A nurse would boil the syringes, fill each with five doses and then jab five boys in a row with a single needle.
“I didn’t want that hot needle touching me, so I thought I’d be smart,” Mr. Ellabbad, 52, said. “I let the other guys go first.”
Abdel Gawad Ellabbad, 52, riding to work in Desouq, Egypt. He contracted hepatitis C as a schoolboy and was cured of the disease this spring after taking a regimen that included the drug sofosbuvir. Credit David Degner for The New York Times
Six million Egyptians were infected with hepatitis C by unsterile needles during the country’s decades-long fight against schistosomiasis. The virus spread insidiously; today, at least 10 percent of Egyptians, nearly nine million people, are chronically infected, the highest rate in the world.
But a grand experiment unfolding across the country may change all that.
Mr. Ellabbad, for one, was finally cured of hepatitis this spring. The air-conditioning repairman took a three-month regimen that included sofosbuvir, first of the new generation of miracle drugs. The pills would have cost more than $84,000 in the United States.
He got them free from the Egyptian government, which paid about $900.
“Before, I felt like I was dying,” he said. “Now I feel like I’ve never felt before. Like I’m 35 again.”
A Worldwide Problem
Hepatitis C is a global crisis: About 150 million people are chronically infected, four times as many as have H.I.V., and about 500,000 die each year of its complications, particularly cirrhosis and liver cancer.
In this archive photo, Egyptians in Cairo lined up to be immunized from schistosomiasis, a parasitic disease. The campaign against the disease infected six million Egyptians with hepatitis C. Credit Al-Ahram Archive Photo
The virus is a resilient foe. Usually transmitted by contact with blood, hepatitis C may not cause symptoms for years. Some patients clear the infection on their own, but in most, it becomes chronic, slowly damaging the liver over time.
Nowhere is the virus more entrenched than in Egypt. There are an estimated 150,000 new infections each year, caused by reuse of disposable syringes, accidental needle sticks, tainted medical equipment, and even the sharing of nail clippers and toothbrushes among family members.
Each infected Egyptian passes the virus to three others on average, said Dr. Manal Hamdy El-Sayed, who directs the national hepatitis-awareness campaign. Egypt’s National Liver Institute runs 50 treatment centers and consumes a third of the national health budget.
Fear of the virus is pervasive.
Sherif Mechawy, a barber in an upper-class neighborhood of Cairo, pumps sanitizer on his hands and holds up a clear plastic package containing a comb and a disposable razor for each client.
“They have to see me open it with their naked eyes,” said Mr. Mechawy, 39. About a quarter of his customers prefer to bring their own clippers and scissors.
For full shaves, he wears latex gloves. The hepatitis virus can survive two days or more on a surface, and Mr. Mechawy knows even the groove where the razor fits in the holder is dangerous.
Even harder hit than Cairo are the villages of the Nile Delta, where half of all men older than 50 are infected.
Mohamed Khafagy, a tour guide from a rice-farming village, said every family he knew had lost someone to hepatitis C.Liver disease killed his father, two uncles and a cousin.
Mr. Khafagy, 39, is infected, too, and has developed Stage 3 fibrosis, which in a wealthier country would prompt rapid treatment.
Fear of hepatitis C is pervasive in Egypt, and barbers take precautions like wearing latex gloves and using disposable razors for each client. Credit Scott Nelson for The New York Times
He knows that drugs to cure his infection are trickling into the country from the West. But the nearest government clinic, in Kafr el-Sheikh, has a three-month wait for appointments.
“Will I last that long?” he wondered aloud.
A Game-Changing Drug
For a poor country, Egypt has a relatively effective health care system, including legions of liver specialists. Committed to repairing the damage done by the schistosomiasis campaign, the health ministry in 2007 developed an ambitious national hepatitis treatment plan using two old drugs: interferon and ribavirin.
The drugs are loaded with side effects and difficult to tolerate. Last year, Gilead Sciences, based in California, offered an alternative.
The company makes sofosbuvir, which since 2013 has been sold in the United States as Sovaldi for about $1,000 per one-a-day pill. A course of the drug, taken with ribavirin and often interferon, usually cures hepatitis C infection in 12 weeks.
Sofosbuvir is an enormous blockbuster; in its first year on the market, the drug earned Gilead more than $10 billion.
But for the past year, Gilead has sold the drug to the Egyptian government for about $10 a pill. The government distributes it to pharmacies across the country, where it is dispensed free to patients.
Gilead also allows 11 Indian and two Egyptian companies to make sofosbuvir under license and to sell it at any price they like, in return for a 7 percent royalty.
Mohamed Khafagy, a tour guide, has the disease, which also killed his father, two uncles and a cousin. Credit Scott Nelson for The New York Times
Gilead was under some pressure to make the drug more widely available. Egypt’s patent office rejected the company’s application, making it inevitable that generic versions would eventually be sold there, said Dr. Wahid Doss, the chairman of the National Committee for Control of Viral Hepatitis.
In return for selling sofosbuvir cheaply, Gilead asked that Egypt impose strict restrictions on every bottle to prevent the drug from being sold on the black market and undermining its business elsewhere.
All pills must be dispensed by government pharmacies, for example, and all patients must turn in an old bottle to get a fresh one. Those receiving new bottles must immediately unscrew the cap, break the seal and take the first pill in front of the pharmacist — making it nearly impossible to resell the bottle.
Those restrictions infuriated international activists pushing for greater access to medicines, who saw them as violations of patients’ rights.
Heba Wanis, a pharmacist who until recently worked at the Egyptian Initiative on Personal Rights, said she found the requirement to take a dose in front of the pharmacist “humiliating” and felt it “raised a lot of ethical issues.”
Dr. Jennifer Cohn, medical director of the drug access campaign at Doctors Without Borders, described the requirements as “a third party introduced into the doctor-patient relationship.” Giving a drug company control over who receives its products sets “an incredibly dangerous precedent,” she said.
But so far, no outrage is visible here in Egypt.