With the number of coronavirus cases growing every day across the world; scientists are desperately looking for a silver bullet to stop the disease in its tracks or at least prevent fatalities from it. As the virus is new and moved so fast from China to the rest of the world; scientists are playing a catch-up race and are looking for shreds of evidence that some people may be spared from the full brunt of the epidemic. It did appear that older people were more likely to die from coronavirus complications than the young and judging from how the flu virus mainly effects people in the cold months; scientists are predicting that people in warmer countries like South Africa could expect less severe outbreaks. The higher fatality rate among men has also been ascribed to vaccinations that teenage girls receive to prevent complications when they become pregnant. And now a study by a professor at the New York Institute of Technology, Dr Gonzalo Otazu has found that there is a correlation between countries that require citizens to get the Bacillus Calmette–Guérin (BCG vaccine) to prevent tuberculosis and lower death rates from the coronavirus. South Africa has mandated this 100-year old vaccine since the 1940s and many will remember it as a stamp on the upper arm. This is clearly good news for South Africa where the infection rate and death rate are still relatively low compared to outbreaks in Italy and the United States. In the UK, BCG vaccines are only administered to people who travel to high risk areas and in some pockets in London. Dr Otazu told Biznews founder Alec on the Inside Covid-19 podcast that clinical trials need to be done to find out if there is indeed a causal relationship between the BCG jab and low Covid-19 fatality rates. This is not an indication that South Africans should become less cautious as he emphasised the importance of combining it with social distancing and many HIV/Aids patients do not receive this vaccination. – Linda van Tilburg
Welcome to Dr. Gonzalo Otazu who’s with the New York Institute of Technology. Dr.Otazu, you, some of your students and a colleague, have put together a research report that is giving hope to many people around the world, focusing on the TB vaccine BCG. What made you have a look at it in the first place?
I was surprised – as were many other people – at how differently the disease was spreading and the strong differences between countries. My attention was caught by the Japanese who had some of the first cases. However, the disease has not spread as widely compared to other developed countries, like Italy, which has been very strongly affected. There are many differences between these countries, but I knew that the BCG vaccination had this property which has been described before as having this broad immunity. So when I looked at the policies of universal vaccination, what immediately jumped out was that the countries that were being hit especially hard by the Covid-19, turned out to be the countries that never implemented a BCG vaccination policy.
This was what started this study. We compiled a lot – at least as comprehensive as possible given the circumstances (of more than 100 countries) – and compared the BCG policies with the number of deaths per million people. This is when we saw these relationships. However, let me point out that our study is a correlational study, it’s possible that there might be some other explanation. It could be for example that the countries who have a BCG vaccination policy might have a younger population. We are doing some analysis that could take that into account. That’s why it’s very important that we wait for the results of the ongoing clinical trials where, in a controlled population, we have randomised; some individuals will get a placebo and some will get the BCG – we’ll then be able to know if indeed there is a causal relationship.
In South Africa – going back to 1940 – we have had BCG vaccinations. Clearly, within this country there is concern given the high HIV/Aids rate that any little bit of help – any little bit of hope – that could come through, is very warmly greeted. If your research turns out to be accurate would there potentially be a problem with HIV/Aids being more of a threat?
That’s a really good point. In fact, the Centre for Disease Control advises against the use of the BCG vaccination in immuno-compromised populations. So that would be a factor that has to be taken into account. But let me point out something very important –Â although there are countries in East Asia that have managed to control the disease or have managed to reduce the number of cases – these countries did have BCG vaccination policies but all of those countries have implemented social distancing, quarantines and widespread testing. I’m not aware of any country that – just by having a BCG vaccinated policy – has been able to control the disease. All these measures might complement the BCG vaccination policy, but again, we have to wait to see the results of clinical trials.
In the research report that you put together, you made a very interesting distinction between Italy and Japan. Could you take us through that?
Actually, we are doing more analysis; I would like to point out some comparisons between Italy and India. One possible explanation that has been brought up, is that the countries that have been hit earlier, have been more strongly hit by the epidemic. So for example Italy; those countries might have been hit early and the spread
of the disease is going to be the same – independent of the country. However, the first reported case was the same in India as it was in Italy, though the number of cases in Italy are much higher for the size of the population.
How much greater – per million people – have the infections (and indeed the mortalities) been in Italy than they have in India?
In Italy as of March 30; there were 11,591 deaths for a population of 60 million, whereas in India – on this same day of March 30 – the number of deaths were 32 for a country of 1.38 billion people.
So it’s many times for the non-BCG vaccinated country?
Yes, but there are many differences and there might be something else that I’m missing – it’s not about the age distribution – but there are other things that might be there. So that’s why a controlled clinical trial is crucial to finding out if this correlation – if this relationship is a causal relationship.
What about the countries where the vaccination has been sporadic and again – in your report – you compared Spain with Denmark?
I wouldn’t say sporadic; it was that historically BCG vaccination was used, but then in some countries, as their rate of tuberculosis cases dropped, there was a switch of policy because, if the whole population has been BCG vaccinated, you wouldn’t know if somebody actually has the infection. So, that is why in some countries this remains in their policy, as is the case in Spain where they had this kind of policy – which they kept for longer times – and in doing so, covered more of their population.
With regards to the countries that have come to the party late (with the BCG vaccinations), as in Iran in 1984, you make the point that this also supports the conclusions that your initial report reached.
That’s correct. As is the case in Iran – which has a universal occurring vaccination policy – it just started in 1984.
So when you have an overall look at it, from the evidence that seems to be available from the United States, the Netherlands, Belgium, Italy – countries that never vaccinate (that never used BCG vaccinations) – are the hardest hit by far. Is there any other reason potentially why this might be the case; did they not practice social distancing? Were they earlier affected?
Those are good points. Right now, I’m in the middle of the quarantine here in New York – so social distancing has been practiced in these countries and they’re a developed country. They’re rich countries with advanced medical technology available to people. However, the death rates are high. But there might be other factors – that’s why a randomised trial should take care of all those factors that I cannot even think of right now.
And what kind of trials would they be?
First of all let me be very clear, I’m not involved in any of the clinical trials. So as I found these correlations –Â which I will submit in our report – we found out that there were actually other researchers that have started or were about to start clinical trials. So, I’m not directly involved in the research but these clinical trials are, as far as I understand, using the health care personnel which is now on the front lines being exposed to the virus. This will further the research regarding BCG vaccinations.
So these are not people who were vaccinated as children or as babies but, if they’re vaccinated now, is there potential that this could also help them?
I’m not familiar with the exact details of the trials but I would imagine that they would divide the population, because some people who are immigrants to this country, might have already had the vaccination. I don’t know if they’re being included.
There was something else in your report where you mentioned that mice (animals) had been used for testing. How exactly did that work?
Usually you have a vaccine for a particular disease, so you introduce that in activated organisms then the body mounts a defence against that and then the next time you get the infection (our memory of that very specific to that particular pathogen), you get a response -that’s the usual mechanisms whereby vaccines work. In the case of the BCG, it was called learning immunity – which is a broad response to most of the pathogens. So remember, the US stocked up for BCG – that was developed for tuberculosis – then later people found that it has this broad protection against other pathogens. So people have found this in animal experiments but also they have found in human observational trials where they compare populations of children in Guinea Bissau where the children that got a BCG vaccination; six months later had a reduced mortality rate compared to the children that did not get any vaccinations.
If you were advising the president of South Africa – remembering we have a population of 58 million people, we are in lockdown, we are on day 10 of lockdown now, 7.7 million people are HIV positive – the country has moved very early or relatively speaking, but the infection and mortality rates are very low, relatively speaking. What is the consequence of your study that should be taken into account by those who are making these decisions?
Again, it’s a correlational study. So I wouldn’t base any policy based on that study. Luckily, there are already these clinical trials and those clinical trials will give us an answer which you could base policy on.
So it’s too early to act on it but it’s a very hopeful sign in a world that is full of fear at the moment.
When I saw that correlation, my objective was for clinical trials to start – it’s worth looking at the clinical trial – luckily there were other researchers around the world that had the same idea and had already started clinical trials.
Are you updating your research as you go along?
Yes, I am in the process of doing that. So, the latest data we have is going to be for March 30 – that’s the data I just gave you. It’s been pretty busy and I’m not finding the data to finish but we are about to release an updated version.
And are you finding that it’s supporting the original hypothesis?
Oh! Yes.
