taken its own public health approach to this issue, but the common thread among successful national campaigns has been a dual focus on ramping up routine testing, particularly among high-risk populations, and increasing access to affordable — or, in many cases, free — medication. England, for example, launched a robust approach to hepatitis C testing, which included implementing “opt-out” testing policies for HIV, hepatitis B, and hepatitis C in emergency departments; rolling out mobile testing vans and care teams to traditionally underserved communities; and offering free at-home testing kits to anyone who requested one. For folks who test positive for the virus, medication is quickly prescribed free of charge through the National Health Service. The strategy is paying off. England, which aims to eliminate the virus by 2030, has already met its goal of treating 80% of its hepatitis C infections. Deaths from the virus have decreased by 36% in the past decade. Among England’s population of people who inject drugs, just 5.2% had the infection in 2024, compared with 28.6% in 2015. Here in the United States, while we are seeing some effective plans deployed at the state level, progress nationally is stalling. Despite having access to the same highly effective medications, the number of new hepatitis C infections reported across the country steadily increased from 2013-2021 and remained stagnant between 2021-2023. Nearly 70,000 new cases were reported in 2023, which was double the annual target set by the Centers for Disease Control and Prevention. Like many issues in public health, cost and red tape within the health care system are factors in our nation’s lack of progress. Hepatitis C medications have historically been expensive, and even though they’re covered through Medicaid and most commercial insurers, only around 50% of Americans with chronic hepatitis C are medicated. People may go untreated because they were simply never prescribed medication. Others may not have access to a primary care doctor due to widespread shortages, or they may find themselves overwhelmed by administrative hurdles, including referrals, prior authorizations, insurance requirements, and follow-up appointments in multiple care settings. The U.S. also has an issue with stigma. Due in large part to the opioid epidemic, injection drug use is now the primary risk factor for new hepatitis C infections in the United States. Yet people who use drugs continue to face significant stigma in our health care system and in the broader public policy debate. Resistance to proven harm reduction strategies can make it harder to reach people with testing, sterile supplies, and other preventive services. Plus, fear of judgment can discourage people from seeking care in the first place. These gaps in our system are leaving people behind and costing our health system billions of dollars. According to the CDC, by avoiding the exorbitant cost of organ transplants and treatment of chronic disease later in life, curative treatment for hepatitis C can save nearly $70,000 in lifetime medical costs per person. Unlike when Pamela Anderson first received her diagnosis, the U.S. today has the tools to cure hepatitis C for good. Other countries around the world are showing this once-ambitious public health goal is very much achievable. If we find the political will to make necessary changes, we can be next. Philip A. Chan, M.D., is the chief medical officer at the Rhode Island Public Health Institute and a consultant medical director with the Rhode Island Department of Health. Alan Epstein, M.D., is a gastroenterologist specializing in hepatology at the Rhode Island Public Health Institute’s Open Door Health clinic in Providence. Amy Nunn, Sc.D., is the chief executive officer of the Rhode Island Public Health Institute.