The case for a universal hepatitis C vaccine to achieve hepatitis C elimination

Abstract

Background: The introduction of highly effective direct-acting antiviral (DAA) therapy for hepatitis C has led to calls to eliminate it as a public health threat through treatment-as-prevention. Recent studies suggest it is possible to develop a vaccine to prevent hepatitis C. Using a mathematical model, we examined the potential impact of a hepatitis C vaccine on the feasibility and cost of achieving the global WHO elimination target of an 80% reduction in incidence by 2030 in the era of DAA treatment.

Methods: The model was calibrated to 167 countries and included two population groups (people who inject drugs (PWID) and the general community), features of the care cascade, and the coverage of health systems to deliver services. Projections were made for 2018-2030.

Results: The optimal incidence reduction strategy was to implement test and treat programmes among PWID, and in settings with high levels of community transmission undertake screening and treatment of the general population. With a vaccine available, the optimal strategy was to include vaccination within test and treat programmes, in addition to vaccinating adolescents in settings with high levels of community transmission. Of the 167 countries modelled, between 0 and 48 could achieve an 80% reduction in incidence without a vaccine. This increased to 15-113 countries if a 75% efficacious vaccine with a 10-year duration of protection were available. If a vaccination course cost US$200, vaccine use reduced the cost of elimination for 66 countries (40%) by an aggregate of US$7.4 (US$6.6-8.2) billion. For a US$50 per course vaccine, this increased to a US$9.8 (US$8.7-10.8) billion cost reduction across 78 countries (47%).

Conclusions: These findings strongly support the case for hepatitis C vaccine development as an urgent public health need, to ensure hepatitis C elimination is achievable and at substantially reduced costs for a majority of countries.

Keywords: Elimination; Hepatitis C; Mathematical model; Vaccine.

Fig. 1

Model schematic

Fig. 2

Countries where the WHO target of an 80% reduction in incidence by 2030 could be reached with or without a vaccine available. Countries are shown according to whether (a) there was a non-dominated scenario without a vaccine that reached the target (green), (b) the only non-dominated scenarios that reached the target required a vaccine (orange), or (c) there were no non-dominated scenarios that reached the target (red). Projections assume 80% coverage of testing, treatment and vaccination programmes, and a maximum testing frequency of six monthly among PWID

Fig. 3

Relative reduction in incidence by 2030, projected for the optimal WHO incidence reduction target strategies without (top) and with (bottom) a vaccine available. Projections assume 80% coverage of testing, treatment and vaccination programmes, and a maximum testing frequency of six monthly among PWID

Fig. 4

Estimated impact of a vaccine on the feasibility and cost of hepatitis C elimination. Total cases averted 2018–2030 using the optimal incidence reduction strategies without a vaccine, or with a vaccine that was 50%, 75%, or 90% efficacious (top left); and the number of countries where the WHO incidence reduction target could be achieved with a non-dominated strategy (top right). For different vaccine costs, the number of countries where a vaccine was a component of the optimal strategy (bottom right); and the total reduction in the cost of elimination if it were used in these countries. Uncertainty bounds represent scenarios with 70% and 90% population coverage of testing, treatment, and vaccination compared to a base of 80%