Will hesitancy be a barrier if a new TB vaccine is proven safe and effective?
"Current BCG coverage is high in most parts of India. If there are better vaccines people will take it - if its safety and efficacy is not in doubt. That is because a general idea that 'vaccines are good for infants' is accepted. But when we talk about vaccines for adults and/or older children (more than one year of age), then there are a whole lot of reasons why people may not want to opt for it," said Dr Jacob John. "Reluctance in some people to take adult vaccination or get older children vaccinated is more of a sociological issue than hesitancy."
We spoke to some leaders who are major influencers of TB response in India. "The existing BCG vaccine is a part of the universal immunization programme and is given to all infants born on day-zero. But the new vaccines that are being researched will hopefully be applicable to a larger population, if proven to be safe and effective. Research is currently underway so we will hopefully get to know soon if these new TB-vaccine candidates under research will be prioritised for most-at-risk populations, household contacts of TB patients, and for re-vaccination of those who got BCG shots earlier. The last word on the new vaccine(s) is not yet out to be used on a programmatic scale," said Dr Kuldeep Singh Sachdeva, former head of India's national TB programme, who has been deeply involved in the fight against TB for around two decades now. He currently heads the Southeast Asia regional office of International Union Against Tuberculosis and Lung Disease (The Union).
There are several new TB vaccine candidates that are currently under different stages of research. Dr C Padmapriyadarsini, who is a noted scientist and the Director of government-run National Institute for Research in Tuberculosis (NIRT), Indian Council of Medical Research, said: "NIRT is involved with the study of recombinant BCG vaccine, which is a TB preventive (prophylaxis) vaccine meant for the household contacts of TB patients. This study has been going on for almost 3 years now and is being done at 12 sites across India. In the study, household contacts of TB patients (who are above 14 years of age) were screened for TB and those who tested negative for TB disease, were given this TB-preventive vaccine. There was a follow up period of 2 years to see whether they developed (or not developed) TB. While we are expecting good results, the interim results will be available by end of March 2023 or early April 2023. Only then will it be known if this vaccine is helpful in preventing TB."
The recombinant BCG vaccine is also being tested in Bangladesh (and a few centres in India) to see if it can prevent TB recurrence when given to treated TB patients. Results of this are also expected around end of March 2023 or early April 2023.
India is also planning a study to investigate BCG revaccination or BCG vaccination in adult population. "We will investigate whether the BCG vaccine (that is currently used to vaccinate infants) can be used for adult vaccination to prevent TB. Some countries are already trying this BCG vaccine in adults to see whether it would prevent TB. A few small studies have shown that it increases the immunity of an individual," said Dr Padmapriyadarsini.
"There could be hesitancy when a new TB vaccine is introduced. And to overcome that and increase its acceptance we need to create awareness in the public. We saw a similar thing in COVID-19 vaccine where initially there was a lot of hesitancy. So, we must create awareness in the public that the vaccine is safe, and from what does it protect. That type of confidence building will go a long way in removing vaccine hesitancy and increase uptake of any vaccine," rightly said Dr Padmapriyadarsini.
Currently, feasibility and acceptability studies are also going on regarding the possible new TB vaccine in India, to find out if and why people might be hesitant to take it. "By the time the vaccine is ready we will have these results also. It would help if the vaccine became a part of the government vaccine immunization programme. For faster uptake, vaccine rollout must be a joint venture involving the manufacturer, government, public and private sector, and all other stakeholders who can help," said Dr Padmapriyadarsini.
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