Potentially Powerful Tools: A Vaccine in the Fight Against HCV

In 1989, Sir Michael Houghton helped discover the Hepatitis C Virus. Last year, he was awarded the Nobel Prize in Medicine for this same discovery. Now, he’s aiming to create a vaccine against the virus.

Just a few weeks ago, Houghton announced an effort at the University of Alberta’s Li Ka Shing Applied Virology Institute that could have a adjuvanted recombinant vaccine ready for global deployment by 2029. Both new mRNA and viral vector vaccines, used in the COVID-19 vaccines currently authorized by the Food and Drug Administration under an emergency use authorization, have the potential strength to produce multiple kinds of antibodies, solving a long-held problem in the search for an HCV vaccine.

A couple of words of caution: A recent study, using two viral vectors, while successful producing HCV specific T-cells, failed to prevent chronic HCV infection. The last decade has seen several attempts at developing an HCV vaccine but few have made it to human trial, specifically because of evasive properties of the virus’ genotypes to behave differently or escape the body’s natural defenses.

If Houghton and his team are successful, a 2029 launch would likely still have much of the globe well behind the World Health Organization’s 2030 goals but adding a clear, definitive prevention tool stopping chains of transmission would, in theory, help countries playing “catch-up”. With complications from Hepatitis C killing more than 400,000 people annually – and possibly more in the coming years due to COVID-19-related disruptions in care – a vaccination effort could very easily save millions of lives and save billions in public health and health care funding. Houghton suggested Canada alone could see a reduction in HCV-related costs of 98%, or $20 million as opposed to $1 billion – annually due to the high costs of direct acting agents, which are the current gold standard in HCV care and can be curative.

However, if global access to COVID-19 vaccine difficulty and notable vaccine distrust and failure to uptake have taught us anything, having the technology is not the same as having the technology. COVID-19 doesn’t appear to be slowing down, despite recurrent waves, and supply demand on shared vaccine ingredients could find HCV deprioritized.

Additionally, there’s other potential complications to consider. While the United States has seen an increase in Hepatitis B vaccine acceptance, in part thanks to an infant vaccination schedule inclusive of HBV, a study published last year found waning immunity over the years post-vaccination. Now, the CDC’s information page does not recommend HBV boosters and technology may differences may naturally boost efficacy of vaccines but anything that needs additional follow up, like multi-stage vaccines or boosters, are always prone to follow-up failures. And – yet again – COVID-19 provides an excellent case study in this (and all other hidden asterisks). With “anti-vax” sentiments rising at exceptional rates, especially associated with “new” technologies, adding yet another vaccine to the schedule may find barriers in acceptance other common vaccines haven’t run into, at least not on this scale.

Nevertheless, a successful HCV vaccine that answers the challenges of the virus, the conspiracy, and the supply would be a game-changer (to use an unfortunately over-used phrase).

If advocates and policy makers have learned anything, being well prepared for an ever-changing environment in terms of technological advancements, the advancement of anti-science sentiments, and a whole host of other challenges is to our benefit. Analyzing the years between now and, hopefully, 2029, perfecting routine vaccination programs and ensuring actual global equity in access and distribution are critical to making sure this kind of discovery doesn’t go to waste.