Around 70 million people worldwide live with chronic HCV infection today. Without treatment, the blood-borne disease can lead to liver failure, liver cancer and death. It can take years for HCV to progress, and the years are often marked by constant fear of what may come.

Din Savorn is a 50-year-old father of three living in Phnom Penh, Cambodia, who was diagnosed with HCV in 1999. In recent years, he had heard about people being cured with newer treatments but lost hope of being cured himself. “I wanted to get treated, but I couldn’t afford it,” he says. “I would have had to sell my house. Then my children would have no shelter. So, I just waited.”

In early 2017, Din started treatment at a MSF clinic in Phnom Penh, the only facility in Cambodia providing HCV treatment free of charge. In May, he got the news he had waited almost 20 years to hear: his treatment was a success. He was cured.

Din’s treatment consisted of the newer drugs sofosbuvir and daclatasvir. Compared to older treatments, these pill-only direct-acting antivirals (DAAs) are simpler for patients to take and have far fewer side effects. With a 95 per cent cure rate, they are also highly effective. MSF medical teams are showing that simplified approaches to HCV diagnosis and treatment can provide the support patients need to complete treatment successfully, but MSF reaches only a fraction of people in need. Less than five per cent of people worldwide who could benefit from DAAs have received them. The drugs have one serious shortcoming: their price.

Although the estimated manufacturing cost for a 12-week course of sofosbuvir and daclatasvir is less than US$100, the manufacturers Gilead and Bristol-Meyers Squibb priced them at a staggering US$147,000 per treatment when they launched them in the United States. The move drew widespread outrage, but exorbitant prices remain a deadly barrier to treatment in both high-income and developing countries.

Since the launch of the first DAAs, MSF has worked to close the HCV treatment gap with strategies aimed at increasing access to affordable, quality-assured generic versions of the drugs. In a major milestone of 2017, MSF’s supply centres and Access Campaign team negotiated successfully with generics manufacturers to procure DAAs for just $120 per treatment in almost all MSF projects, allowing teams to start more people on treatment.

MSF announced the deal widely to increase transparency and give governments more power to negotiate better prices. Rollout of newer HCV treatments remains slow in most countries, however. The outlook is most worrying in middle- and high-income countries where patent monopolies block the production and importation of generic DAAs and allow pharmaceutical companies to keep prices high for 20 years or more.

Patents are granted according to technical criteria defined in national patent laws. Technologies that do not meet these criteria should not be awarded patent protection, even if they offer significant medical benefits for patients. When unmerited patents stand in the way of affordable access to medicines, MSF challenges them by supporting and filing legal oppositions.

MSF filed two such challenges to HCV treatment patents in 2017, and both are currently under review. The first challenges a patent application in China that would block generics companies from producing and exporting affordable versions of a treatment that combines two crucial DAAs. The second – filed together with a broad coalition of health advocates in the European Union – challenges a patent that could block 38 European countries from producing or importing generic sofosbuvir.

We finally have the tools we need to cure and prevent transmission of HCV, and almost all governments have committed to eliminating the disease as a public health threat by 2030. Making good on that commitment requires bold, decisive action to rapidly expand access to HCV screening and treatment.