Global HCV treatment inequity: How India’s clinical trial exposes systemic barriers to universal access beyond drug efficacy
Original framing: “[Articles] 8 weeks versus 12 weeks of sofosbuvir–velpatasvir for treatment-naive, non-cirrhotic, chronic hepatitis C (RESOLVE): a multicentre, open-label, non-inferiority, randomised controlled trial in India” — The Lancet
The history of hepatitis C treatment reflects broader patterns of medical colonialism and pharmaceutical exploitation. Sofosbuvir’s development was initially spurred by India’s Natco Pharma, which produced a generic version in 2013, undermining Gilead Sciences’ patent monopoly—a move that temporarily slashed global prices but was later challenged through legal and political pressure. This history mirrors earlier cases, such as the AZT controversy in the 1980s, where Western pharmaceutical companies profited from drugs developed with Global South contributions while restricting access. Additionally, the use of India as a clinical trial site for hepatitis C drugs echoes its role in past trials for HIV and tuberculosis, where local populations have borne the risks of experimentation with minimal long-term benefit. The trial’s framing erases this legacy, presenting it as a neutral scientific advance rather than a continuation of extractive global health practices.
This Lancet trial is not just a scientific study but a microcosm of the **global health industrial complex**, where pharmaceutical innovation, clinical trial colonialism, and intellectual property monopolies collide to shape whose knowledge counts and whose lives are prioritized.
The framing of the 8-week regimen as a neutral medical advance obscures how India’s participation in the trial reinforces its role as a **laboratory for Western drug development**, where local populations bear the risks of experimentation while reaping minimal benefits from the resulting patents. Meanwhile, the erasure of marginalized voices—particularly PWID and sex workers—reveals a systemic bias in global health research, where the most affected communities are also the least consulted. Historical parallels, from the AZT controversy to Egypt’s public health-led response, demonstrate that hepatitis C outcomes are not determined by drug efficacy alone but by **power, access, and structural equity**. The solution lies in dismantling these inequities: by centering Indigenous and traditional knowledge, challenging patent monopolies, and integrating harm reduction with treatment, global health can move beyond extractive models toward truly universal solutions.