By Madison Ximenes-Merrill
The vaccine for tuberculosis was not discovered until 1921. It is still the same vaccine currently administered (Luca and Mihasecu 2013). The creation of the vaccine progressed from 1900 to 1956, including discovery of of the vaccine subculture and numerous trials over it’s long-term effectiveness. French scientists Albert Calmette and Camille Guerin started cultivating the vaccine in the early 1900s. Formation of the BCG vaccine, or the Bacille Camille Guerin vaccine, happened in 1919, after the subcultures created by both scientists showed no signs of active TB progression. Initially, the first trial for the vaccine was to take place in 1913 using cattle as the test subjects, but due to WWI, the trials were halted. The first human test subject for the BCG vaccine was an infant in Paris, France. The vaccine was administered orally by Benjamin Weill-Halle after the mother of the infant had died from TB. The effectiveness of this first trial led to the vaccination of 664 infants by 1924. Soon after, Camille Guerin created a specialized laboratory for the mass production of the BCG vaccine in Lille, France.
However, trials for the vaccine still needed to take place to prove it was effective in treating all forms of tuberculosis. In Leyton 1950, a medical health officer talked about the concern over the lack of evidence proving the effectiveness of the BCG vaccine. Creation and administration of a vaccine required a lot of time and resources, and proof was needed before production of the vaccine could take place. A report from Walthamstow 1960 explains that the Medical Research Council first needed to approve the scheme of the trials. In 1950, a plan was approved to test BCG’s effectiveness in herd immunity among school children. The majority of the Medical Officer of Health reports talk about the trials carried out with the BCG vaccine. Due to lack of resources, the vaccine was only administered to those seen to be at higher risk of exposure to TB (Leyton 1950).
In a report from Eastham 1958, medical officer Dr. Pollock stated that widespread vaccination in children aged 13-17 years old would vastly decrease the spread of TB in adolescents. There was a higher concern that children would catch TB in schools since the disease was airborne, and the children spent the majority of their time in close quarters. Although BCG was mostly effective in stopping the spread of TB, trials and inspections of its effectiveness still continued for the vaccine past the late 1950s, with the majority of the trials taking place in primary and secondary schools (Leyton 1954). Medical inspections of the vaccine within schools were highly common, since TB took the lives of many young children. The majority of the children were volunteered by their parents after a scheme of the trial was sent out to parents. The inspections usually involved a chest X-ray, a tuberculin test, and multiple home visits spanning over three years (Tottenham 1951). The chest X-rays would take place during the home visits using a mobile X-ray unit (Southall 1957).
Another complication with mass production of the vaccine came from a report in 1933, which stated that the culture in Guerin and Calmette’s vaccine was not completely avirulent or unable to produce active bacteria (Birkhaug 1933). Some opponents believed the lack of avirulence within the vaccine would lead to the progression of a fatal form of TB within those given the vaccine. The concern over the vaccine increased further because the BCG vaccine was already being administered heavily within infants without any research on its adverse effects. However, this claim did not halt the production of the vaccine but increased the want for further investigation into the effectiveness of the vaccine by carrying out trials.
A report from Southall 1958 goes into exquisite detail about how the medical inspections took place within the schools and during the home visits. Nearly 60,000 participants entered the trial between September 1950 and December 1952, all of which were school children. The trials involved a TB skin test and a chest X-ray. After both procedures were completed, the children were administered the BCG vaccine. Home check-ups were done by nurses working for the Local Health Authority. Home visits were an essential part of every trial, since they could confirm that the vaccine effectively prevented TB over time. As stated previously, the home visits also involved chest X-rays of the participants. The reason the trial spanned more than one year was to ensure that the vaccine protection persisted or whether a booster of the vaccine was needed. The trial spanned over six years, with no incidence of TB happening within any of the participants. After approximately six years of trials of the BCG vaccine, the first results were published in 1956, stating that the BCG vaccine was effective in preventing TB (East Ham 1956).