Having spent a little time looking at the Ig Nobel prizes, let’s give some attention to this year’s Nobel Prize in Physiology or Medicine, awarded equally to Harvey J. Alter, Michael Houghton and Charles M. Rice “for the discovery of Hepatitis C virus.” Hepatitis C is primarily transmitted by direct blood contact, such as a blood transfusion or sharing of needles for intravenous drug use. Knowing that the virus exists, how it is transmitted, and how to detect it has significantly increased the safety of our blood supply, making all manner of surgical treatments better therapeutic options. Preventing hepatitis C infections is also a major reason for needle exchanges, important public health programs which not only reduce infection rates but also provide avenues for overdose prevention and rehabilitation by establishing positive relationships to the healthcare community. The still-compounding public health benefits of this discovery certainly merit recognition at this highest level.
Most people who get infected with hepatitis C experience no symptoms initially. So they have no indication of their infection status. Still, many of them will develop a chronic infection of the liver. They can remain asymptomatic yet potentially contagious indefinitely. Eventually, some will develop serious and potentially fatal liver disease. That’s a high price to possibly pay for a blood transfusion, but for many years that was a risk. Thanks to the efforts of this year’s laureates and many scientists and scientists-in-training working with them, we can now screen donated blood and greatly reduce that risk.
I thought the timeline was interesting to compare to our present circumstances. By the 1960s, we had recognized that blood transfusion recipients had higher rates of liver cancer and other liver diseases, and by the 1970s it was clear that not all of that risk could be explained by hepatitis B infections. But it wasn’t until 1989 that the hepatitis C virus was isolated and identified, leading to the availability of screening tests in the 1990s. Antiviral treatments are available; early options from the 1980s were developed to treat other viruses and presently available therapies can achieve 95% cure rates with fewer side effects than previous options. However, there is no licensed vaccine.
Compared to that multi-decade journey, it is astonishing that we are less than one year from the first human SARS-CoV-2 infections and already have an identified pathogen and multiple vaccine candidates and therapeutic options in final phases of clinical testing. There are some biological differences at play; for example, hepatitis C virus mutates at a higher rate and so there are seven distinct strains circulating, complicating vaccine development. At the same time, we are benefiting from substantial improvements in the tools of virology and molecular biology to get where we are so quickly. So in celebrating this prize, we can be doubly grateful that our blood supply is safer and that we no longer have to wait decades to identify new viruses.
The other Nobel prizes will we announced this week; you can see the latest announcements here.