Proposition 53K0260

Proposition de résolution relative à la lutte contre l'hépatite C.

General information ¶

Authors

CD&V Nahima Lanjri, Nathalie Muylle, Inge Vervotte

Submission date

Oct. 4, 2010

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

health policy resolution of parliament indemnification public health illness

Voting ¶

Voted to adopt

Groen CD&V Vooruit Ecolo LE PS | SP Open Vld MR

Abstained from voting

∉ N-VA LDD VB

Party dissidents ¶

• Peter Luykx (CD&V) abstained from voting.

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Discussion ¶

May 3, 2012 | Plenary session (Chamber of representatives)

Full source

I refer to the written report.

Of course, I can only be pleased. The Public Health Commission has been able to work with good intelligence and has thus managed to reach a consensus around the fight against hepatitis C. This consensus, through the filing of a comprehensive amendment, has the great merit of updating requests initially dispatched in three resolution proposals.

If parliamentary work, disease by disease, must in no way become the rule at the risk of injuring certain patients suffering from a condition that is not the subject of such an initiative, we must hope that the cost of the projector that we give today to the fight against hepatitis C will above all prevent new contaminations, because what holds my attention above all is the avoidable side of this condition.

We must therefore insist on awareness-raising, prevention with regard to the medical body, but also with regard to the groups of patients at risk and this, in perfect collaboration with the federal entities, who have their word to say and who will be able to say it in the framework of the interministerial conference – I want to reassure everyone.

It is also the support of patients in improving accessibility to treatments with regard to the use of Fibroscan in particular, as well as accessibility to new molecules and combined therapies. Accessibility was the main word of our work.

Let us bet that thanks to this text and the government’s follow-up, patients with this condition will see in the coming weeks, in the coming months, their treatment opportunities expanded, the quality of care improved and their hopes for healing, consequently, increased.

Knowing the Ministry of Health’s commitment to people suffering from chronic illnesses, I have confidence in the future.

Finally, I would like to conclude, Mr. Speaker. I want to repeat it because it is primary: let us hope that thanks to this text, more screening will be done, more contaminations will be avoided and that the fight against this disease will gain in visibility and, consequently, in effectiveness.

President: André Flahaut, President

President: André Flahaut, President

Mr. Speaker, it is important to approve this proposal for a resolution today, given the risks of hepatitis C to public health. The danger lies mainly in the fact that many people do not know that they are infected with hepatitis C. The symptoms persist for many years, causing liver cirrhosis or even liver cancer to manifest only after ten to thirty years.

The introduction of the text is for Open Vld is the detection: we need to make a diagnosis faster. Therefore, we also need to inform and raise awareness of doctors. In particular, we should also screen risk groups and provide refund for the less invasive fybroscan. It is important to diagnose earlier, because early treatment can prevent the development of liver cirrhosis.

Another important thing for Open Vld is reimbursement of treatment in young people. Therefore, the Communities and the federal government must cooperate constructively, in the interests of the patients.

Hepatitis C is often called the silent epidemic: about 100 000 Belgians are, often without knowing it, carriers of the hepatitis C virus. Symptoms only appear after 10 to 20 years. Moreover, half of the carriers of the virus do not know that they are infected. It is a very contagious disease, against which there is no vaccine today. Infection occurs through contact with the blood.

It is high time to intervene politically, as the infection can lead to cirrhosis, bleeding, liver failure and liver transplant in the long run. Up to 76% of all cases of primary liver cancer are due to infection with the hepatitis C virus. Persons with an increased risk of infection include drug users or former drug users through the exchange of infected needles, persons who received blood products in the early 1990s or earlier, or persons who today receive blood in non-Western countries, first-generation migrants, persons who have undergone a tattoo, piercing or circumcision, as well as persons who come into contact with blood by their profession, for example after a sting incident such as nurses and doctors.

Other people can also unwittingly become victims of an infection. This can be done at home through the common use of nail cuts and toothbrushes.

With the joint draft resolution, we want the government to work on, first, the preparation of a national action plan in which all levels of competence take responsibility and conclude a cooperation protocol. For the sake of clarity, we know that the Communities are competent in this regard. We therefore call on them to take their responsibilities and work together with the federal level.

Secondly, we want the government to work with awareness and active screening of the risk groups, so that the correct diagnosis is made at an early stage. This, on the one hand, will help in combating a number of infections. On the other hand, the patient can be treated earlier, which makes the chances of recovery much greater. If not treated in time, the disease can indeed lead to chronic liver cirrhosis or liver cancer.

The high cost of the treatments, which can sometimes take months, ranges from 12 000 to 22 000 euros. We ask the RIZIV to extend the refunds or fees on the various domains to those target groups as well. Our resolution calls for special attention to the forgotten target group of children and adolescents, for the reimbursement of a vaccine against hepatitis A and B, for chronic patients with hepatitis C and for the reimbursement of the use of the fibroscan as a diagnostic and follow-up tool.

Finally, it also calls for the continued stimulation of research and development of a vaccine and of new medicines. In this regard, we congratulate the fact that the Artsenkrant announced two weeks ago that the pharmaceutical companies Janssen Pharmaceutica and MSD Belgium have jointly won the Galen Prize 2011 with a new drug for hepatitis C.

Mrs. Minister, with the draft resolution, which we have jointly approved, we ask you as competent minister and the RIZIV to develop the initiatives that will finally put an end to this silent epidemic.

Finally, I would like to thank my colleagues for the good cooperation, as well as, of course, our employees, who have incurred a lot of preparatory work here. I thank you.

Mr. Speaker, colleagues, in itself we can agree that a number of actions should be taken in the field of hepatitis C to reduce the number of infections on the one hand and to provide the best possible treatment for patients on the other.

With regard to the latter, we can agree to the proposal to reimburse the fibroscan for all possible patients, since in all the scientific literature we have tried to read it states that it is a valid alternative to the biopsy, which is still a very heavy procedure for the patients.

With regard to the question of reimbursement of the medicines in question also for young people under the age of 18, we have some reservations. After all, these drugs have a lot of undesirable side effects, which are not negligible in young patients. Sometimes there are psychological disorders, but also growth delays. I think we should take this into account. Apparently, however, these drugs have the best effect when they are applied at a young age and as soon as possible in the treatment. Therefore, we can also participate in this.

But – and now we come to the bottom of the matter – it does not seem appropriate to me that the federal government, even in close cooperation with the Communities, should set up a national action plan which is primarily focused on prevention, awareness raising and other powers which are primarily community powers. This is why we abstained from this proposal. We can agree with the idea of the resolution, but not with this national action plan. We will remember today.

Mrs Sminate, I will not repeat what we have said in the committee. We have said very clearly that each is on its own competence and that the sensitization of doctors is a competence that belongs to the federal government.

Under no circumstances we advocate for exceeding the powers. Each in its competence. This is literally stated in the resolution. Maybe you can approve them.

Mrs. Lanjri, if the awareness of doctors would be a common competence, why can you not agree to our amendment? In this we ask that this be scheduled by the federal government at the Interministerial Conference, so that those powers can then be succeeded by the Communities? That would have been a perfect solution to this problem.

This is also a point already included in the resolution. Scheduling, consulting, scheduling at the Interministerial Conference, meeting and concluding a protocol agreement, that’s all in the resolution, so I don’t understand it.

You want to make this file a symbol file, while it really isn’t necessary. You could perfectly approve this proposal, with the preservation and respect for everyone’s powers.

You say that you do not start the debate again, but you do it again. Mr. Calvo, you are in the wrong position to comment, since you are accustomed to this type of behavior.

Mr. Speaker, Mrs. Lanjri, I would like to add to this very briefly the following. It is very clear in the resolution that you place the powers and responsibilities of those powers which belong to the Communities at the federal level. That is our problem.

Mr. Speaker, I am ⁇ pleased that a broad consensus has been reached in favour of this proposal, even though some still feel certain states of mind; I will return to it. Overall, we take on an extremely heavy problem to bear for victims of this disease, hepatitis C, and finding a broad agreement within our parliament to improve their living conditions is ⁇ happy.

In fact, hepatitis C poses a serious threat not only to those who are affected, but to the whole community. We know that about 100,000 people in our country suffer from this disease, or a prevalence rate of 1% of the population. Thus, statistically, there is more than one person with the hepatitis C virus in the hemisphere. This is important to know: many people do not know they are carriers of the virus and can transmit it. That is why providing them with the best possible treatment as early as possible is a major public health challenge.

This resolution provides for a few guidelines.

First, the development of a so-called national or federal action plan. This seems to me quite ridiculous in relation to the issue. Currently, patients with hepatitis C must undergo a biopsy to prove a diagnosis of hepatic steatosis and receive access to the most useful drugs. I’m sorry to say it plainly, but they don’t care if it’s a national, more or less regional, or more or less community action plan! The truth is not there: it is in the suffering of those sick who wait for the Public Health of their country to take care of this pathology and improve the conditions of treatment and access to treatment.

Other guidelines include the inclusion of the problem of hepatitis C on the agenda of an interministerial conference to establish a protocol of understanding; taking care of people with hepatitis C by allowing them to be vaccinated against the hepatitis A and B viruses – in fact, we know that the cumulative of liver infections greatly increases the mortality rate of people already with hepatitis C –; study the possibilities of concluding INAMI conventions; finally, review the conditions of reimbursement for treatment.

I would like to address three aspects in particular. First, much easier access to fibroscan, a technique that allows to diagnose but also to quantify non-invasively hepatic fibrosis. Currently, we are going through biopsy, which some hepatologists advise not to practice anymore. For the patient, it is much more difficult to undergo a biopsy than a fibroscan. The fact that fibroscan allows access to treatment reimbursement conditions represents a significant progress. This implies less suffering for the patient and results in fewer side effects.

Secondly, treatment for hepatitis C is currently reimbursed only when transaminases are very high, when tests are peyorative. For our part, we wish that treatment can be started as soon as possible when patients have normal transaminases and that it is not expected that the disease has reached an advanced stage to have access to treatment refund. This situation is, in my opinion, unacceptable.

Third, special attention should be paid to children. Currently, treatment is only reimbursed for adults. Hepatitis C also affects children. Therefore, accessibility to treatment must be provided for them.

This resolution also calls on the government to give rapid access to new molecules and to support the development of combined therapies. New molecules have just arrived on the market: specific protease inhibitors, Boceprevir and Telaprevir. These molecules have proven themselves in the treatment of the hepatitis C virus. They can eliminate a greater number of these diseases. Too often, Belgium has been lagging behind other European countries, including France, in terms of access to treatment. Patients and specialists are very hopeful that our country will not be delayed in terms of authorizations for reimbursement of the latest molecules. Any delay leads inevitably to a loss of luck for the affected patients.

Furthermore, new molecules now promise more effective quadriterapies that can, in many cases, shorten the duration of treatment by making it from twelve to six months. This is a progress that must be within the reach of the patients concerned.

Finally, the resolution calls for incentives for research, the development of new treatments and vaccine therapy.

Although there is a vaccine against the forms A and B of the disease, there is currently no vaccine for type C.

Finally, Mr. Speaker, Mrs. Minister, I look forward to the support you would like to give to this resolution. It is a form of recognition for people who suffer from this disease as well as for the associations that take care of these patients and who have been fighting for many years to improve the conditions of treatment. I am aware that there is still much progress to be made, that we are laying the foundations for a true plan of action against this disease. This is an important signal. Public authorities and our healthcare system must mobilize against this evil. I welcome this parliamentary awareness.

I also see, through the adoption of this resolution, the hope of seeing a bill that I have submitted and which aims to compensate victims of hepatitis C following a blood transfusion soon be addressed by Parliament. People who were affected by the AIDS virus under such circumstances could benefit from compensation. And we cannot find any justification, from the point of view of ethics or public health, to make a distinction between patients with a virus X and those with a virus Y by the same mode of contamination – in this case, blood transfusion. It is important to grant the same rights to victims of hepatitis C following a transfusion. The issue of compensation will therefore need to be discussed again in this Parliament in order to make further progress, which is expected not only by patients, but also by all those who take care of them.

I thank you for your attention.

Mr. Speaker, it is positive that the majority shows so much concern for patients suffering from hepatitis C. It is a serious illness. The likelihood of cure is quite high if the disease is diagnosed in time, but if the disease is not treated, it can develop into a serious chronic condition.

Proper prevention, good screening policies and effective treatment of the infection are essential and in many cases even vital.

Our group is therefore pleased that a balanced resolution has been achieved through good cooperation between the various majority parties. Even more important, of course, is that the resolution is adopted today.

Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker. This is obviously a progress for all patients with the hepatitis C virus. I hope that you will quickly implement these different measures.

This is an important public health issue, due to the number of patients affected, but also because one in two patients ignore their disease and is therefore unfortunately likely to transmit this virus to other people.

It was important to operate a comprehensive approach from prevention, screening, care, without forgetting future research for the development of new molecules and possible new approaches on the diagnostic level. It is therefore important to extend the conditions of reimbursement of hepatitis C treatment, including when the diagnosis is made, not only by liver biopsy but also by using Fibroscan for both adults and children, who may not be frequently affected but on whom the effects of the disease are ⁇ significant.

This is a first advance. Of course, it is important, but we have always wanted to go further. Ten years ago, my colleague, Georges Dallemagne, a pioneer in this field, wanted to advance in compensation for people who, unfortunately, are infected with the hepatitis C virus as a result of a blood transfusion or blood products.

I hope – and I call on all my colleagues – that we will soon, within this Parliament, have a constructive work on these bills regarding the compensation of these patients.

Mr. Speaker, our group will vote in favour of this text because it improves access to care as well as patient comfort. We are sensitive to these aspects.

On behalf of my group, I would like to express my regret that I was not associated with this resolution. When it is said that it has obtained a broad consensus, it is a consensus limited to the majority, which was the only one admitted to participate in the drafting of the text. I have had the opportunity to say this in the committee.

As Mrs. Lambert said, I also wonder if a disease-by-disease plan should be made: a hepatitis A plan, a hepatitis B plan, a hepatitis C plan. We are at the limit of logic. Furthermore, this text does not refer to the very good KCE report, which dates from 2011, on the prevention and screening of hepatitis C and which offers recommendations for research and testing for detecting the virus. I regret not having drawn elements into this report, which could have enriched the resolution.

In addition, you can read a bit everywhere that hepatitis C treatments have extremely severe side effects: 80% of the patients treated suffer from anemia, which therefore needs to be treated afterwards. I therefore insist on the need to remain vigilant in this regard as well.

Overall, we are in favour of this text. If there is a follow-up in terms of compensation, we ask to be associated with the bill.

Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker! Finally, the future of patients with hepatitis C seems less dark. And finally ! Because this disease affects about 1% of the population in Belgium, 3% in the world. We are finally giving ourselves the means to fight this pathology.

For about ten years, a number of bills and resolutions have been debated in the House and the Senate. It would take at least a decade to reach a consensus.

Therefore, I can’t help but wonder whether the political interest has not, during all these years, simply served the cause, since politicians often try to get cover on them in the framework of an initiative. In the present case, this concerns the refund conditions, or even the extension of them, for patients with hepatitis C. What a waste of time and energy for so many years to come to an obvious! It was necessary to recognize the pathology and help the sick with all the means at our disposal, knowing that they would become more and more performing over time.

Also, why not have allowed interventions or reimbursement of treatment earlier? Where some now scream victory, I would rather be tempted to say that it is not too early! And when is a full reimbursement of the costs related to this serious pathology ranging from the free of charge of preventive medicine to also, for example, through vaccination and any other parallel preventive measure?

In any case, we gave birth to a consensus, which makes it possible to advance the matter in the interest of the citizens, but you will not bother me – I refer to what Ms. Snoy has just said too – I allow myself not to appreciate the method used!

Indeed, I was personally associated with the drafting of a bill and a resolution and we were not even consulted as part of the completion of this project, set up by the government probably to draw some glory from it. But it is inconceivable and very unpleasant to have to find that where some work, they are not thanked for what they have done or what they have participated in.

In the committee, we were told not to worry, that we could always join in counter-signing this draft resolution. Ultimately, the information I received in the committee was completely false because once the vote took place, it was no longer possible to act like this!

The situation is obviously regrettable. Nevertheless, we must remain positive. I therefore confirm that the FDF will support this resolution because it largely corresponds to what the Association of Patients and all people with this pathology have requested.

However, as I pointed out in the committee, unfortunately I did not get answers to all my questions. We are talking about active participation. What exactly does this consist of?

I have also pointed out, and I maintain, that a screening campaign should not only be free, but it should be done anonymously. If we refer to AIDS screening campaigns, we know that some patients may be afraid to participate in them. It is a certain advantage to be able to participate under the coverage of anonymity.

I also ask not to abandon the formula of compensation for victims of hepatitis C. by Mr. Bacquelaine touched a word. At the moment, things are not yet clear enough in this regard. I say this because we have found that for other serious diseases, for which we have requested compensation from patients, we have not always obtained it for budgetary reasons. Therefore, it is necessary to remain extremely attentive in this matter.

The implementation of the amended draft resolution is therefore fundamental. It will also, unfortunately, depend on the cost of the measures as proposed, in particular with regard to extended refunds, prevention campaigns and new campaigns. This must be taken into account. I also imagine that there will be, in the event of budget changes, a specific point that will attempt to carry out this resolution.

In conclusion, despite the method used, despite the few points I have just cited, I confirm that the FDF will support the resolution proposal even though we may feel hurt about the way things went.

Mr. Speaker, I just want to thank Parliament for the extraordinary work done on hepatitis.

It is appropriate, I think, to go beyond the stories of denomination, such as "national action plan", among others. It is necessary to adopt a coordinated strategy. On this point, we all agree. Moreover, I do not like this notion of a national action plan: we could adopt one for each disease, while defining coordinated strategies, in case of absolute necessity as for hepatitis, seems to me more sensible.

In this context, I took note of all the proposals and what came to consensus. I am already working on monitoring the action of parliamentarians, whether it is on the agenda of the next inter-ministerial conference, taking care of vaccination against the hepatitis A and B virus, studying a system of convention with INAMI for taking care, extending reimbursement conditions, supporting combined therapies, quick access to new molecules, supporting research and development of new treatments and a vaccine.

We will work closely with patient associations and I will have the heart to keep Parliament informed of the progress of our work.

Thank you very much to Parliament for this remarkable work!