As India inches closer to the deadline it set itself to eliminate tuberculosis in the country, the Director General of the Indian Council of Medical Research has said that vaccines for TB will play an important role in this endeavour. Dr Rajiv Bahl was speaking during the roundtable discussion on ‘Asia Region TB Vaccine R&D Financing’ held as part of the World Health Summit Regional Meeting in New Delhi on Friday. 

India has said that they would eliminate TB by 2025,  five years before the World Health Organisation’s (WHO) deadline. While the country has made some strides in this, it is still a looming task. 7.2 lakh new TB cases were identified recently during a 100 day intensified campaign, raising questions about whether the country would be able to meet the ambitious deadline or not. 

“India is committed to eliminating tuberculosis and we think the vaccine will play an important role in that elimination and keeping it that way. So certainly we are prioritising having the vaccine in India,” said Dr Bahl. 

The discussion, which also saw Dr Soumya Swaminathan, the former Chief Scientist at the World Health Organization, Dr Veena Dhawan, the Additional Commissioner at the Ministry of Health and Family Welfare, Dr Urvashi Singh, the Deputy Director General at the Central TB Division, and Dr Nivedita Gupta, scientist at the ICMR, among others share their insights, looked at “to bring together Indian and regional stakeholders to refine and prioritize the recommendations for an innovative financing initiative for TB vaccine R&D discussed at the World Health Summit event in Berlin (in 2024), tailoring them to the specific context and needs of India and the broader South Asia region.”

Currently the BCG vaccine, which is given to infants and newborns, is the only licensed vaccine available, but it’s protection also wanes by early childhood, according to Dr Dhawan, underlining the unmet need for a new and improved vaccination for TB.

“What is ultimately needed is a preventive measure at population level, so that we can reduce incidence,” she added.

Multiple vaccine candidates

Dr Swaminathan mentioned that there are multiple vaccine candidates, and 11 are in late-stage development. 

“We definitely need to diversify the TB pipeline. As I showed you, there are a few there. Some of them have been sitting there for a very long time. So we need to see more candidates coming in and more exiting on the other side as well,” she said.

Variations of existing BCG vaccine for TB being studied

The central agencies have been experimenting with the existing BCG vaccine and trying to see if it would allow protection in adults. The ICMR recently concluded a phase 3 trial to evaluate safety and efficacy of recombinant BCG in preventing TB in healthy household contacts of newly diagnosed pulmonary TB patients. However, Dr Bahl highlighted that the results of this trial were not “encouraging” as “there was no significant reduction in the incidence of tuberculosis disease.”

However, the results showed some promise in a sub group of 6-18 year olds, he said.

“However this is a sub group analysis which is fraught with certain difficulties of making inference and what we are now going to suggest is to conduct a research study of some kind. We will design carefully which is fast enough for us to really know if there is a benefit in this school age population,” added Dr Bahl.

Dr Dhawan from the ministry of health, said that the govt was now trying to see if re-vaccination of vulnerable adults- including those who have had TB before, are over 60 years of age, have a history of smoking, are diabetic, are close contacts of other patients and have a BMI of less than 18- with the existing BCG vaccine would be beneficial.

“Till date 18 states have already implemented it, we have vaccinated around 10 million of beneficiaries. And two more states are in the process of introducing the process,” she said.

Dr Singh highlighted the potential for this saying that these vulnerable groups account for 80% of the burden.

“Now if we can give the BCG vaccine to protect our neonates, our zero day babies, with the hope that it will protect against disseminated TB, neurological TB, severe TB… why not our vulnerable population. This will be the first study of its kind where we will know the outcomes of BCG protection in a vulnerable population,” she said, while adding that if it is found to be “useful,”  it could possibly “contribute to our efforts towards TB elimination.”

Misinformation fuelled vaccine hesitancy a concern for TB control strategies too

The speakers spoke of how vaccine hesitancy was impeding on vaccine trials and also disease control strategies- including the studies involving the BCG vaccine.

“We have been facing vaccine hesitancy during this whole process. So whenever we are doing adult vax, we need to have a very effective communication strategy and a risk communication strategy,” said Dr Dhawan. 

Dr Bahl said that the COVID pandemic showed us that “even if you have an effective vax, people may not take it,” and that they were facing a similar issue with the BCG.

“I don’t think the media or the other many anti vax groups have done service to this area when they have talked about what the side effects and sometimes exaggerated side effects of COVID vax, for eg., globally. And that has put a lot of people at some trepidation about taking vaccines which are preventive of course in nature,” he said. 

He highlighted the consequences of such misinformation filled vaccine hesitancy, citing the example of the measles outbreak in the US because of “unfounded” claims that the vaccine can cause autism. 

“We are anyways going to continue our efforts towards elimination… and at the same time we will continue to work towards developing a new vaccine as much as we can. And we do hope it will be in time for us to be used during the day limitation of TB,” he said. 

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