A brief history of hepatitis C: 1989 - 2023

2023

• The first provincial hepatitis C elimination roadmap released in Canada, the Ontario Hepatitis C Elimination Roadmap outlines how Ontario can eliminate hepatitis C by 2030.

2022

• Action Hepatitis Canada released Prison Health Is Public Health, a report and recommendations for federal and provincial/territorial policy-makers about the right to hepatitis C prevention, diagnosis and care in Canada’s correctional settings.
• The Public Health Agency of Canada released National Hepatitis C Estimates: Incidence, prevalence, undiagnosed proportion and treatment, Canada, 2019.
• Wednesday, May 11, 2022, marked the inaugural Canadian Viral Hepatitis Elimination Day. In Ottawa, Action Hepatitis Canada, CanHepC, CanHepB, the Canadian Liver Foundation, and the Canadian Association for the Study of the Liver called for viral hepatitis to be elevated to a national and provincial priority and for concrete action to be taken to eliminate viral hepatitis as a public health threat in Canada by 2030.

2021

• Action Hepatitis Canada, a national coalition of organizations responding to viral hepatitis, launched a progress report on viral hepatitis elimination efforts in Canada.
• The World Health Organization (WHO) released the first guidelines on hepatitis C virus self-testing.
• Maviret (glecaprevir and pibrentasvir) was the first hepatitis C treatment approved by Health Canada for the treatment of chronic hepatitis C in children who are three years or older.

2020

• The novel coronavirus disease (COVID-19) has disrupted the delivery of services globally and has a major impact on hepatitis C elimination efforts. Those working in hepatitis C were required to adapt approaches and explore innovative ways to maintain and sustain services during a time of unprecedented uncertainty.
   
• The 2020 Nobel Prize in Physiology or Medicine is jointly awarded to Dr. Michael Houghton (University of Alberta, Canadian Network on Hepatitis C), Dr. Harvey J. Alter (U.S. National Institutes of Health) and Dr. Charles M. Rice (The Rockefeller University) for their roles in the discovery of the hepatitis C virus.

2019

• CanHepC, a national hepatitis C research network, launches the Blueprint to inform hepatitis C elimination in Canada.
   
• Maviret reaches an agreement with the pan-Canadian Pharmaceutical Alliance (pCPA), the body that represents provinces and territories in drug pricing agreements.
   
• 8^th International Conference on Hepatitis Care in Substance Users conference, hosted by the International Network on Hepatitis in Substance Users (INHSU), takes place in Montreal, Canada.
   
• The Government of Canada launches a Five-Year Action Plan on Sexually Transmitted and Blood-Borne Infections to accelerate efforts to prevent, diagnose and treat STBBI (including viral hepatitis), and address barriers to care, in Canada.
   
• Alberta becomes the second province to publish its cascade of care, revealing that only 3.4 per cent of patients diagnosed with hepatitis C had been cured within two years of being diagnosed. (British Columbia released its cascade of care for hepatitis C in 2016.)
   

2018

• All remaining jurisdictions remove restrictions on access to hepatitis C treatment based on amount of liver injury (fibrosis score).
• Simeprevir (Galexos), Holkira Pak and Technivie discontinued in Canada.
• CanHepC, a national hepatitis C research network, initiates a process to develop recommendations to inform a national action plan on the elimination of hepatitis C in Canada.
• Updated Canadian hepatitis C treatment guidelines released: The management of chronic hepatitis C: 2018 guideline update from the Canadian Association for the Study of the Liver. These guidelines include recommendations to screen people born between 1945-1975 for hepatitis C and risk-based screening. 

2017

• The pan-Canadian Pharmaceutical Alliance (pCPA), the body that represents provinces and territories in drug pricing agreements, negotiates an agreement with several pharmaceutical companies to lower prices for six hepatitis C medications including asunaprevir, daclatasvir, Epclusa, Harvoni, sofosbuvir and Zepatier.
• Alberta, B.C., Nova Scotia, Ontario, Quebec and Saskatchewan change their formularies to increase access to hepatitis C treatments.
• Ontario, Quebec and BC commit to unrestricted hepatitis C treatment access in 2018.
• Peg-interferon no longer available in Canada for treating hepatitis C.
• Health Canada approves the use and sale of a point-of-care hepatitis C antibody test. It is called the OraQuick HCV Rapid Antibody Test.
• Canada’s first recommendations for hepatitis C screening are released by The Canadian Taskforce for Preventative Health Care (CTPHC). The guidelines, which apply to the general adult population, do not recommend population-wide screening for older adults, instead they recommend continuing to screen people at higher risk of infection, such as people with a history of injection drug use.
• The Canadian Liver Foundation (CLF), Action Hepatitis Canada (AHC) and several Canadian liver experts criticise the screening recommendations.
• Maviret (glecaprevir and pibrentasvir) and Vosevi (sofosbuvir, velpatasvir and voxilaprevir) approved by Health Canada.
• Asunaprevir (Sunvepra) discontinued in Canada.
• The second World Hepatitis Summit is convened in São Paulo, Brazil by the World Health Organization (WHO), the World Hepatitis Alliance and the Brazilian government. Eighty-two countries have viral hepatitis elimination plans in place. Canada does not have a national plan.

• Epclusa (velpatasvir and sofosbuvir) and Zepatier (elbasvir and grazoprevir) approved by Health Canada
• Common Drug Review recommends treating everyone for Hep C regardless of level of liver injury, starting with those with the most liver injury
• Quebec adopts a staged approach to treating people with hepatitis C
• Boceprevir discontinued in Canada
• The 69^th World Health Assembly unanimously adopted the Global Health Sector Strategy on Viral Hepatitis, signalling the greatest global commitment on viral hepatitis ever
• Canada’s Minister of Health reaffirms commitment to end hepatitis by 2030
• A cascade of care for hepatitis C is released for British Columbia. This is the first cascade of care for hepatitis C for any Canadian province or territory.

• Sofosbuvir and Harvoni added to many provincial and territorial formularies, providing the first broad access to interferon-free regimens
• New drugs and drug combinations approved by Health Canada included sofosbuvir and simeprevir, daclatasvir, Technivie (a combination of ombitasvir, paritaprevir and ritonavir) and Holkira Pak (the last being added to all provincial and territorial formularies by year end)
• P.E.I announces a five million dollar hepatitis C strategy
• Updated Canadian Hep C treatment guidelines released: An update on the management of chronic hepatitis C: 2015 consensus guidelines from the Canadian Association for the Study of the Liver
• Telaprevir discontinued in Canada
• The first World Hepatitis Summit, is held in Glasgow, Scotland. The summit is convened by the World Health Organization and World Hepatitis Alliance and is hosted by the Scottish Government and supported by Glasgow Caledonian University and Health Protection Scotland.

• Two new powerful Hep C medications, sofosbuvir (Sovaldi) and simeprevir (Galexos) are approved by Health Canada
• Activists at the 49th International Liver Conference call for affordable Hep C treatments
• The CIHR Canadian HIV Trials Network releases Canadian guidelines for management and treatment of HIV/hepatitis C coinfection in adults
• The World Health Organization releases Guidelines for the screening, care and treatment of persons with hepatitis C infection
• National Aboriginal Hepatitis C Awareness Month is launched in May by the Canadian Aboriginal AIDS Network, Pauktuutit  Inuit Women of Canada and Hepatitis Services, BC Centre for Disease Control (BCCDC)
• HepCBC Hepatitis C Education and Prevention Society (HepCBC)  launches the HCV Manifesto
• Harvoni approved by Health Canada
• Hep C service providers in New Brunswick release a plan to address Hep C

• The Sexuality Education Resource Centre (SERC) in Winnipeg, Manitoba releases Living Healthy: What You Need to Know about Hepatitis C in Canada a brochure in six African languages, English and French.
• The Canadian Coalition of Organizations Responding to Hepatitis B and C changes its name to Action Hepatitis Canada.
• The Canadian Liver Foundation releases Liver Disease in Canada: A Crisis in the Making. This report outlines the scope of liver disease in Canada and urges federal, provincial and territorial governments and related health agencies to work together to develop a national liver disease strategy.
• B.C. announces $1.9 million in funding for Hep B and C research and education, awareness-raising and prevention of hepatitis B among immigrant communities.

• PHAC releases the Hepatitis C in Canada: 2005-2010 Surveillance Report. This is the first comprehensive, national report on hepatitis C that summarizes the current data on infection and risk factors in Canada.

• The 1^st Canadian Symposium on Hepatitis C Virus is held in Montreal, Quebec.

• The Canadian Association for the Study of the Liver (CASL) releases An Update on the Management of Chronic Hepatitis C: Consensus Guidelines from the Canadian Association for the Study of the Liver containing information about the clinical management of direct-acting antiviral medications.

• CATIE launches yourlanguage.hepcinfo.ca, with hepatitis C information in Simplified Chinese, Urdu, Punjabi and Tagalog.

• The U.S. Centers for Disease Control and Prevention recommends that all Baby Boomers (people born between 1945 and 1965) get tested for hepatitis C.

• Following many legal battles, the Supreme Court of Canada rules that Insite can continue to operate under a constitutional exception to the Controlled Drugs and Substances Act. Since this ruling, discussions on supervised injection facilities have gained momentum in cities across the country.
• Almost ten years after the last development in hepatitis C treatment, two new medications are approved for genotype 1 hepatitis C.
• The MOHLTC establishes multidisciplinary treatment and support teams throughout the province to expand access to care and improve treatment outcomes.
• Musicians Gregg Allman, Natalie Cole and Jon Secada turn up the volume around hepatitis C at Tune in to Hep C, a US-based public health campaign created to raise awareness about the virus.
• On the occasion of World Hepatitis Day 2011, the Canadian Coalition of Organizations Responding to Hepatitis B and C releases a report card that, using the six Canadian “Asks,” assesses provincial, territorial and federal government responses to hepatitis C.
• The WHO sponsors its first official World Hepatitis Day with the theme, “This is Hepatitis … Know it. Confront it. Hepatitis affects everyone, everywhere.” The WHO supports activities around the world through collaboration with civil society.
• In response to the Resolution on Viral Hepatitis, the WHO establishes a Global Hepatitis Program.
• CASL convenes a 3^rd national consensus conference on the management of viral hepatitis.

• The Vienna Declaration, a statement seeking to improve community health and safety by calling for the incorporation of scientific evidence into illicit drug policies, is launched at the 18^th International AIDS Conference in Vienna, Austria.

• The 63^rd World Health Assembly of the World Health Organization (WHO) passes a viral hepatitis resolution, recognizing, among other points, “the need to reduce incidence to prevent and control viral hepatitis, to increase access to correct diagnosis and to provide appropriate treatment programmes in all regions.”

• The WHO endorses July 28^th as World Hepatitis Day, making it the fourth official global health awareness day, alongside HIV, malaria and tuberculosis.

• The 1^st Canadian HIV/HBV/HCV Co-infection Research Summit is held in Toronto, Ontario. It is organized by the Canadian Treatment Action Council (CTAC) in partnership with many national and community-based organizations.

• The Canadian Society of International Health (CSIH) signs a Contribution Agreement with PHAC to coordinate and implement a Global Hepatitis C Network. CSIH coordinates World Hepatitis Day activities in Canada.
• The Canadian Coalition of Organizations Responding to Hepatitis B and C is formed to unite organizations and individuals to focus increased attention on these epidemics and to coordinate advocacy efforts.
• CATIE receives federal funding to become the national source for hepatitis C information.
• The Canadian government releases the document A Strategic Framework for Action outlining Canada’s future directions, priorities and long term plan to address hepatitis C.
• The 5^th National Aboriginal Hepatitis C Conference, hosted by the Canadian Aboriginal AIDS Network, takes place in Toronto, Ontario.
• The Canadian Liver Foundation and the Canadian Ethnocultural Council release the report Engaging Ethnocultural Communities on Hepatitis C. This report describes how to engage in raising awareness about hepatitis C in ethnocultural communities.

• The World Hepatitis Alliance launches the first World Hepatitis Day on May 19 with a campaign called Am I Number 12? This refers to the statistic that, worldwide, one in every 12 people is living with a form of viral hepatitis. A World Hepatitis Day in Canada planning committee is established under the leadership of CLF. Advocacy and awareness-raising activities are organized across Canada including the development of six Canadian government “Asks”.
• Canada’s federal Minister of Health, Tony Clement, announces the renewal of the Hepatitis C Prevention, Support and Research Program with the commitment of ongoing funding, annually.
• The Hepatitis C Research Initiative, a collaboration between PHAC and the Canadian Institutes of Health Research (CIHR), is announced for a seven year period, ending March 2015.

• The World Hepatitis Alliance is founded.
• The new National Anti-Drug Strategy is the first in many years to explicitly exclude funding for—or even any mention of—harm reduction measures, while adding significant new funding for additional efforts to enforce criminal laws on drugs.
• The Pre-1986/Post-1990 Hepatitis C Class Action Settlement Agreement is approved by the courts. This is a compensation plan for people infected with hepatitis C through the blood system in Canada before 1986 or after 1990.
• Without a commitment of funding for the next year, many hepatitis service organizations close their doors, including the Canadian Hepatitis C Information Centre and the Hepatitis C Society of Canada.
• The 4^th National Aboriginal Hepatitis C Conference, hosted by Akaitcho Territory Government, takes place in Yellowknife, Northwest Territories.
• CASL convenes a 2^nd national consensus conference on the management of viral hepatitis.

• By 2006, prison needle exchange programs have been established or piloted in a number of countries around the world including Switzerland, Germany, Spain, Moldova, the Kyrgyz Republic, Armenia and Iran.

• The Safer Tattooing Practices Initiative evaluation report prepared by CSC concludes, among other things, that “initial results of the initiative indicate potential to reduce harm, reduce exposure to health risk, and enhance the health and safety of staff members, inmates and the general public with higher risk groups.” The initiative is canceled.

• Commissioned by CSC, PHAC prepares a report of scientific and technical advice on the potential benefits and risks of prison needle exchange programs. The report concludes that, in other jurisdictions, these programs significantly reduce disease transmission and there is no evidence that they increase drug use or compromise institutional safety.

• Canada’s hepatitis C community collaborates to publish Responding to the Epidemic: Recommendations for a Canadian Hepatitis C Strategy.
• The 12^th International Symposium on HCV & Related Viruses is held in Montreal, Quebec.
• Correctional Service Canada (CSC) and PHAC collaborate in the development of the ‘Safer Tattooing Practices Initiative’ pilot project, launched in several men’s federal institutions and one women’s institution.
• The 3^rd National Aboriginal Hepatitis C Conference, hosted by All Nations Hope AIDS Network, takes place in Regina, Saskatchewan.

• The 5^th edition of the Canadian AIDS Society’s HIV Transmission: Guidelines for Assessing Risk includes a section on hepatitis C transmission. This addition is “acknowledging the many AIDS Service Organizations and front-line workers who have taken on the role of delivering HCV transmission information in the absence of an official strategy from Health Canada on coping with this second epidemic.”

• Hepatitis C virus transmission in the prison/inmate population is published in the Public Health Agency of Canada's (PHAC) Communicable Disease Report. It highlights a significant disproportionate hepatitis C prevalence rate among people in prison (between 19.2% and 39.8%) compared to the general population in Canada (approximately 0.8%).

• The Ontario Ministry of Health and Long-Term Care (MOHLTC) establishes the Ontario Hepatitis C Secretariat to develop policies and programs that meet the needs of people with hepatitis C in that province.

• The 2^nd Canadian Conference on Hepatitis C is held in Vancouver, British Columbia.

• A provincial committee on hepatitis C, the Comité de travail sur l'état de la situation sur l'hépatite C, is established in Québec.

• Insite, North America’s first supervised injection facility, opens its doors in Vancouver, British Columbia.
• The Canadian Public Health Association announces the establishment of the Canadian Hepatitis C Information Centre. The Centre is to be a multi-service information centre (online, in print and by telephone) that collects and circulates hepatitis C educational materials across the country.
• The Centre Associatif Polyvalent d’Aide Hépatite C is founded in Québec.
• The 2^nd National Aboriginal Hepatitis C Conference, hosted by Chee Mamuk, takes place in Vancouver, British Columbia.
• The Canadian Association for the Study of the Liver (CASL) convenes a national consensus conference on the management of viral hepatitis.

• CATIE-News reports on the possible sexual transmission of hepatitis C among men who have sex with men. This controversial and initially discounted mode of transmission is now well-established.

• Actress Pamela Anderson publicly announces that she has hepatitis C. She speaks openly about living with hepatitis C and kicks off a 2002 Canadian Liver Foundation (CLF) hepatitis campaign.

• The Hepatitis C Council of BC (now the Pacific Hepatitis C Network) is founded in British Columbia.

• The 1^st National Aboriginal Hepatitis C Conference, hosted by NECHI Training, Research and Health Promotions Institute, takes place in Edmonton, Alberta.

• Pegylated interferon is developed for the treatment of hepatitis C.
• The 1^st Canadian Conference on Hepatitis C, organized by the Canadian Hemophilia Society, takes place in Montreal, Québec.

• Health Canada approves the first combination of alpha interferon and ribavirin for the treatment of hepatitis C.
• The Canadian government launches the Hepatitis C Prevention, Support and Research Program as part of its response to the report of the Commission of Inquiry on the Blood System in Canada. Scheduled to finish in 2004, the program will go on to receive three separate one-year extensions before finally wrapping up in 2007.
• The Atlantic Hepatitis C Coalition (now Hepatitis Outreach Society of Nova Scotia) is founded in Nova Scotia.
• The Canadian Harm Reduction Network is formed.
• The first glass stems are distributed as part of safer crack kits.

• The Canadian government agrees to offer financial assistance to Canadians infected with hepatitis C through the blood system between January 1, 1986, and July 1, 1990.

• Health Canada holds a national consensus conference in Ottawa: Hepatitis C – Prevention and Control: a Public Health Consensus.

• The Canadian government establishes the Enhanced Hepatitis Strain Surveillance System (EHSSS), a national initiative to investigate newly identified cases of HCV and acute hepatitis B virus (HBV) from participating sites.

• The final report from the Commission of Inquiry on the Blood System in Canada is published.

• The Egyptian Ministry of Health estimates that 15 to 20 percent of Egyptians are infected with HCV. Similar to the experience of many countries including Italy, the Ministry links the epidemic to a nationwide vaccination campaign, during which needles were re-used. Egypt continues to report the highest hepatitis C rate in the world.

• The Hepatitis C Society of Canada (HeCSC) is founded by Dr. Alan T.R. Powell. The HeCSC is a national voluntary health organization whose mission is to fight hepatitis C through prevention, early detection, treatment and support. Over time, the HeCSC grows to around 40 chapters across Canada, offering support groups, local peer counseling, publications and seminars.

• Commission of Inquiry on the Blood System in Canada (called the Krever Inquiry) begins.

• A more sensitive screening test is developed and used to screen blood donations for hepatitis C, effectively eliminating hepatitis C transmission through the blood supply in Canada. It is estimated that 90,000 to 160,000 Canadians contracted hepatitis C through infected blood or blood products between 1960 and 1992.

• In response to growing concerns about the efficiency, effectiveness and safety of Canada’s blood system, the House of Commons Standing Committee on Health and Welfare, Social Affairs, Seniors and the Status of Women form a subcommittee to report on the subject.

• The first alpha interferon is approved for the treatment for hepatitis C.

• Hepatitis C becomes a notifiable disease in Canada. Non-A, non-B hepatitis is removed from the list of notifiable diseases in 1999.

• A hepatitis C screening test is developed. Blood banks across Canada begin screening blood donations for hepatitis C.

• The hepatitis C virus (HCV) is discovered and is quickly established as the major cause of non-A, non-B hepatitis.