A preliminary study was posted on medRxiv, an online archive for unpublished medical research and pre-print articles, that regarded TB/BCG vaccine as a potential answer to the COVID-19 ridden world. Subsequently researchers all over the world have started providing additional data inputs on the same, with WHO issuing a public advisory to keep the clueless public in sync with them. So before the clinical development of a new vaccine for COVID-19 is successful, can BCG help us in reducing the symptoms, if not be the ultimate cure, in the meantime? Complete Coverage: Coronavirus
Crux of the Matter
What’s all the hype about? Since more than 3 billion people have been its recipients in the past century, Bacillus Calmette-Guerin (BCG) vaccine is the world’s most used vaccine & is cheap and safe to be used for protection against respiratory infections and child morbidity and mortality. Tuberculosis (TB) and COVID-19 may be two very different respiratory diseases wherein the former is caused by a type of bacteria (Mycobacterium Tuberculosis) and the latter is caused by a virus strain (SARS-CoV-2). However, the new epidemiological study has discovered a probable correlation between countries where it is mandatory to be vaccinated against the lung-damaging TB or BCG, and the impact of COVID-19.
Source: CDC, A Database of Global BCG Vaccination Policies and practices
Gonzalo Otazu, one of the study’s authors said how the team became curious to know why countries like South Korea having lenient social isolation policies were faring better in the fight against COVID-19 than ones like Italy, USA and Netherlands who had taken more stringent containment measures. As they dug deeper, it was found that the former had a universal tuberculosis vaccination policy while the latter had none.
Stating timing as an important factor, the scientists contrasted two countries that have applied universal BCG vaccination, Japan to Iran, but at different periods of time. Japanese policy was placed in 1947 and it has about 100 fewer deaths per million inhabitants than Iran, whose policy got activated later in 1984. Similarly China, where this 21st century pandemic began, has a BCG vaccine policy but it wasn’t adhered to strictly before 1976.
A story of two neighbours – Spain and Portugal. #CoVID19 Deaths. Portugal has Universal BCG Immunisation. Spain does not.@laoneill111 @ARanganathan72 pic.twitter.com/S2rmY2GlRB — Gobardhan Das (@dasgobardhan) April 11, 2020
Global Race for framing the perfect trials Without further ado, countries around the globe have started off their respective probes and forming hypotheses. Australia plans to test the BCG vaccine on a larger scale to protect it’s healthcare staff and 4000+ workers would participate in this trial named BRACE, as per Murdoch Institute in Melbourne. Denise Faustman, director of immunobiology at Massachusetts General Hospital, Boston has been studying BCG for years as a therapy for type 1 diabetes. She wants to seek institutional permission to mount a trial at Boston’s Brigham and Women’s Hospital.
#Maharashtra govt has sought to use BCG vaccine for clinical trials on #Covid19. #Coronavirus #TheBurningQuestion More Videos: https://t.co/wMGGKJy9GN pic.twitter.com/W40cODLKV3 — IndiaToday (@IndiaToday) April 15, 2020
According to Rakesh Mishra, director of the Centre for Cellular and Molecular Biology (CCMB) in the nation with the largest manufacturing capacity of BCG, India, isolation and quarantine work the best against COVID-19 as of now.
BCG, DTP and PCV are vaccines of interest to be considered for containing COVID19. This study finds the relation between the immunization program in various countries and how it impacts the current spread and fatality of the corona virus. https://t.co/gSToGS7QYn@drsanjaygupta pic.twitter.com/dnDoiCcjVn — Hari Krishnan (@haricertify) April 9, 2020
BCG and Coronavirus: When a bacterium and virus meet Dr. Randy Cron of University of Alabama, Birmingham says BCG is a live-attenuated vaccine, containing live but weakened TB. This is called an adaptive immune response that provokes the body to develop antibodies to attack the specific pathogen after encountering it.
The only catch being, that it would be risky to administer it to hospitalized COVID-19 patients as they would have a compromised immune system or a system that simply overreacts to the SARS -CoV-2 virus, causing a deadly effect called cytokine storm. Cytokines are small proteins released by many different cells in the body that coordinate the body’s response against infection and trigger inflammation. But when more than required immune cells are activated, it results in hyperinflammation.
The unlikely allies in causing destruction
Glitches in this medical fairytale The current number of coronavirus cases is dramatically underestimated around the world due to shortages of diagnostic tests. It is even likely that under-funded health systems have low COVID-19 testing capacity, but happen to have universal BCG vaccination policies still in place, given that TB burden is highest in such places.
Then there exist countries with varying underlying demographic characteristics, such as differences in the age distribution of the populations of interest. South-East Asia and Africa have a median age of 27.0 and 18.7 years while Europe has a median age of 38.6 years, which is integral data to be considered for COVID-19 whose severity increases with age.
What Doctor WHO says The WHO (World Health Organization) has coldly stated how there is no solid evidence that the BCG vaccine can help in COVID-19 prevention and thus wouldn’t recommend it. It was quoted as saying “Studies like the Johns Hopkins one, are prone to significant bias from many confounders, including differences in national demographics and disease burden, testing rates for COVID-19 virus infections, and the stage of the pandemic in each country.”
In the absence of evidence, WHO does not recommend BCG vaccination for the prevention of #COVID19. WHO continues to recommend neonatal BCG vaccination in countries or settings with a high incidence of #tuberculosis. https://t.co/gWmsDKxFID — World Health Organization (WHO) (@WHO) April 13, 2020
Currently two clinical trials are underway and it will evaluate the evidence when it is available.
BCG may help in the fight against COVID-19 after all, but only well conducted, randomized and controlled clinical trials can answer this question. Mike Frick, Project Co-director, Treatment Action Group
In the meantime, epidemiologists and doctors can provide the medical facts while communities can provide the contextual details of what has worked for them in the past in surveys conducted by the local governments.
Great news: @MoHFW_INDIA & @WHOSEARO initiated a systematic engagement of @WHO’s national polio surveillance network, and other field staff, for 🇮🇳’s #COVID19 response, tapping into the best practices & resources that helped 🇮🇳 win its war against polio. https://t.co/G7ttUz5QkH — Tedros Adhanom Ghebreyesus (@DrTedros) April 15, 2020
Curiopedia
Bacillus Calmette–Guérin (BCG) vaccine is a vaccine primarily used against tuberculosis. In countries where tuberculosis is common, one dose is recommended in healthy babies as close to the time of birth as possible.
The BCG vaccine took almost 13 years to develop. When Albert Calmette, a French physician and bacteriologist, and his assistant and later colleague, Camille Guérin, a veterinarian, were not able to cause tuberculosis disease in research animals, they came to the conclusion that they had isolated the BCG Strain from virulent strain on glycerine potato medium after subculturing it 239 times (in 13 years).
As of 2006, only a few countries do not use BCG for routine vaccination. Two countries that have never used it routinely are the United States and the Netherlands.
In the summer of 1930 in Lübeck, 240 infants were vaccinated with BCG in the first 10 days of life; almost all developed tuberculosis and 72 infants died. It was subsequently discovered that the BCG administered there had been contaminated with a virulent strain that was being stored in the same incubator, which led to legal action against the manufacturers of the vaccine.
Curated Coverage
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The Week – Four people injured in Indian Army firing across LoC, says Pakistan
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The Economic Times – Pakistan summons Indian diplomat over ‘unprovoked ceasefire violations’
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