Robert Nakibumba is a Kampala-based community health research consultant, TB advocate, and community representative to the Stop TB Partnership’s working group on new vaccines.
TB remains a major killer in the world, claiming the lives of 1.4 million people annually. With two billion people latently infected with TB, a third of the world’s population is at risk of developing TB disease. And despite the fact that TB is curable, dangerous drug-resistant strains of the disease are on the rise.
Mathematical modeling studies show TB cannot be eliminated as a public health threat without a better vaccine that is safe and effective in all the world’s populations, and that prevents all forms of TB. The only existing TB vaccine – Bacillus Calmette Guerin (BCG) – is effective against severe forms of childhood TB, but does not offer protection against pulmonary TB, the most infectious form of the disease. According to Medical Research Council studies, BCG’s variable protection wanes with age and is completely lost in adolescence. Furthermore, BCG is found to cause a life-threatening disseminated infection if given to HIV-positive infants. As a result, in 2007 the WHO stopped recommending the use of BCG among HIV-positive infants even if there is a high risk of exposure to TB. (http://connection.ebscohost.com/c/articles/25258381/revised-bcg-vaccination-guidelines-infants-risk-hiv-infection
This makes developing a TB vaccine that is safe and effective in all the world’s populations and age-groups a very urgent objective. But to achieve this objective, community demand for a new vaccine will be very important. There is, however, very low community awareness about the numerous shortcomings of BCG, which has made it untenable to generate the required demand necessary to push for the development of a better, new TB vaccine.
In October 2010, as a community representative to the New Vaccines Working Group of the Stop TB Partnership, I conducted a knowledge assessment survey in Eastern Uganda about community understanding of the importance of a new TB vaccine (presented at the 19th African region Union conference). Seventy percent of respondents said there was no need for another vaccine because there was one already. To them, TB is rampant in the community because some mothers do not take their children for immunization (BCG vaccination); but they get surprised that even some people who were immunized for TB as children have ended up catching the disease. This information shortfall has made it difficult to make a case for increasing investment in TB research and development.
So what can we do? Scientists, researchers, and philanthropists working on TB vaccines should prioritize tactical community sensitization activities on the limitations of the BCG vaccine and the need for new, better TB vaccines. It is only then that we will be able to generate the critical support and political will needed to increase investment in TB vaccines research; create an enabling and supportive environment for clinical trials, and lay the groundwork for acceptance and adoption of new TB vaccines once licensed.