Hepatitis C is a bloodborne infectious disease that primarily damages the liver and can progress to chronic liver disease, cirrhosis, and end-stage liver failure. The virus has been known since 1989, and until relatively recently effective, well-tolerated cures were not available. Public figures such as Pamela Anderson have emphasized how the diagnosis once felt like a "death sentence," underscoring how dramatically the clinical landscape has changed.
Since the 2000s, potent direct-acting antiviral regimens have transformed hepatitis C care. These once-daily oral medications cure more than 95% of people with chronic infection, typically in 8–12 weeks, with minimal side effects. Those drugs created a realistic pathway toward eliminating hepatitis C as a public health problem, provided health systems can identify infections and deliver treatment at scale.
Hepatitis C remains one of the leading causes of medically necessary liver transplantation, second only to alcohol-associated liver disease. Many infections remain undiagnosed because symptoms can be delayed or silent, so patients often present only when they develop advanced liver disease.
The development and regulatory approval of curative hepatitis C medications in the 2000s and later represent a major medical breakthrough. These treatments are short in duration, highly effective, and have limited adverse effects, enabling individual cure and population-level strategies aimed at eradication.
Several countries have implemented coordinated national campaigns that combine broad testing initiatives with guaranteed access to treatment. The common features among successful programs include expanded routine testing — often targeted to high-risk groups and delivered through opt-out policies or mobile/community-based testing — and provision of affordable or free medication for those who test positive.
Examples cited include England, Egypt, and Norway, each of which tailored public-health approaches to their contexts but shared the dual focus on testing and accessible treatment.
England implemented a multifaceted approach: opt-out testing policies for HIV, hepatitis B, and hepatitis C in emergency departments; mobile testing vans and outreach care teams to underserved communities; and free at-home testing kits available on request. Treatment for those who test positive is prescribed quickly and provided at no cost through the National Health Service.
The results have been substantial. England set a goal of eliminating hepatitis C by 2030, has already met its target of treating 80% of identified infections, and has seen hepatitis C–related deaths fall by 36% over the past decade. Among people who inject drugs, infection prevalence fell from 28.6% in 2015 to 5.2% in 2024, illustrating meaningful declines in a high-risk population.
The U.S. has access to the same curative medications but is not achieving comparable population-level progress. Nationally, reported new hepatitis C infections rose from 2013 to 2021 and were roughly stagnant between 2021 and 2023. Nearly 70,000 new cases were reported in 2023, roughly double the annual target the Centers for Disease Control and Prevention had set.
Despite the availability of effective therapy, only about 50% of Americans with chronic hepatitis C receive medication, leaving a large reservoir of untreated infection and ongoing potential for transmission and disease progression.
Several system-level factors limit uptake of curative therapy in the United States. Hepatitis C medications have historically been expensive, and although they are generally covered by Medicaid and most commercial insurers, administrative obstacles remain. Common barriers include requirements for referrals, prior authorizations, insurance constraints, and the need for multiple follow-up appointments across care settings.
Workforce shortages — including limited access to primary care clinicians — further reduce opportunities to diagnose and treat patients. Some people who could benefit from treatment are simply never prescribed medication because they lack a medical home or encounter fragmented care pathways.
The epidemiology of hepatitis C in the U.S. has shifted, with injection drug use now the primary risk factor for new infections. Stigma toward people who use drugs persists in health care and public policy, complicating efforts to reach high-risk populations.
Resistance to proven harm-reduction measures — such as syringe services and low-threshold testing and treatment in community settings — reduces access to testing, sterile supplies, and preventive services. Fear of judgment also discourages some people from seeking care, further widening gaps in diagnosis and treatment.
Delaying or failing to provide curative therapy has substantial economic consequences. The Centers for Disease Control and Prevention estimates that curative treatment can prevent costly downstream outcomes — including organ transplantation and prolonged care for chronic liver disease — and can save nearly $70,000 in lifetime medical costs per treated person.
Addressing hepatitis C through broad testing and prompt treatment is not only a clinical imperative but also a cost-saving public-health investment when compared with long-term care for advanced liver disease.
Other nations demonstrate that elimination is achievable when public-health systems combine routine and outreach testing with guaranteed, low- or no-cost access to treatment. Key components that could be emphasized in U.S. efforts include:
The article notes that some U.S. states have deployed effective plans at the state level, indicating that scalable models already exist domestically. What is lacking, according to the authors, is coordinated national political will to implement the changes needed to match the progress seen elsewhere.
The United States has the medical tools to cure hepatitis C and the economic rationale to treat people early, yet progress lags behind countries that have prioritized testing and universal access to treatment. Eliminating hepatitis C will require system-level reforms to remove cost and administrative obstacles, concerted outreach to marginalized and high-risk populations, and a reduction in stigma that impedes prevention and care. With sustained political commitment and adoption of evidence-based strategies, the U.S. can follow the examples set by England, Egypt, and Norway and move toward elimination.