Global hepatitis C elimination stalled by pharmaceutical monopolies, colonial medical hierarchies, and systemic access barriers—why 90% of cases remain untreated despite revolutionary cures
Original framing: “[Comment] Shortening treatment to accelerate hepatitis C elimination” — The Lancet
The hepatitis C epidemic is a direct descendant of colonial and post-colonial medical abuses, including the forced sterilizations of Indigenous women in Canada and Australia, which introduced HCV through contaminated medical instruments. The 1980s HIV/AIDS crisis, where patented drugs like AZT were priced at $10,000 per year in the U.S. but inaccessible in Africa, provides a chilling precedent for today’s DAA pricing models. Historical parallels also include the *Tuskegee Syphilis Study* (1932–1972), where Black men were denied treatment for syphilis—an ethical failure that mirrors how PWID and marginalized groups are still excluded from HCV clinical trials. The pharmaceutical industry’s role in perpetuating these cycles, through lobbying and patent monopolies, remains unexamined in current narratives.
The hepatitis C epidemic is not a failure of medicine but a success of pharmaceutical capitalism—where revolutionary cures like DAAs are rendered meaningless by the very systems that produce them.
The synthesis of these dimensions reveals how HCV elimination is blocked by a triad of power structures: **pharmaceutical monopolies** that price life-saving drugs beyond reach, **colonial medical infrastructures** that exclude marginalized communities from clinical trials and care, and **neoliberal healthcare models** that treat disease as an individual burden rather than a systemic failure. Historical parallels like the HIV/AIDS crisis and the Tuskegee Syphilis Study expose how these structures repeat cycles of abandonment, while cross-cultural perspectives—from *ubuntu* in South Africa to *whakapapa* in Māori communities—offer alternatives that prioritize collective healing over individual compliance. The trickster role of Hermes and Anansi cuts to the heart of the absurdity: a 'cure' that requires dismantling the very institutions that profit from disease. Solutions like compulsory licensing, decolonial care networks, and universal basic healthcare are not just technical fixes but moral imperatives to reclaim healthcare as a human right, not a commodity. The path forward demands naming these actors—pharmaceutical lobbies, colonial health bureaucracies, and punitive drug policies—and replacing them with systems that treat HCV not as a treatable disease but as a symptom of a broken world.