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The success of the hepatitis B vaccine


Hepatitis B: eradication or control?
Baruch Blumberg Physician
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Well, in 1985, ‘86, I… I was a… a co-chair of a big meeting we had in Switzerland on, well, they wanted to call it the eradication of hepatitis, but I… I think we changed it to the possibility of eradication. And I think on the face of it, you know, if you vaccinate enough people, which is happening, and re-vaccination may be required, but let's say you maintain vaccination levels, and you start treating people who are already infected, and you break the mother-child transmission by vaccinating newborns, then, you know, conceivably, it'll go away. But there's a very interesting question about whether you want to push for eradication. The… the eradication of smallpox was feasible, because there's only human-to-human transmission, and… and it's human to… of human transmission with pretty close contact — it's not respiratory spread, you know, it's close contact. And the… and they had a really good campaign and they… you really… which went through various stages, but finally they tried to find the last few cases, and then they kind of put a wall around… around them with vaccination processes. And that was pretty effective. But, you know, for years now, they've been trying to eradicate polio. And the Rotary International, as you may know, has taken a particular interest in that. And they have really pushed it enthusiastically; highly organized, they're very, an international organization, and they're very well organized. And they've made that a kind of goal. But they have, you know, they've eliminated it from the United States, pretty much. And they've eliminated it from other places. But the… the argument is, well, if it's anywhere in the world, you know, it can spread. And then you have to ask the question, do you want to spend all your money and effort on getting rid of those last few cases – something that would be very desirable — or, do you want to say, okay, we know how to control it, we've got it pretty well controlled; it's not perfect, but then, nothing's perfect. So, why not do something else? And I've spoken to them at Rotary to ask them if they want to consider directing their considerable energy and resources towards doing work on hepatitis B, and I've elicited an interest. I must say, I haven't sort of pushed it very far, but I think I may, again, I met, I've spoken to several people from Rotary. It's a remarkable organization, you know their health-orientation towards public health is really commendable. So that, I… I think that's about it. My guess is there will be more discussions about it.

One of the problems with hepatitis B is that it's never generated the kind of interest that AIDS has, for example, although, probably a lot more people have died from hepatitis B than have died from AIDS. And I've seen some formulations that this is still the case. It probably is, there's probably more people dying from it. But somehow or another, it's much less dramatic. And it’s… it affects the same people, essentially, the same population groups, more or less, not… it varies from country to country. So our, my money, the practical thing, I think, is to try to continue to extend it and I've tried to do that in China when, my small bit is never, it's always hard to tell what actual impact you had. That trip I took to India, I think that had some role, but things move slow. And India, now, they're really pushing it forward. So, I… I, eradication, fine, but in the meanwhile, let's work towards control. It's... one of the things I've learned, is don't do things you can't do. You know, it's not going to happen. Don't do… there's something else you can — but I wouldn't despair. But again, there can be interesting consequences when there isn't any more hepatitis B virus around. We don't know what they are. And you know, I'd like to find out. For example, I told you about this funny grouping of bacteria that are all related to the same susceptibility gene. Okay, let's say you vacate, you remove hepatitis from that class, that classification of bacteria — what's going to happen to the other ones? Are they going to increase? You know, the world's a very… nature is very dynamic. You change one thing, something else happens, like with Paul Bunyan and the radiators. So, we, and I'm not... that's not an argument not to go ahead — don't misunderstand — it's an argument to find out more and to investigate things at the population level. And investigate with, well, in field studies, not just in the laboratory.

American research physician Baruch Blumberg (1925-2011) was co-recipient of the Nobel Prize in Physiology or Medicine in 1976 along with D Carleton Gajdusek for their work on the origins and spread of infectious viral diseases that led to the discovery of the hepatitis B virus. Blumberg’s work covered many areas including clinical research, epidemiology, virology, genetics and anthropology.

Listeners: Rebecca Blanchard

Dr Rebecca Blanchard is Director of Clinical Pharmacology at Merck & Co., Inc. in Upper Gwynedd, Pennsylvania. Her education includes a BSc in Pharmacy from Albany College of Pharmacy and a PhD in Pharmaceutical Chemistry from the University of Utah in Salt Lake City. While at Utah, she studied in the laboratories of Dr Raymond Galinsky and Dr Michael Franklin with an emphasis on drug metabolism pathways. After receiving her PhD, Dr Blanchard completed postdoctoral studies with Dr Richard Weinshilboum at the Mayo Clinic with a focus on human pharmacogenetics. While at Mayo, she cloned the human sulfotransferase gene SULT1A1 and identified and functionally characterized common genetic polymorphisms in the SULT1A1 gene. From 1998 to 2004 Dr Blanchard was an Assistant Professor at Fox Chase Cancer Center in Philadelphia. In 2005 she joined the Clinical Pharmacology Department at Merck & Co., Inc. where her work today continues in the early and late development of several novel drugs. At Merck, she has contributed as Clinical Pharmacology Representative on CGRP, Renin, Losartan, Lurasidone and TRPV1 programs and serves as chair of the TRPV1 development team. Dr Blanchard is also Co-chair of the Neurology Pharmacogenomics Working Group at Merck. Nationally, she has served the American Society of Clinical Pharmacology and Therapeutics on the Strategic Task Force and the Board of Directors. Dr Blanchard has also served on NIH study sections, and several Foundation Scientific Advisory Boards.

Tags: Rotary International, India, China

Duration: 5 minutes, 7 seconds

Date story recorded: September 2007

Date story went live: 28 September 2009