|The troubled life of the BCG-Vaccine, 1945-82|
|Ever since the BCG-vaccine against tuberculosis was developed by Calmette and Guerin in 1921, it has been controversial. Two point of criticism have been put forward against the vaccine:
· It was not safe
· It was not efficacious
After WWII it was generally agreed that BCG was harmless, but disagreements over its efficacy continued. France and the Scandinavian countries tended to favour the use of BCG-vaccine, while scepticism was widespread in the United States and Britain. In 1948 UNICEF and WHO nevertheless adopted BCG-vaccination as the primary international strategy against TB, arguing that it was the best preventive available in the immediate post-war period.
During the 1950s UN-organisations invested large sums of money in world-wide BCG-vaccination campaigns, but it was not until 1959 that WHO made a systematic assessment of the ‘degree of protection’ provided by BCG. Although the information available at the time was ambiguous, WHO concluded that BCG could give up to 80% protection against TB and decided that BCG-vaccination should continue to have an important place in the WHO-recommended strategy against TB.
In 1980 results published from a major trial in South India suggested that the vaccine was virtually without effect against pulmonary TB, the most serious form of the disease. These results came as a big surprise, but WHO continued to recommend the vaccine as part of national vaccination programmes up to1982 (and perhaps beyond). Today BCG is still used, no longer as a preventive against pulmonary TB, but against childhood tuberculous meningitis.
The paper will trace the arguments tabled for and against BCG-vaccination and give a critical assessment of WHO’s policy regarding the use of the BCG-vaccine, in the attempt to control TB worldwide.