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Insights into Editorial: Vanquishing viruses: On Nobel prize for medicine

2020_noble_prize

 

Context:

At a time when the world is faced with multiple assaults from a frighteningly obscure virus, it cannot be mere coincidence that the Nobel Committee decided to anoint three scientists who peeled the layers off another virus that confounded generations of physicians the Hepatitis C virus (HCV).

The 2020 Nobel Prize in Physiology or Medicine, to Harvey J. Alter, Michael Houghton and Charles M. Rice, is a stout endorsement of years of work that went towards identifying one of the world’s greatest scourges.

But to see it shorn of the context it is couched in would be to miss the larger point or purpose it could serve.

Choosing researchers who went after a pathogen and succeeded in unwrapping the whole puzzle at a time when others are fighting fatigue in a daily battle against the SARS-CoV-2 virus, is also a hat tip to the virologists and geneticists burning the midnight oil, for over nine months now.

Identification of Hepatitis C virus:

  1. Identification of the novel virus was now a high priority. All the traditional techniques for virus hunting were put to use but, in spite of this, the virus eluded isolation for over a decade.
  2. Michael Houghton, working for the pharmaceutical firm Chiron, undertook the arduous work needed to isolate the genetic sequence of the virus. Houghton and his co-workers created a collection of DNA fragments from nucleic acids found in the blood of an infected chimpanzee.
  3. The majority of these fragments came from the genome of the chimpanzee itself, but the researchers predicted that some would be derived from the unknown virus.
  4. On the assumption that antibodies against the virus would be present in blood taken from hepatitis patients, the investigators used patient sera to identify cloned viral DNA fragments encoding viral proteins.
  5. Following a comprehensive search, one positive clone was found. Further work showed that this clone was derived from a novel RNA virus belonging to the Flavivirus family and it was named Hepatitis C virus.
  6. The presence of antibodies in chronic hepatitis patients strongly implicated this virus as the missing agent.

Hepatitis – a global threat to human health:

  1. Liver inflammation, or hepatitis, a combination of the Greek words for liver and inflammation, is mainly caused by viral infections, although alcohol abuse, environmental toxins and autoimmune disease are also important causes.
  2. In the 1940’s, it became clear that there are two main types of infectious hepatitis. The first, named hepatitis A, is transmitted by polluted water or food and generally has little long-term impact on the patient.
  3. The second type is transmitted through blood and bodily fluids and represents a much more serious threat since it can lead to a chronic condition, with the development of cirrhosis and liver cancer.
  4. This form of hepatitis is insidious, as otherwise healthy individuals can be silently infected for many years before serious complications arise.
  5. Blood-borne hepatitis is associated with significant morbidity and mortality and causes more than a million deaths per year world-wide, thus making it a global health concern on a scale comparable to HIV-infection and tuberculosis.

Difference between hepatitis A, hepatitis B, and hepatitis C:

Hepatitis A, hepatitis B, and hepatitis C are liver infections caused by three different viruses.

Hepatitis A is usually a short-term infection.

Hepatitis B and hepatitis C can also begin as short-term infections, but in some people, the virus remains in the body and causes chronic (long-term) infection.

There are vaccines to prevent hepatitis A and hepatitis B; however, there was no vaccine for hepatitis C. Hepatitis C is a liver infection caused by the hepatitis C virus.

Hepatitis C can range from a mild illness lasting a few weeks to a serious, long-term illness.

Hepatitis in India:

  1. 40 million people are chronically infected with the Hepatitis B virus and 6 to 12 million with the Hepatitis C virus.
  2. According to the World Health Organization, about 71 million people in the world have chronic infection with the Hepatitis C virus, which is also a major cause of liver cancer.
  3. A vaccine for the disease has still not been developed but it can be treated with the help of anti-viral drugs.
  4. In 2018 the National Viral Hepatitis Control Programme (NVHCP) was launched which has the target to eliminate Hepatitis C by 2030.
  5. The program is the largest program for Hepatitis B and C diagnosis and treatment in the world.
  6. Hepatitis B is included under India’s Universal Immunization Programme (UIP) which provides free of cost vaccination against a total of 12 vaccine-preventable diseases.
  7. The first recombinant DNA-based vaccine for Hepatitis B infection was made in India by Hyderabad-based Shantha Biotech.

Significance of this Nobel Prize-awarded discovery:

The Nobel Laureates discovery of Hepatitis C virus is a landmark achievement in the ongoing battle against viral diseases.

Thanks to their discovery, highly sensitive blood tests for the virus are now available and these have essentially eliminated post-transfusion hepatitis in many parts of the world, greatly improving global health.

Their discovery also allowed the rapid development of antiviral drugs directed at hepatitis C.

For the first time in history, the disease can now be cured, raising hopes of eradicating Hepatitis C virus from the world population.

To achieve this goal, international efforts facilitating blood testing and making antiviral drugs available across the globe will be required.

Conclusion:

The Nobel Committee called it “among the most impactful scientific accomplishments of the 20th century”.

In true lineage of other Nobel Prizes for Medicine, their identification represents “milestone achievements that have revolutionised medicine and substantially improved human health”.

The triumph of humanity, over the pathogens that debilitate and kill men and women is certainly a singular achievement that is worth celebrating and showcasing this achievement will send a deeply inspiring message at a time when another virus is holding the world to ransom.