Why does hepatitis B, which can lead to liver cancer, often go undetected, even though tests exist? : Ingfei Chen / The New Yorker

Maurice Hilleman

Article shared by John Gilmartin

In 1978 I was a young supervisor in the Merck vaccine manufacturing plant in West Point PA. Maurice Hilleman was then head of vaccine research at Merck; he was sort of famous for vaccine success, and for being difficult to work with. Maurice dropped into the filling and freeze-drying office space with no warning one day. This was like Tom Brady or Taylor Swift dropping in to chat. We were busy, and his reputation fearsome, so we hung back wondering what’s up. A year before I volunteered as a phase one trial volunteer for Maurice’s new Hepatitis B vaccine. The company needed a few healthy volunteers to take the new vaccine to see if we had reactions. None of us reacted to the vaccine, and we may have shown a 'sero-conversion' (the lab told us nothing, but monitored our health for the coming year. At that time, Maurice believed his Hep B was going to be the first licensed anywhere. The French Pasteur Merrieux, and Belgian Smith Kline Glaxo were further behind in development.

During the visit Maurice declared, “this vaccine will be the first product to prevent cancer.” His tone was not bragging, but he was empathetic. I think he wanted us to know we had a small part in making the first vaccine that would prevent a cancer. I remember thinking, that is some big statement. He went on to say, 'this product will prove that some cancer is caused by viruses. And, that some cancer can be prevented by a vaccine.’ I remember thinking, why is Maurice Hilleman talking to us, we are a bunch of ex army production supervisors? If Maurice was right why wasn’t Merck putting him on a stage and addressing a real audiences. Merck Westpoint at that time had 3,000 people in the plant and research facility.

None of us who processed the first batches of the vaccine understood why Maurice said that. None of us had seen some one dying from acute Hepatitis, or cirrhosis. None of us knew Asian populations had high Hep B infection rates that began at infancy, nor did we know that Hep B infections were high in homosexual communities and male prison populations.

Maurice forced Merck to bring Hep B vaccine to a licensed product. Perhaps, one reason Maurice was talking to us, was the Marketing boys (100% male at that time), thought Maurice was weird and wasting their time. Before any product goes into final development the marketing folks decide what the likely sales and profit of will be. Marketing decided the only people in the US who would buy Hep B vaccine were surgeons, dentists and their nurses, ie elites who worked with blood daily. Further they believed that elite group did not suffer acute hepatitis, cirrhosis or other similar disease. Maurice threatened the board of Merck, to finish the hep b, or he would quit and take his people with him. Hilleman’s other vaccines were mainstays, and earned good returns.

The marketing boys wanted to get even with Maurice’s threats, so they said, Okay, we’ll sell his new vaccine, but at $50 a dose. The full schedule was three doses, so Hep B was $150 for a full course, which in 1979 was outrageous. Unicef at this time bought Merck Measles vaccine for 12 cents a dose. Maurice despised marketing, they were slick, and he could be crude. His lab was famous for people running screaming from him.

Maurice decided to do his own marketing analysis for Hep B vaccine, and hired a consultant epidemiologist. Then he called an all management meeting at the Westpoint plant site. Mauriced introduced his consultant, and this man asked the men in the audience to shake hands with the man in front of them, and the men next to them, and the man begind them. All 500 of so managers started handshaking and being jolly. Merck was a friendly place, and the company was a successful research pharmaceutical maker.

The men sat down, and the consultant said, ’thank you men, very good. Each of you has shaken the hand of four or five men. I want you to know, reliable data shows one of those men is or was a practicing homosexual at some time.’ Whereupon the collected management had the most astonishing reaction. They were in disbelief, and objecting. When things quieted down, the consultant then provided his data, and outlined the links with hep b, the disease, and populations. The consultants assessment was there was going to be a large demand for the vaccine at some point in the near future.

No one believed him, and all of them wondered what the semi famous vaccine man Hilleman was up to. The meeting became Merck folklore. Remember, the HIV/ Aids epidemic didn’t become visible until six or seven years later.

Hep B went on sale at $150 dollars a course. Sales were poor, just as marketing predicted. Then AID’s came, and then the linked hepatitis issue became known.

Hep B vaccine with no promotion became the first billion dollar vaccine in any vaccine company’s experience. With the advent of large Hep b sales, the once sleepy vaccine labs at Merck and other vaccine makers became the seed place of the Biotech revolution. Today Unicef and similar buy Hep B for less than 25 cents a dose. Today China is the world’s largest maker of Hep B vaccine.

Why tell you all this? A month ago The New Yorker ran a good piece on Hepatitis B, its impact, treatment and prevention. It remains a large deadly under recognized threat. I think it’s a good story worth your time.

And, since Maurice Hilleman remains the most under appreciated vaccinologist, and the only one I got to know (later in my unicef days), I’ve attached his Wikipedia entry which is also worth your time to study.

Ps. Maurice thought we in unicef were naive do-gooders. He’d say this with a smile, and ask me if I could find his son in law a job in the UN.

Thanks, John

Click here for the article

Summary

This article explores the quiet, widespread presence of hepatitis B virus (HBV) in the United States—a virus that can lead to liver cancer and cirrhosis but often goes undetected for years. Although vaccines and effective diagnostic tests exist, millions of Americans—particularly immigrants and people of Asian, Pacific Islander, and African descent—are unknowingly living with chronic HBV infections.

Chen tells the story through individuals and families affected by HBV, such as a Vietnamese immigrant who lost her husband and sister to liver cancer caused by undiagnosed HBV. The narrative highlights how cultural stigma, language barriers, medical neglect, and lack of awareness among clinicians have contributed to the persistence of the disease in the U.S.

Public health officials and advocates are pushing for universal screening, greater awareness, and proactive treatment to prevent liver disease and cancer. Despite guidelines from the CDC recommending HBV testing for all adults at least once in their lifetime, implementation remains inconsistent.

The article weaves scientific detail with human stories, revealing the emotional toll of the virus and emphasizing the urgent need for improved outreach and health equity.

Quotes
“Two-thirds of people in the U.S. with chronic hepatitis B don’t know they have it.”
“When you have hepatitis B, you feel fine until you don’t—and then it’s often too late.”
“Asian Americans and Pacific Islanders account for more than half of hepatitis B infections in the U.S., despite making up only 6 percent of the population.”