England set to eliminate hepatitis C
By Josie Calloway ·
They are calling it a triumph—a monumental public health achievement that puts England "on the cusp" of eliminating Hepatitis C.
We Celebrate Progress While Ignoring the Diagnostic Gaps
They are calling it a triumph—a monumental public health achievement that puts England "on the cusp" of eliminating Hepatitis C. Professor Frankie Swords, NHS national medical director, stated in an interview cited by independent.co.uk that we are leading the world toward this goal. And looking at the headlines, you can’t argue with the sheer scale: over 100,000 people diagnosed and treated since 2015. The decline in deaths from the virus is stark, a fall of 36% reported by bbc.com. It reads like a victory lap, doesn't it? A clean, decisive chapter closure for a disease that used to poison our livers and haunt our hospitals.
But I’ve spent my career reading the fine print on public health reports—the stuff they bury in appendices—and this narrative of inevitable triumph feels dangerously close to complacency. We are celebrating treatment coverage hitting 80%—a WHO target, yes—but we are still missing that crucial diagnosis rate, sitting at an estimated 84.6%, short of the 90% mark required by the World Health Organization (WHO). While the press focuses on the curative power of antiviral tablets, they gloss over the infrastructure gaps: who is being missed? Who is too quiet to even walk into a GP’s office and order the free home test kit that independent.co.uk so kindly reminds us about? The system sees success in the numbers it can count, not the people it fails to reach.
Elimination Demands an Infrastructural Siege, Like Polio Eradication
This is not just another medical breakthrough; this is systemic elimination, and it demands a specific kind of sustained effort that goes far beyond simply having a cure available. When we look at global public health history, the only precedent that truly matches this scope—the combination of advanced medicine, massive infrastructure overhaul, and relentless community screening—is the Global effort to eradicate polio.
Polio eradication wasn't achieved by inventing vaccines; it required a multinational commitment to systematic surveillance, reaching every village, every child, regardless of political stability or economic status. It was an infrastructural siege against disease. The mechanism shared between that monumental campaign and what we are doing now is not the cure itself, but the process of finding the last few pockets of infection—the quietest patients who haven't shown up yet.
The data from gov.uk confirms that while incidence rates are projected to meet WHO targets by 2030, the persistent gap in diagnosis coverage is a structural failure waiting for us to get too comfortable with success stories like Paul Eatwell’s. The system must understand: elimination means zero cases, not just low rates.
Vigilance Must Follow Every Single Diagnosis
The true lesson here isn't that we can cure Hepatitis C; it’s how close we came to failing at finding everyone who needs help in the first place. We are told that adults born in certain Eastern European countries, or those who have had tattoos abroad, should be tested. These aren't suggestions; they are targeted calls for vigilance aimed at specific populations whose histories—often involving substandard medical care before 1991—created a vulnerability we must now systematically address.
The progress is undeniable and deserves recognition: the sharp fall in liver transplants related to Hepatitis C, the success of free home testing kits, the sheer volume of people treated since 2015. But I refuse to let this be framed as an end point. It is merely a sustained effort toward one. The system must understand that "elimination" requires the same relentless commitment to surveillance and equity that defined the Global effort to eradicate polio. We cannot allow the sheer magnitude of success in treatment coverage (81.5%, according to gov.uk) to blind us to the diagnostic gaps, the structural inequities, or the marginalized patients who remain invisible until it’s too late.
We must treat this moment not as a celebration of what we have done, but as a mandate for continued, relentless vigilance against every single patient who hasn't yet walked into the clinic door.