Page - 78 - in Critical Issues in Science, Technology and Society Studies - Conference Proceedings of the 17th STS Conference Graz 2018

STREAM: Life Sciences / Biotechnology Treating the Infection: Hepatitis C in Ethnographic Perspective LEHNER, Lisa Department of Science & Technology Studies, Cornell University, United States From Hepatitis C to a Cure: From Elusiveness to Finality Hepatitis C is a viral disease spread from human-to-human by a blood-borne single-stranded RNA-virus. The virus, like its kin, attacks the human liver. Hepatitis C as such was not formally “discovered” until 1989. This “discovery” came late compared to Hepatitis B in the 1960s and Hepatitis A in the 1970s (Choo et al. 1989; Kuo et al. 1989; Alter 1991). For decades this obscure third Hepatitis became known as “non-A/non-B”-Hepatitis – a disease known only by its negation. As Fraser and Seear (2011, 32) have demonstrated, HCV is and has long remained a virus frequently shrouded in “metaphors of mystery and elusiveness.” The “non-A/non-B”-Hepatitis-Virus staunchly eluded us for decades. “It took us decades to even see the virus in the first place,” Dr. Holzmann at the Vienna Institute for Virology remarked to me, a glint of fascination in her eyes. Eventually, HCV was not even observed microscopically or identified serologically but genetically manufactured. It was built to be known. Yet even after its description in 1989, after it had been pinned down just enough, HCV has remained a mysterious fellow. HCV mutates very quickly and is prone to errors and transformations. It constantly produces, as is the normal modus operandi for viruses, quasi-species: replications of itself that are always a little different. Quasi-species are the “motor of virus evolution,” if you ask Tim Skern at the Vienna Perutz Labs, but HCV specifically has “very active quasi-species.” So, the HC-Virus in our body is never one, always many: Not only are there a hundred different genotypes and subtypes to start with, but then also countless wonky transformations with every cycle of reproduction. Such, HCV has proven hard to control and conquer. “One-size-fits-all” approaches to treatment proved impossible for the longest time. Its mutations and transformations made Hepatitis C remarkably resilient. In fact, our immune system has such a hard time keeping up that HCV, unlike other hepatitides, develops into a chronic condition in the majority of cases – a chronic condition that tends to go unnoticed and remains asymptomatic for decades. This has earned Hepatitis C the label of a “silent killer.” With its “silent” and “slow progression,” Hepatitis C appeared only low on the list of diseases health institutions vow to fight and eradicate. For decades, more pressing epidemics were far more important. And yet Hepatitis C has been curiously loud and dominant in the past five to six years; called a “ticking time bomb” by the Lancet, an “epidemic” by the New York Times (Goodnough 2015; Sachs 2015; The Lancet 2013). On top of that, the WHO (2016) issued its first-ever “Global Health Sector Strategy on Hepatitis” in 2016. Its core target: eliminate the Hepatitis C-threat. This WHO strategy marks a milestone on Hepatitis C’s rise to the status of an “epidemic” in recent years: an “epidemic” without an outbreak. What has made Hepatitis C an epidemic of 78