The first cancer vaccine

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Dec 22, 2025

The discussion delves into the groundbreaking hepatitis B vaccine, a pivotal achievement that marked the first viral protein subunit vaccine. From tracing historical jaundice outbreaks to the vaccine's life-saving impact on newborns, the hosts cover incredible scientific journeys. They recount the intricate manufacturing processes, ethical debates over early testing, and how recombinant technology transformed vaccine creation. The episode also highlights remarkable reductions in liver cancer incidences and the vaccine's legacy in shaping future medical innovations.

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ADVICE

Layer Multiple Inactivation Steps

When purifying blood-derived vaccines, inactivate contaminants using multiple independent steps.
Use orthogonal methods (enzymes, denaturants, fixatives) to reduce residual infectious risk.

ANECDOTE

Patent Drama With Blumberg And Hilleman

Baruch Blumberg patented a hepatitis B vaccine concept before others had made it.
That patent later triggered disputes over credit and manufacturing control.

INSIGHT

Recombinant Yeast Replaced Plasma Production

Recombinant DNA let manufacturers produce HBsAg in yeast, matching natural particle structure and immunogenicity.
That shift removed dependence on human plasma and improved scalability and safety.

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Hepatitis B is a tiny virus that causes hundreds of thousands of deaths from liver disease and cancer each year. The vaccine against it became the first of many milestones: it was the first viral protein subunit vaccine, the first recombinant vaccine, and the first vaccine to prevent a type of cancer.

In this episode, Jacob and Saloni follow the trail of strange jaundice outbreaks that scientists traced to a stealthy liver virus, how scientists turned one viral surface protein into a lifesaving shot for newborns, and how it was all built upon breakthroughs in immunology.

Hard Drugs is a new podcast from Works in Progress and Coefficient Giving about medical innovation presented by Saloni Dattani and Jacob Trefethen.

You can watch or listen on YouTube, Spotify, or Apple Podcasts.

Chapters:
0:00:00 Introducing the hepatitis B vaccine
0:15:46 The mysterious trail of jaundice outbreaks
0:28:03 How a tiny virus causes cirrhosis and liver cancer
0:53:19 Maurice Hilleman's purified hep B vaccine
1:17:36 Turning the hep B vaccine recombinant
1:29:14 The impact of hep B vaccination
1:39:27 The 19th century battle for immunology
2:01:34 How the body makes an almost infinite number of antibodies
2:30:57 How subunit vaccines took over
2:45:33 Conclusion

Saloni’s substack newsletter: https://www.scientificdiscovery.dev/

Jacob’s blog: https://blog.jacobtrefethen.com/

Books:

Paul Offit (2007) Vaccinated: One Man's Quest to Defeat the World's Deadliest Diseases
Arthur M Silverstein (2009) A history of immunology
Ronald W Ellis (1993) Hepatitis B Vaccines in Clinical Practice
Sally Smith Hughes (2011) Genentech: The beginnings of biotech

Articles:

Timothy M. Block et al. (2016) A historical perspective on the discovery and elucidation of the hepatitis B virus https://doi.org/10.1016/j.antiviral.2016.04.012
Naijuan Yao et al. (2022) Incidence of mother-to-child transmission of hepatitis B in relation to maternal peripartum antiviral prophylaxis: A systematic review and meta-analysis https://doi.org/10.1111/aogs.14448
Jill Koshiol et al. (2019) Beasley’s 1981 paper: The power of a well-designed cohort study to drive liver cancer research and prevention https://pmc.ncbi.nlm.nih.gov/articles/PMC5866222/
William J. McAleer et al. (1984) Human hepatitis B vaccine from recombinant yeast https://doi.org/10.1038/307178a0
Chunfeng Qu et al. (2014) Efficacy of Neonatal HBV Vaccination on Liver Cancer and Other Liver Diseases over 30-Year Follow-up of the Qidong Hepatitis B Intervention Study: A Cluster Randomized Controlled Trial https://doi.org/10.1371/journal.pmed.1001774
Anthony R Rees (2020) Understanding the human antibody repertoire https://doi.org/10.1080/19420862.2020.1729683

Correction: Urea was mentioned as a protein, but is actually the product of a protein breakdown process, not a protein itself.

Acknowledgements:

Aria Babu, editor at Works in Progress
Graham Bessellieu, video editor
Abhishaike Mahajan, cover art
Atalanta Arden-Miller, art direction
David Hackett, composer

Works in Progress & Coefficient Giving