Identifying HCV carriers is also challenging, because most people do not know that they have the disease until they develop severe cirrhosis or liver cancer — sometimes decades after being infected. Mandatory screening of at-risk populations such as the elderly and drug users would need to be a major part of an eradication effort, says virologist Charles Rice of Rockefeller University in New York. Crucial too is education to prevent people from contracting the disease in the first place. Even the most effective oral drugs do not raise a lasting immune response against the virus, and people can be reinfected.
That is why the search for a preventative HCV vaccine continues, with the most promising ones currently in phase II clinical trials. “Even if we have all the drugs we need—which is still an open question—it will be decades, if not a century, before it’s gone,” says Rice.