With Hepatitis C, We Are Only as Healthy as Our Jails

In stark relief to countless Executive Branch assaults on American public health infrastructure and the passage of the “Big, Beautiful Bill” against medical guidance earlier this year, recent governmental actions to address Hepatitis C Virus (HCV) — the country’s most common and most deadly bloodborne infection — appear refreshingly informed by scientific consensus. Indeed, these policy proposals seem to recognize that eliminating Hepatitis C will be impossible without making direct-acting antiviral medications (DAAs) available to people in prisons and jails; and doing so would save government money, too.  

America has struggled to keep up with the “stupendous” increase in Hepatitis C cases in the last 25 years. The disease occurs when HCV attacks and damages liver cells, causing inflammation and scarring (fibrosis), which, if left untreated, can progress into liver failure, cancer, or death, among other severe complications. Before the deadly COVID-19 pandemic, Hepatitis C killed more people in the United States than the next 60 infectious diseases combined.

At Prisoners’ Legal Services of Massachusetts, our Hepatitis C litigation and advocacy reflects the reality that roughly 1 in 3 people with active HCV infections pass through prisons and jails each year, putting thousands at unnecessary risk of liver damage, cancer, and death and fueling a public health crisis. We filed Caron v. Coppinger in April because our clients with Hepatitis C at a local jail were repeatedly denied treatment and told to manage their disease with ‘diet and lifestyle modifications’ or ‘self-care.’ Unfortunately, our clients are far from alone in this regard. The rate of Hepatitis C infections in correctional facilities is substantially higher than in the general population, with some studies showing incidence to be as high as one-third of any given institution, or about 10-20 times the national rate … and twice as deadly. Prevalence of HCV in these settings is often even higher than reported, as more than half of people with Hepatitis C are unaware that they are infected, and jails and prisons also often lack comprehensive testing that would reveal the high volume of cases in their custody. More than 90 percent of incarcerated people with the disease then reenter the community, where they may contribute to disease transmission. 

Meanwhile, we have a highly effective cure for this disease. National and global consensus is that use of DAAs for Hepatitis C treatment is the standard of care, but national efforts toward elimination have failed because we are not reliably testing and treating incarcerated populations with this medically necessary cure. 

It is through this lens that these recent public policy shifts seem especially promising, though in the battle against Hepatitis C in America, this year began worse than most. The U.S. Department of Health and Human Services (HHS) drew global condemnation for firing all 27 lab scientists at the Center for Disease Control’s Division of Viral Hepatitis (along with thousands of others at the CDC that day) by email on April 1. Consequently, ongoing investigations of Hepatitis outbreaks in Florida, Oregon, Pennsylvania, Massachusetts, New Mexico, Wisconsin, West Virginia, and Georgia were indefinitely halted. 

Yet in June, HHS quietly announced a reversal of its April Fools’ Day layoffs at the HCV lab. And six weeks after this about-face, the Department announced a $100 million pilot funding opportunity (“Hepatitis C Elimination Initiative Pilot”) to prevent, test, and cure Hepatitis C among people with substance-use disorders. These grants may well have an impact on prison and jail HCV infection rates, as widespread criminalization of drug use contributes to disproportionate incarceration rates among people who inject drugs.   

The biggest summer blockbuster for Hepatitis C news, however, came from Congress. In a bipartisan bill known as the “Cure Hepatitis C Act of 2025,” co-sponsors Senator Bill Cassidy (R-LA) and Senator Chris Van Hollen (D-MD)  build on the Biden HHS’s National Strategic Plan for Hepatitis C Elimination. The new Act proposes a $9.8 billion nationwide Hepatitis C Elimination Program, reflecting expert consensus that significant national investment in DAA treatment will save American taxpayers billions of dollars otherwise spent on treatment from later-stage complications of Hepatitis C. 

Crucially, the Cure Hepatitis Act of 2025 explicitly integrates incarcerated populations into its HCV-elimination program. By allocating $25 million to the Bureau of Prisons and allowing state and local correctional systems to opt into a subscription program for Hepatitis C treatments, the bill would allow people with Hepatitis C access to treatment in the many jails and prisons that currently limit or deny access to DAAs because of their cost. (With limited exceptions, people in prisons and jails are ineligible for Medicaid under federal law.)

Although updated treatment guidelines, litigation to increase treatment among incarcerated populations, decreased DAA costs, and so-called 1115 waivers have meaningfully expanded access to DAAs for people in jails and prisons, we have a great deal more work to do to fill the critical gap in national Hepatitis C testing and treatment in jails and prisons. The Cure Hepatitis C Act of 2025, the restoration of the CDC’s Division of Viral Hepatitis, and HHS’s Hepatitis C Elimination Initiative Pilot are welcome steps in the right direction.