First BCG shot in 1921: Why did it take decades to scale up its rollout?
BCG vaccine was first administered in humans in 1921. Despite the crippling burden of TB, it took almost another half a century for governments to begin resolving issues, which marred its rollout in TB-affected nations, including manufacturing and supply-chain related issues.
"In 1970s and early 1980s, supply of BCG vaccine was very erratic for a very long time. So, we did not have much vaccine stock. BCG immunization picked up only after mid-1980s," said Dr Jacob John, Professor, Community Health department, Christian Medical College (CMC), Vellore, India. Vaccine shortage was so acute back then that "we had to import it from Denmark. Moreover, as it is not easy to maintain these doses, there was lot of wastage of the doses," said Dr John.
"In those days not just BCG vaccine uptake was low, but all other vaccination rates were low too. Institutional delivery rate was also low. Institutional delivery rates began picking up in mid-1980s," said Dr John. "BCG vaccination is now a part of institutional deliveries - when babies are born people know they have to give them vaccines, including BCG vaccine."
Agrees Dr Shibu Vijayan, a noted public health crusader who currently serves as Medical Director (Global Health) at Qure.ai. "Births that earlier happened at homes are now happening at medical facilities. The route of BCG vaccine is a health facility-based function. So, if the baby is not delivered in a medical facility, he/ she/ they may not get the vaccine."
A similar situation thrives in Nigeria: The nurse in charge of primary health centre (PHC) Angwan Maikai, Keffi, Nasarawa State in Nigeria, said that, like other PHCs, mothers are informed of the various vaccines, including BCG, during antenatal care. The challenge comes for those who do not attend antenatal or delivery at health facilities.
When vaccine coverage is low, hesitancy is also low
"I do not think it was an issue of vaccine hesitancy in those times, but an issue of the reach of immunization services, including those for BCG," said Dr Jacob John. "When your vaccine coverage is quite low, then issue of vaccine hesitancy is also low."
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