23 - 24 novembre 2022
Rethinking Global Access to Viral Hepatitis Care
- Tousignant Noemi
- Giles-Vernick Tamara
Viral hepatitis has, in the last five to ten years, burst onto the scene of global health advocacy. Striking displays of the high and rising toll of hepatitis virus infections (especially HBV and HCV) – as rivalling and even outstripping the falling numbers of deaths from HIV, tuberculosis or malaria – have proliferated (e.g. Thomas 2019). A loose growing network of actors, in and around the World Health Organisation (WHO), is working to expand access, in low and middle-income countries (LMICs), to antiviral therapies that can cure HCV infection, and prevent chronic HBV from progressing to severe liver disease. A central focus of these efforts is on simplifying and lowering the cost of diagnostic strategies to select and monitor individuals for treatment, alongside the procurement of cheaper generic drugs (e.g. WHO 2015; 2017). Debates have largely centred on questions of affordability, feasibility and cost-efficacy and on the technical rather than political parameters of accessibility.
Anthropologists and other social scientists played a crucial role in illuminating the social and political conditions and consequences of early limits on, and then massive scaling up of, access to HIV therapies in LMICs (e.g. Nguyen 2005;2009;2010, Whyte et al. 2004; 2015, Robins 2004; Desclaux 2004). By contrast, there is very little social scholarship on viral hepatitis, its biomedical framing or the stakes of (unequal) access to preventive, diagnostic and therapeutic management, particularly in the localities, in Asia and Africa, where infection rates and challenges to public health and care are most acute (for notable exceptions, see, e.g.: Giles-Vernick et al. 2016; Chabrol 2018). As the drive to expand access to biomedical care intensifies, there is an urgent need to examine how viral hepatitis is being enacted and imagined within these efforts (e.g. as a deadly condition amenable to technical intervention) and beyond (e.g. as a variably embodied, experienced, explained and historicized source of suffering).
In this workshop, we propose to bring together historians, anthropologists, public health experts and patient advocates to critically examine the content, context and emerging effects of this recent drive to expand access to viral hepatitis therapies, as well as to broaden the terms of debate – beyond the currently dominant technical-economic focus – about the conditions and stakes of viral liver infection and of access to care.
Our aim is fourfold:
1) To examine the political assumptions and ethical values underlying recent viral hepatitis advocacy and technical/policy recommendations, and discuss how these may propel and/or constrain the scope of these efforts;
2) To explore the variable, located histories and bio-eco-social environments of viral hepatitis infections and consider how these may shape both the pragmatic terrain and political implications of access to antiviral therapy in specific locations;
3) To outline future directions for social scholarship on viral hepatitis/liver disease, taking stock of the relevant body of work and identifying key underexamined questions and potential forms of engagement with advocacy, particularly by Community Based Organisations (i.e. patient associations);
4) To debate the relevance of “lessons learned” from HIV, both for the socio-technical organisation of expanded access to viral hepatitis diagnostics and drugs in low-resource settings, and for social scholarship on the conditions and effects of unequal and expanded access to drug-centred biomedical care in global health. As part of this objective, we also consider how the politics of global health (or other models of transnational health) have changed since the early 2000s, and what these imply for the actual and potential role of technology, advocacy and ethnography.
Chabrol, F. (2018). Viral hepatitis and a hospital infrastructure in ruins in Cameroon. Medical anthropology, 37(8), 645-658.
Desclaux, A. (2004). Equity in access to AIDS treatment in Africa: Pitfalls among achievements. Unhealthy Health Policy. A Critical Anthropological Examination, 115-132.
Giles‐Vernick, T., Traoré, A., & Bainilago, L. (2016). Incertitude, hepatitis B, and infant vaccination in west and Central Africa. Medical anthropology quarterly, 30(2), 203-221.
Nguyen, V. K. (2005). Antiretroviral globalism, biopolitics and therapeutic citizenship In: Ong A, Collier SJ, editors. Global Assemblages: Technology, Politics and Ethics. Politics and Ethics. London: Blackwell.
Nguyen, V. K. (2009). Government-by-exception: Enrolment and experimentality in mass HIV treatment programmes in Africa. Social Theory & Health, 7(3), 196-217.
Nguyen, V. K. (2010). The republic of therapy: Triage and sovereignty in West Africa’s time of AIDS. Duke University Press.
Robins, S. (2004). 'Long live Zackie, long live': AIDS activism, science and citizenship after apartheid. Journal of Southern African Studies, 30(3), 651-672.
Thomas, D. L. (2019). Global elimination of chronic hepatitis. New England Journal of Medicine, 380(21), 2041-2050.
Whyte, S. R., Whyte, M. A., Meinert, L., & Kyaddondo, B. (2004). Treating AIDS: Dilemmas of unequal access in Uganda. Sahara-j: Journal of Social Aspects of Hiv/aids, 1(1), 14-26.
Whyte, S. R., et al. (2015). Second chances: surviving AIDS in Uganda. Duke University Press.
World Health Organization. (2015). Guidelines for the prevention care and treatment of persons with chronic hepatitis B infection
World Health Organization. (2017). Global hepatitis report 2017. World Health Organization.