Theme: Social Science & Policy Research Year: 2018
The hepatitis C (HCV) treatment landscape is entering a new era. New drug developments
have transformed treatment options. Direct-acting antiviral treatments offer reduced toxicity,
simpler adherence, shorter duration, and up to 100% cure rates. These medicines are
heralded as having “revolutionised treatment”. It has been suggested that elimination of HCV
can be achieved through what is called a ‘treatment-as-prevention’ strategy, by treating
those most at risk of acquisition and onwards transmission (people who inject drugs). In
2016, the World Health Organisation (WHO) published the first global health strategy to
address viral hepatitis, aiming to exploit new opportunities including advances in treatments,
and setting a goal of eliminating viral hepatitis as a major public health threat by 2030. While
implementation scientists have responded rapidly to this call, to date there has been little
critical examination of the productive capacity and constitutive effects of this policy.
Taking the WHO’s Global Health Sector Strategy on Viral Hepatitis as a springboard for
analysis, we apply Bacchi’s poststructural approach to examine how ‘elimination’ – as a
proposal – constitutes the problem of HCV.
By tracing the translation of elimination targets into other national strategies, we critically
consider the conceptual logics underpinning the elimination goals, and the multiple materialdiscursive effects of this policy. We examine how governing takes place through numbers,
by analysing ‘target-setting’ and ‘metrics’ (and their accompanying practices of accountability
and surveillance) as governmental technologies.
At a time when governments internationally are investing in elimination strategies, we
suggest that such analysis is both timely and imperative.
Disclosure of Interest Statement
The Centre for Social Research in Health is supported by a grant from the Australian
Government Department of Health. No pharmaceutical grants were received in the
development of this study