108th Congress

“Stalking a Furtive Killer: A Review of the Federal Government's Efforts to Combat Hepatitis C” – Hearing before the House Government Reform Committee, Representative Tom Davis [R-VA], Chairman

December 14, 2004

Witnesses:

• Dr. Jay Hoofnagle, Director, Liver Disease Research Branch, Division of Digestive Disease and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases

Other Witnesses:

• Dr. Rima Khabbaz, CDC
• Dr. Lawrence Deyton, Department of Veterans Affairs
• Dr. Michael Rudman, Frederick County Hepatitis Clinic, Inc
• Ms. Ann Jesse, Hep C Connection
• Mr. John Niemiec, Fairfax County Professional Firefighters and Paramedics
• Ms. Erika Stein, Robinson Secondary School

Chairman Tom Davis (R-VA) stated that the purpose of the hearing was to examine the progress that has been made in responding to the hepatitis C epidemic and to identify the areas for improvement since the last hearing that was held by this Committee in 1998. Representative Eleanor Holmes Norton (D-DC) admitted that she knew nothing about this epidemic and appreciated the Chairman having this hearing to call attention to this important matter. Representative Henry Waxman (D-CA) said that there was a public health problem and we need to ask "What went wrong?" He mentioned that an NIH Consensus Panel on Hepatitis C (HCV) recommended needle exchange for intravenous drug users (IDUs), but the political ideology gets in the way of sound policy being put in place. Representative Edolphus Towns (D-NY) discussed a bill that he sponsored, H.R. 3539, the Hepatitis C Epidemic Control and Prevention Act, stating that the legislation, if passed, would represent the first Federal effort to provide a strategic approach to combat this disease by requiring the development and implementation of a plan for public education, testing, and counseling efforts.

Dr. Hoofnagle discussed how HCV is now the most common cause of chronic liver disease in the United States, the most common cause of liver cirrhosis, the most common indication for liver transplantation, and now the most common cause of liver cancer. HCV is the most critical area of all liver disease research. He then discussed how research at the NIH is focused on diagnosis, better treatment and prevention. In terms of prevention, he said, there is hope that one day there will be an HCV vaccine. He explained that the delay in developing a vaccine has to do with the fact that antibodies to HCV fail to prevent re-infection. Thus, he explained that conventional means of vaccine development have not been successful and new approaches are being investigated.

Dr. Khabbaz, CDC, discussed the National Hepatitis C Prevention Strategy. She stated the objective of the Strategy is for identification of infected persons and surveillance. The CDC has developed evidence-based guidelines to assist health care professionals and the public in identifying individuals with the disease since many people are asymptomatic. In addition, the CDC has funding available to provide each State with a Hepatitis C coordinator to accelerate the integration of HCV testing, counseling and referral for medical evaluation.

Dr. Deyton discussed the Department of Veterans Affairs (VA) HCV program. Hepatitis C has been a high priority for the Department since veterans seen at VA facilities for health care are affected by Hepatitis C in greater proportion than the nation as a whole. Dr. Deyton discussed in detail the VA's public health approach to Hepatitis C.

The questions were directed primarily to CDC. Representative Waxman tried to get an answer from CDC on whether needle exchange for IDU's is a sensible preventative measure, as recommended by the NIH consensus panel. Representative Norton followed up asking both Dr. Hoofnagle and Khabbaz, as scientists, would they agree with the consensus panel's recommendation on needle exchange? Dr. Hoofnagle answered "yes" and Dr. Khabbaz stated that she would not disagree.

The witnesses on the second panel focused on the need for more Federal action to combat this disease. Erica Stein, a high school student from Virginia whose father has Hepatitis C, discussed how her advanced marketing class took on the issue of Hepatits C as a project and has been lobbying Capitol Hill trying to get Representative Towns' bill passed.