Hepatitis C may be the serious disease that most combines widespread prevalence with widespread ignorance. According to the WHO, it kills 350,000 people per year, and 150 million have the chronic form of the hepatitis C virus (HCV). Yet, HCV is entirely preventable and largely curable. 

 Scotland’s Hepatitis C Action Plan is often cited as a leading example of good practice. The active phase of the plan, which ran between 2008 and 2011, made significant progress. Between 2007 and 2010 the number of people tested by the four largest Scottish health boards rose from about 34,000 to around 44,000. Meanwhile, the number of diagnoses rose from just over 1,500 in 2007 to more than 2,100 in 2011. Most important, the number of people being treated more than doubled, exceeding plan targets. The slight drop in 2011-12 seems related to a number of patients waiting for the introduction of protease inhibitor-based treatment, promised by the Scottish health authorities for 2013.

 At the heart of the Scottish plan was a comprehensive and co-ordinated approach. It had integrated initiatives and goals covering awareness-raising, prevention, diagnosis and treatment, as well as co-ordination. Each local health board had, or was affiliated to, a local treatment and care network, as well as a local prevention network. These were, and still are, responsible for the implementation of policies, but they also come together in national networks which share best practice. Professor David Goldberg, chair of the Hepatitis C Action Plan governance board from 2008 to 2011, points out that such an overarching plan involving both prevention and treatment is relatively unusual.

 Professor Goldberg believes that a number of factors came together to allow the plan to be launched, including a growing realisation based on epidemiological data that Scotland faced an above-average problem with HCV, heightened awareness among the public and politicians driven by effective activists, good clinical and public health leadership, and the appearance of cost-effective therapies around the start of the decade.

 The government was interested, but before acting it required a thought-out strategy. This request proved beneficial. Interested parties spent the next year-and-a-half gathering new information and working in various ways on a detailed scheme. These efforts also allowed the development of links with stakeholders, which proved essential to the effective co-ordination of activities later.

 According to Professor Goldberg, the keys to success were proper funding – stakeholders had little time for an earlier, poorly funded HCV strategy – as well as co-ordination. Accordingly, while most of the funding went to prevention and treatment, a sizeable proportion was allocated to co-ordination and further information-gathering to better inform policy. Also very important, says Professor Goldberg, were transparency and accountability. The plan had built in clear goals, which it by and large achieved.

 Much work remains to be done. Health Protection Scotland estimates that approximately half of those with HCV remain undiagnosed. Rather than simply being renewed in 2011, efforts to combat the disease have evolved further. Specific HCV prevention initiatives, including general education and a new peer-to-peer counselling initiative for IDUs, will continue, and Professor Goldberg and his team will continue to monitor the effectiveness of these. Meanwhile, the ongoing national networks for treatment and prevention are developing indicators to measure the quality of HCV care. Perhaps the longest-lasting legacy of the action plan will be that it has helped to make the prevention and treatment of HCV a mainstream healthcare matter.

 This case study appears in The Silent Pandemic, a report from the Economist Intelligence Unit (EIU) and supported by Janssen, which investigates the health challenge posed by hepatitis C and how systemic innovation can minimise its impact. To read the full report, click here.

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the views of The Economist Intelligence Unit Limited (EIU) or any other member of The Economist Group. The Economist Group (including the EIU) cannot accept any responsibility or liability for reliance by any person on this article or any of the information, opinions or conclusions set out in the article.