Challenges in coverage of future hepatitis C vaccines: Review and potential solutions.

Background: Motivated by the high mortality burden of hepatitis C virus (HCV) and the unprecedented rapid development of the COVID-19 and respiratory syncytial virus (RSV) vaccines, we note that a prompt HCV vaccine rollout may streamline the World Health Organization's goal to eliminate HCV before 2030. While progress in the development of HCV vaccine candidates has rapidly flourished, vaccine hesitancy and HCV incidence are both particularly prevalent in people who inject drugs (PWID). The aim of this paper is to document several potential challenges in HCV vaccine uptake and provide a set of preliminary recommendations for public and community health professionals to improve acceptance.

Methods: We conducted a forward-looking integrative narrative review and identified relevant articles from PubMed. We survey literature discussing barriers to vaccine acceptance in past rollouts (e.g., COVID-19, hepatitis B) and barriers to HCV management, particularly in PWID.

Results: Six key challenges were identified: (1) structural and social barriers affecting PWID, (2) vaccine safety, efficacy, and relevance concerns, (3) multiple-dose attrition and vaccine fatigue, (4) media presentation and misinformation, (5) awareness and attitude towards infection, and (6) information framing and primary care linkage. Four possible recommendations were also identified: (1) vaccine promotion in targeted educational and outreach campaigns, (2) community-level support programs integrated with vaccine rollout, (3) rollout of a pan-genotypic, multivalent, or combination vaccine, and (4) cost-benefit analysis supporting the vaccine.

Conclusion: This forward-looking paper offers several recommendations to address potential gaps in HCV vaccination-from linkage with syringe exchange programs to economic analysis of vaccination program costs.