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Infectious Diseases

Updated 29 April 2020

Keep TB vaccine for babies, implore experts

Babies in countries with high rates of tuberculosis must have priority access to the Bacille Calmette-Guerin (BCG) vaccine, warn experts.

Babies in countries with high rates of tuberculosis must have priority access to the Bacille Calmette-Guerin (BCG) vaccine, warn experts.

There has been an increase in demand for the vaccine after a paper was published that speculated it might offer protection against Covid-19.

But a global shortage of BCG, particularly in 2014 and 2017, resulted in a “dramatic increase in the incidence of TB meningitis in young children”, according to the 11 public health and paediatric specialists in a letter published on Tuesday in the International Journal of Tuberculosis and Lung Disease.

Describing BCG as a “scarce resource” because of a lack of production facilities, the authors appeal to the global community to exercise “responsible stewardship” by ensuring that the vaccine goes first to all newborns and unvaccinated children under the age of three where TB is prevalent.

“The use of BCG for an unproven indication is irresponsible and may deplete BCG stocks for young children, for whom it has been proven to be a lifesaving preventive tool against TB-related morbidity and mortality,” state the experts, including Professor Simon Schaaf from the Desmond Tutu TB Centre and University of Stellenbosch’s Paediatrics and Child Health department, Professor Mark Cotton, Director of Stellenbosch’s Children's Infectious Diseases Clinical Research Unit, and Dr James Seddon from Imperial College in London.

'No compelling evidence'

Professor Schaaf said they had written the letter after they had “become aware that clinicians were starting to look for BCG to ‘protect’ themselves and their unvaccinated patients against Covid-19”. 

The paper that suggested BCG might offer protection against Covid-19 has not been peer-reviewed. However, three trials are underway - in South Africa, the Netherlands and Australia - to study the impact of BCG on Covid-19.

Schaaf described the paper as “biased” because it “excluded countries with good outcomes [against Covid-19] that were not giving BCG routinely as well as in the fact that countries included were at different stages of the epidemic”. 

“There is currently no compelling evidence, either for or against, that BCG protects individuals from Covid-19,” according to the letter.

“Outside of a clinical trial, healthcare workers (or other individuals) should therefore not receive BCG vaccination for protection against Covid-19. Healthcare workers, many of whom are at high risk of Covid-19 disease, should consider enrolling in trials, including those where BCG is used as an intervention, if feasible.” 

They also warn that health workers who are already infected with latent TB –  common places where TB is widespread – might have a “strong local reaction” where they have been injected.

Global fear of the Covid-19 pandemic has sparked a run on medicines that may have the potential to protect people against infection. In the US, there were stock-outs of hydroxychloroquine, used to treat autoimmune diseases such as lupus, after US president Donald Trump touted it as a possible Covid-19 treatment

Cullinan is the health editor for openDemocracy 50.50, and based in South Africa.

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