Taiwan and Egypt show that hepatitis C elimination is achievable when governments connect universal screening, confirmatory testing, affordable antivirals, and local treatment into one continuous pathway.
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Hepatitis C kills about 290,000 people worldwide every year and about 15,000 in the United States, even though a 12-week course of oral pills cures more than 95% of infections. Egypt eliminated the virus in a single national campaign. Georgia and Pakistan have made steady progress. Now Taiwan has joined in.
A new study in Nature Communications reports that a countywide program in central Taiwan lifted hepatitis C screening from 54% to 90%. It also increased the complete treatment rate from 39% to 84%. The progress put the region on track to meet the World Health Organization’s 2030 elimination targets.
If Taiwan and Egypt can do it, why can the United States not do the same?
The book Ending Hepatitis C: A Seven-Step Plan for a Successful Eradication Program argues that elimination is not a scientific problem. It is a political and organizational problem. The United States has the drugs, the diagnostics and an $11.3 billion plan, but still lacks the political will, the unified health system and the affordable access that make elimination real.
What Changhua Did
In 2019, Changhua County in Taiwan launched the Changhua Integrated Program to Stop Hepatitis C Infection, known as CHIPS-C. The program targeted the entire county population of 1.28 million. It paired routine community screening with focused outreach to seven high-risk groups, including people who inject drugs, people on methadone substitution, people living with HIV, people on dialysis, people with chronic kidney disease, people managed under a diabetes shared-care program and people held in correctional facilities. Antibody testing was linked to RNA confirmation on the same blood sample. A positive result did not require a second visit. Treatment with antivirals began on-site as well.
Screening coverage rose substantially. Treatment initiation rose as well. The cure rate reached 99.0%. Models predict that by 2030, Changhua will have dramatically lower rates of liver cancer and death caused by hepatitis C. The Ministry of Health and Welfare has since expanded the model nationally. Expected treatment coverage is above 92% among viremic patients. This means that almost everyone in Changhua with hepatitis C is expected to get the medicine they need to be cured.
The Seven Steps, Applied
The framework in Ending Hepatitis C sets out seven requirements for eliminating an endemic infectious disease. Changhua checked every one.
International resolve came from Taiwan’s alignment with the WHO 2030 targets and from decades of investment in a national viral hepatitis strategy. The scientific means, step two, were already in hand. Political will came from the Ministry of Health and Welfare and from Taiwan’s National Health Insurance decision to reimburse antiviral therapy for hepatitis C. Popular consent was fully built through community-based screening woven into cancer, hypertension and diabetes check-ups that people already trusted.
Step five, an effective healthcare system, was the operational engine. Taiwan’s single-payer National Health Insurance covers 99.9% of residents, which meant the program could layer outreach onto an existing program rather than build a parallel one. Low-cost diagnostics and treatment came from that same reimbursement decision. Step seven, careful follow-through, was seen in multiple ways. Examples of this meticulous execution include: testing done right away, care offered at local clinics and jails, ensuring every person who injects drugs got plenty of clean syringes and keeping the program going during the pandemic with phone appointments and clinic visits.
Why the United States Falls Short
The United States has the same tools. It does not have the same will, nor the same system. Roughly 40% of Americans with hepatitis C don’t know they are infected until liver damage is already advanced. Only about one in three diagnosed patients receives timely treatment. Many insurers also still require proof of sobriety or documented cirrhosis before covering direct-acting antivirals. This locks out the very populations- people who inject drugs, incarcerated people and Medicaid beneficiaries- who carry most of the disease burden.
The National Hepatitis Elimination Program, launched in 2023, proposes to spend $12.3 billion over five years to change that. It uses a subscription, or “Netflix,” model in which states pay a fixed sum for unlimited access to hepatitis C drugs. Egypt eliminated hepatitis C for a cost to the government of roughly $45 per person treated. The United States plan costs more than 10 times that per person and takes 5 times as long. The gap reflects a fragmented insurance system, uneven Medicaid coverage, restrictive prior authorization and the absence of a national setup that connects screening, confirmation and treatment in one visit.
The results from Taiwan show that an effective health system and a modest budget can push hepatitis C to the edge of extinction in five years. It confirms that the seven steps in our roadmap describe not a theory but a working plan. It has already been tested in Egypt, Georgia and Pakistan, and is now being tested in central Taiwan. What is missing in the United States is not the science. It is the decision to build one connected system, pay for it and finish the job.