Christopher Shays

Chairman, House Government Reform and Oversight Committee
Statement on Hepatitis C

The silent epidemic can remain silent no longer. Hepatitis C infection has now spread to an estimated four million Americans, more than a million of whom may not yet know they contracted a potentially fatal liver disease. Those people need to be told. They need to be tested. Many will need treatment, and many will need to learn how to prevent further spread of the disease.

The hepatitis C virus (HCV) poses a daunting challenge to public health. Chronic infection can linger without symptoms for more than 20 years, then produce profound health consequences, including liver failure and cancer. There is no preventive vaccine or generally effective treatment. Up to ten thousand will die this year from the disease. That number could triple in the next two decades, according to the National Institutes of Health (NIH). Unless confronted boldly, directly and loudly, the threat posed by hepatitis C will only grow more ominous.

But as we learned when the Human Immunodeficiency Virus (HIV) breached our public health defenses, scientific uncertainty, cultural biases and bureaucratic inertia can silence the early warnings of an elusive viral invader. Since 1989, when the hepatitis C virus (HCV) was first unmasked, federal public health agencies have often pondered, but never implemented, a comprehensive response to this insidious infectious agent. In testimony before this Subcommittee in October 1995, Health and Human Services (HHS) Secretary Donna Shalala committed that hepatitis C would be the top priority for the Department's new blood safety committees. Our 1996 oversight report on the safety of the blood supply called for broad HCV notification and public education efforts. Yet, it was only this January that HHS announced specific plans to

notify those at substantial risk of HCV infection due to exposure through blood and blood products prior to 1990.

Only in 1995 did NIH commit to HCV research on a level commensurate to the threat. Only recently was the Food and Drug Administration directed to give guidance to blood banks, plasma centers and hospitals on tracing HCV-infected donations. Why has the public health response to hepatitis C been so muted? As it lurked in the shadow of the AIDS epidemic, hepatitis C was for too long characterized - or marginalized - as a disease confined to intravenous (IV) drug abusers, still the primary at-risk population.

But now we know too well that this is not just a disease of IV drug users. Anyone who received blood or plasma products before 1990 is at-risk. The disease can be transmitted from mother to child. Hepatitis C can also be contracted through high-risk sexual practices and occupational exposures to infected blood. In about 30 percent of chronic cases, infection cannot be attributed to a known risk factor, suggesting an unknown transmission route. So continued silence only abets the spread and progression of the disease, prevents those at risk from taking prudent precautions, and contributes to

justifiable public unease about a health problem increasingly evident in their midst.

What the public needs to hear are the sounds of their government taking action against hepatitis C: Effective look back and notification. Outreach to affected minority populations. Information for patients. Education for physicians. Research into prevention and treatment. As an oversight Subcommittee long committed to pro-active public health policies, we convene today's hearing seeking an open, constructive discussion of how HHS will take these steps to confront the threat of HCV more aggressively. In that effort, we welcome the testimony of the new Surgeon General, Dr. David Satcher. As head of the Centers for Disease Control and Prevention (CDC), Dr. Satcher appeared before us on a variety of issues. His expertise, experience and candor were of immense value to our work.

We welcome his views today, and look forward to a continuing collaboration on this and other pressing public health matters. Our other witnesses also bring important perspectives to this issue. The Departments of Defense and Veterans Affairs are charged with the care of many who will seek relief from the suffering caused by hepatitis C. Former Surgeon General Dr. C. Everett Koop will offer his characteristically unvarnished views on the problems and promises of our current HCV strategy. Physicians, and a patient, will offer important insights into the human toll of hepatitis C. The voices of all our witnesses today will help break the silence masking the hepatitis C epidemic, and convey vital information the public needs to protect their health. Welcome.