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In episode 12 of our Inside Covid-19 podcast, much needed hope for South Africa’s fight against the virus as research from a top US university suggests the BCG vaccination against TB, administered in the country for the past 80 years, provides protection against Covid-19. More on that coming up, including an interview with assistant professor Dr Gonzalo Otazu, head of the NYIT research team whose paper is global reshaping thinking and has sparked a fresh wave of clinical trials. Also in this episode, a US-based South African is spearheading a drive to get a skin prick Covid-19 testing kit into the market and we go to Groote Schuur for a peek into how SA medics are preparing for the expected wave of coronavirus patients. – Alec Hogg
We’re joined now by Dr. Noluthando Nematswerani, the head of the Discovery Health Centre for Clinical Excellence. Nolu, it’s always good to talk with you, particularly today after some encouraging news from the New York Institute of Technology College of Osteopathic Medicine. Some of the research suggests that there’s a very good reason why we have such different mortality rates in the US, Italy and Spain – which are way ahead of the rest of the world in Covid-19 infections – and it’s got something to do with a vaccine called BCG or Bacillus Calmette–Guérin vaccine. I’m really way outside my comfort zone here, what exactly is BCG?
It’s an old vaccine that has been incorporated into our vaccination schedules in South Africa. The vaccine is used to protect ourselves against tuberculosis which is an infection that is quite prevalent here. It’s usually given to kids at birth in South Africa as well as other countries who have these vaccine policies in place. When we grew up, it used to be like a stamp that was administered on one’s shoulder or the upper arm. It’s a subcutaneous injection and you get a little bump that forms on the upper deltoid.
Do many South Africans have this?
The policy in our country is that every child has to have the BCG vaccine at birth. If you look at the immunisation schedule tended program, it includes BCG vaccination at birth and so most kids – by the time they leave the hospital – have been immunised against TB.
How long have we had this policy in place?
Many years. It’s something that was already here when I was born. We are also vaccinated at schools but most importantly it is done at birth. All kids have to have the BCG vaccine before they can leave the hospital.
So we are one of the countries where most of the population – one hopes – got BCG’s. The research that now comes from the New York Institute of Technology – that we referred to right in the beginning – is very interesting in this regard. Is it something that we can take seriously?
Any promising protective mechanism that relates to BCG or any other form of treatment – that could be seen as stopping this epidemic – is something that we will have to take interest in. We need to make sure that it is well researched before we make any conclusions. I think at this stage, there’s still a lot more research that needs to be done before we can say that this is something that is going to be useful. I think from a South African point of view – considering that there is this universal policy around immunising against TB – it would be a good outcome if there is protection against Covid-19, considering our high prevalence of HIV which we are worried about. If there is any hope of protection – on some level – with BCG that would be great.
To summarise – and maybe you can fill in the gaps here – according to the research that has come out in the countries which have BCG immunisation (and as you’ve explained South Africa is one of them), they have had far lower mortality rates than the countries which don’t have this policy in place – particular Spain, Italy and the United States. Does it make sense to you as a doctor and a scientist?
Yes. The analysis actually shows that the countries that don’t have the universal TB vaccine program seem to have worse infection rates. The number of infections that are in those countries – when you compare it with countries like Japan and all the other Asian countries – where there is some form of enforcement of this universal TB vaccine clinician programs. So right now, it is too soon to say. It does look quite compelling when you look at it, but there could be other factors and only research will give us those answers. There are other practices in those countries which are slightly different. There may be different responses to the epidemic which may have resulted in the picture you see, but this BCG discussion thats in the mix needs to be thoroughly investigated. It’s very interesting but I think there’s still a little way for us to make a definitive conclusion around what we are finding in the data.
The whole thesis here is that this vaccination against TB has given the body immunisation – or a certain degree of immunisation – against Covid-19. What exactly is the purpose of a vaccination?
We give a vaccine – which is usually a weakened strain of either a bacteria or a virus – to stimulate the immune system so that when you’re faced with a real infection, your body has already developed antibodies to fight it. Usually those antibodies are quite specific to the infection you’re trying to immunise against. So the procedure will be to immunise against tuberculosis so the immune response protects you against TB. There are some immunotherapy benefits that have been seen with BCG, that extend beyond TB and other respiratory infections and it does appear that it is protective against some of these viral infections. Their whole argument around BCG is that it has extended benefits – that are now being researched – which show this could be useful against Covid-19, which also causes a respiratory type of infection.
Isn’t it amazing though, something that was never intended at the time – it was intended to fight TB – and out of left field comes something that actually might by accident be protecting us against this very serious disease.
Definitely, which is why I think this is going to be a very important piece of research and it’s going to be of great interest to our local researchers too. Countries where they do not have this universal TB vaccination program may start thinking about it now, they may start using BCG to fast track the development of immunity. We are watching the research very closely and hoping for positive results, because it has a huge bearing in terms of the South African context.
Just to close off with, why would the United States, Spain and Italy not have immunised the children or not use this vaccine?
If you look at South Africa the incidence rates of TB are relatively high – which is why they have immunised the community – but where there is a relatively low incidence rate of TB, maybe there is no requirement for some of these policies to be in place. Instead of worrying about infectious diseases they worry more about non-communicable diseases which are bad news in some of those environments. It just depends on the burden of disease in each country and the focus of their doctors. In a country where we’ve got a very high burden of infectious diseases – regarding our immunisation schedule – we have a very strong focus on preventing those infections. TB is a huge problem and we know that the HIV/TB partnership is something that is quite significant for us. There are other countries similarly to us that have also got a higher burden of infectious diseases and therefore they will have the same approach as us. So it just depends on each country and their current disease prevalence and their burden of disease, that’s how they would structure their policies. HIV testing and screening in South Africa, is something that needs to be enforced as well as in countries where there is a high prevalence of HIV. You have to have a universal testing program. But other countries, where prevalence is very low, testing for those diseases is optional.
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