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who can be treated each year, so usually only patients with higher fibrosis levels receive treatment. Other
countries such as Spain, Belgium, and Switzerland only provide treatment for patients with a certain fibrosis
level by prioritizing severe cases. Some of these countries are already considering broadening access to
additional fibrosis levels. For instance, in Spain access has been broadened to all fibrosis levels in some
regions and commitment to broaden it at national level has been recently announced; and in Belgium access
was extended to second stage fibrosis (F2) patients in January 2017, and full access is expected by 2019.

Patients who inject drugs, a European and Australian approach
The European Monitoring Center For Drugs and Drug Addiction (EMCDDA) has been working since the
era of HIV. It has published different policies on its website and those were heavily cited and were taken
into consideration by major health providers. It has recently been presenting its data describing insights for
policy making to halt the HCV prevalence in the EU and Turkey but also the strategies for meeting the 2030
elimination goal.

[23]
According to EMCDDA report 2017 , 14 EU countries plus Norway have HCV policies in place, which
are very effective. Thirteen of them were adopted recently between 2013 and 2017. Nine EU countries have
clinical guidelines limiting treatment access to people who use drugs.

After effectively bringing down the prevalence in general population of EU countries, and providing treat-
ment to all patients who are chronically infected with the exception of a few EU countries. Now the focus
is on patients who inject drugs (PWIDs), which includes lifting the ban from those who are actively
injecting and treating this population apart from providing them more syringes to break the transmission
[24]
chain .

The European Liver Patients’ Association (ELPA) is also providing a platform for policy making as is
[25]
reflected by the Hep-Core 2017 study, which is acting as a benchmark for monitoring changes in European
policy landscape.

As per the current policies, EU and Australia will achieve the WHO target much earlier than 2030.

Egyptian model, an eye opener for the middle to low income countries
In the middle and low income countries the Egyptian model is the best strategy for combating HCV. Egypt
[11]
was regarded as one of the countries with the highest prevalence till 2015 according to WHO report . This
was the outcome of mass treatment with unsterilized syringes for schistosomiasis during 1960s to 1980s,
[26]
which has represented the largest ever iatrogenic spread of blood borne infection in the history . After
[27]
this mammoth burden with an estimated 10% seroprevalence , the agreement of Gilead Sciences, than
Bristol-Meyers-Squibb and Ministry of Health, brings down cost of Sofosbuvir and Daclatasvir and making
local brands in much cheaper cost. Then with continuous efforts of opening up of health care provision,
treatment centres and web based appointment system, Egypt is regarded as being on the right path as per
[28]
latest estimates from local and international audits . Egyptian model is not only cost efficient but also easily
acquirable. Egypt is the only low- and middle-income country, among nine of countries which are on the
track of WHO 2030 elimination program.

Situation in Pakistan
[11]
According to latest estimates Pakistan has the second largest viremic pool of HCV patients after China,
with ever increasing morbidity and mortality due to this highly prevalent infection in the country. With
the advent of DAAs, like the Egyptian strategy of getting Sofosbuvir in low cost, Gilead Sciences gave the
similar licensure to Ministry of Health, Pakistan, by this effort and now with the availability of the generic