England Is Close to Erasing a Disease Its Own Health Service Once Spread

NHS England announced this week that hepatitis C is on track to be eliminated in the country, four years ahead of the World Health Organization's 2030 target. It is the kind of statement that ought to draw more attention than it will, not least because of what the disease represents in Britain's recent history. More than 30,000 people in this country were infected with hepatitis C and HIV through contaminated blood products between the 1970s and early 1990s, a scandal a public inquiry concluded could largely have been avoided and involved deliberate concealment. Around 3,000 died. The infected blood scandal is not ancient history. Compensation payments are still being processed. Survivors are still giving evidence. And now the same health system responsible for that catastrophe says it is on track to eliminate the disease it once spread, four years ahead of the World Health Organization's 2030 target.

There is something genuinely significant in that. Over 100,000 people diagnosed and treated since 2015, mortality down by more than a third, a treatment that now cures upwards of 95 per cent of cases in a matter of weeks rather than months. Scotland and Wales are close behind. Programmes reaching people through GP registration, A&E blood tests and free home testing kits have done what elimination targets usually fail to do, which is find the people who do not know they are sick and would never otherwise present.

The harder question is whether this kind of achievement survives the next twelve months. Elimination programmes of this sort depend on precisely the parts of the health system that carry the least political weight when money gets tight: public health outreach, specialist commissioning for a relatively small patient cohort, sustained testing infrastructure aimed at populations who are hard to reach and easy to deprioritise. Rachel Halford of the Hepatitis C Trust made the point plainly, warning that continued commitment and long-term investment are essential to finishing the job. That is not a routine plea for funding. It is a warning that momentum built over a decade can be lost quickly once attention moves elsewhere.

Attention is about to move elsewhere. John Healey delivers his first Budget as Chancellor on 28 October, under a government that has promised fiscal discipline and is working against forecasts tighter than anything Rachel Reeves faced. Health spending protections in that environment tend to flow toward what is visible and politically costly to neglect, principally waiting lists and emergency care, rather than toward programmes whose success looks like a disease quietly disappearing from the statistics. A hepatitis C testing programme does not generate headlines when it works. It generates headlines when it is cut and cases start rising again.

There is a second, less discussed risk. The infrastructure that delivered this result sits substantially within NHS England's public health and specialised commissioning functions, which are currently being dismantled and folded back into the Department of Health and Social Care. Reorganisations of this scale routinely disrupt exactly the kind of long-horizon, low-visibility public health work that elimination targets depend on, even when nobody intends that outcome. Staff leave, contracts lapse, institutional memory disperses. Nobody votes to abandon a hepatitis C programme. Programmes like this fade through neglect rather than decision.

None of this diminishes what has been achieved. It is a rare instance of an NHS target actually being hit early, and a rarer instance of a health system correcting for its own historical failure. But elimination is not a fixed state. It requires the same testing infrastructure and the same funding discipline indefinitely, applied to a shrinking and increasingly hard to reach population, at precisely the moment the government's fiscal choices are about to be made. Whether England actually finishes the job will say more about the Budget than about the disease.