Page - 80 - in Critical Issues in Science, Technology and Society Studies - Conference Proceedings of the 17th STS Conference Graz 2018

In other words, Hepatitis C, if treated, was treated as a chronic affliction: as a disease of the whole body, the whole person. But in only the last five years, things have profoundly changed. In 2013, U.S. and European medical agencies approved a Hepatitis C-drug called Sovaldi by industry giant Gilead (EMA 2013). Today – just five years later – treatment standards are based exclusively on DAAs. They promise to “cure” Hepatitis C as a single viral infection – no more mystery, no more elusiveness. As Dr. Peck of Klagenfurt Hospital, told me: “[...] these are developments [finding a cure] you will really only see with infectious diseases. Because I will never [...] in the area of other chronic diseases, such as obesity [Fettsucht], diabetes [...|, see similar developments. Because those are multi-factorial things [multi-faktorielle Dinge]. [...] The effect can never be as strong as with infectious diseases, where I can really just get a handle on this thing from one day to the next. Because the target is entirely clear.” DAAs like Sovaldi inhibit viral reproduction directly. The target is entirely clear. “The cure” for Hepatitis C is therefore a cure associated with the virus–not with the disease, with a body, or a person. The target is to get rid of the virus, not manage a chronically ill body or the patient afflicted with it. The locus of treatment has shifted to the virus, and so has the temporality of Hepatitis C. A chronic affliction is long-term. But by concentrating on the virus, treatment is oriented towards the earliest moments of infection, thus presenting ever earlier needs for testing. In other words, action needs to be taken as early as possible. This is the kind of action that instills a sense of urgency and emergency. The shift to treat Hepatitis C more and more like an infectious disease reverberates in the “global health” strategies attached to it, like the “Finding the Missing Millions” campaign run by the World Hepatitis Alliance at this very moment. Infections carry a threat in a way that chronic diseases do not. It is only such that we can better understand a discourse about “epidemics” and ticking “time-bombs.” Where the “creeping” effects of a “silent” killer are aligned with a chronic disease, infections demand immediate intervention. Discussion At first glance, the Hepatitis C-“epidemic” appears to fit neatly with what Collier and Lakoff (2008, 17) have called the “emergency modality of intervention.” As a functional regime, this modality describes the way in which contemporary global health efforts are implemented to prevent infectious biothreats. In that sense, we could see this shift in Hepatitis C-ontology as a functional, strategic move on the side of transnational agencies like the WHO (see also Brown, Cueto, and Fee 2006). That, however, is only one part of a larger story. In a time where Nicholas King (2002) has found global public health to be dominated by a “(re)emerging disease worldview,” Hepatitis C is, strictly speaking, neither an emergent nor a re- emergent disease. In fact, Hepatitis C’s shifting ontology makes visible the intricate and practical logics attached to this worldview. The Hepatitis C case highlights what it takes to turn a silent and complex viral disease into an object of global health efforts in this historical moment. As such, it can also make visible the lived consequences for individual subjectivity and where these transformations leave gaps or incite struggles. 80