The case against B.C.G

COVID-19 and Beyond: Exploring Public Health Benefits from Non-Specific Effects of BCG Vaccination

Bacille Calmette–Guérin (BCG) vaccination, widely used throughout the world to protect against infant tuberculous meningitis and miliary tuberculosis (TB), can provide broad non-specific protection against infectious respiratory diseases in certain groups. Interest in BCG has seen a resurgence within the scientific community as the mechanisms for non-specific protection have begun to be elucidated. The impact of the COVID-19 pandemic on nearly every aspect of society has profoundly illustrated the pressure that respiratory infections can place on a national healthcare system, further renewing interest in BCG vaccination as a public health policy to reduce the burden of those illnesses. However, the United States does not recommend BCG vaccination due to its variable effectiveness against adult TB, the relatively low risk of Mycobacterium tuberculosis infection in most of the United States, and the vaccine’s interference with tuberculin skin test reactivity that complicates TB screening. In this review, we explore the broad immune training effects of BCG vaccination and literature on the effects of BCG vaccination on COVID-19 spread, disease severity, and mortality. We further discuss barriers to scheduled BCG vaccination in the United States and how those barriers could potentially be overcome.

'We shall not find salvation in inoculation': BCG vaccination in Scandinavia, Britain and the USA, 1921-1960

BCG vaccination against tuberculosis was discovered in France in 1921. It was soon adopted with great enthusiasm in Scandinavia. By contrast, it was not introduced into Britain until around 1950 and was never used on a large scale in the USA. This article discusses the debates surrounding the efficacy and safety of BCG in the period 1921-1960 and the reasons for the very different responses in Scandinavia, Britain and the USA. It argues that while the debates centred on the scientific value of BCG, they were underpinned by ideological differences and different approaches to disease prevention and health and welfare policies.

Field trials of tuberculosis vaccines: how could we have done them better?

Nineteen controlled trials of vaccination against tuberculosis are reviewed. Most involved very large numbers of participants and represented a wide variety of geographic and socioeconomic conditions. The trials were conducted under field conditions that sometimes verged on the primitive. Length of follow-up for tuberculosis ranged from 3 to 23 years, and up to 28 years for cancer. Under these circumstances, compromises and mistakes were made along with notable successes. With the current interest in the immunology of tuberculosis and other chronic infectious diseases giving rise to renewed hope for more efficacious vaccines, lessons from the past can be useful in planning the long-term evaluations that will be needed as these hoped-for vaccines become available.

Development of subcutaneous abscesses due to Mycobacterium bovis following hepatitis and bacillus Calmette-Guerin vaccination

Vaccination to prevent hepatitis B and tuberculosis (TB) forms a part of the national immunization program in the Kingdom of Saudi Arabia. The hepatitis B vaccination was introduced in the Makkah region in January 1991G. Since then, 25 children have developed post vaccination subcutaneous abscesses at the site of vaccination. Microbiological studies proved these to be of bacillus Calmette-Guerin vaccine (BCG) origin. Ten patients were treated successfully with isoniazid (INH) and rifampicin and 15 with INH alone. Four patients required incision and drainage. Possible reasons for this complication in our patients are discussed.

BCG: who were Calmette and Guérin?

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