Tuberculosis

In June 2010 we ran a blog post about the International Tuberculosis Campaign, a post-WWII effort that TB tested and vaccinated tens of millions of people in 23 countries. The tenor of the campaign was optimistic and heroic, evident in this 1948 radio announcement from the president of the Danish Red Cross: “The spirit of the Nordic Vikings has been part of this campaign as in the old days. Earlier we went out sword in hand to conquer and fight each other. Today we go out together with the needles as our only weapon to fight the scourge of the Second World War: tuberculosis” (Brimnes 2007). Despite the wide reach of that promising campaign, tuberculosis today is an enormous global problem, with 1.4 million deaths from the disease and 9 million new cases a year. The disease orphans millions of children and robs individuals and communities of vital earning capacity. Worryingly, each year more than 500,000 cases of multidrug-resistant TB occur, and in December 2011 several cases of completely drug resistant TB were reported in India. Emergence of resistant strains of TB highlights the need for effective TB vaccines to try to prevent infection entirely. More

June 18, 2011, marks an important anniversary in the history of infectious disease and vaccines—on June 18, 1921, the tuberculosis vaccine was first given to a human. The vaccine, developed by French scientists Albert Calmette and Camille Guérin, was an oral preparation of Bacillus Calmette-Guérin, or BCG in shorthand. BCG is a weakened form of a tuberculosis bacterium that causes the disease in cows. Benjamin Weill-Hall (1875-1958), French pediatrician and bacteriologist, fed the vaccine to infants in Paris who were at risk for the disease in this first use of the vaccine.

Albert Calmette (1863-1933) had acquired the Mycobacterium bovis strain of tuberculosis, which had been isolated from the milk of an infected cow, in 1904. In 1908, at the Institut Pasteur in Lille, France, he and veterinarian Jean-Marie Camille Guérin (1872-1961) began attenuating M. bovis by passing it through a growth medium they had developed specifically for this purpose. Their immediate goal was to weaken the bacteria to the point where they could no longer kill a guinea pig. In the end, the researchers hoped to produce an attenuated strain of the bacillus that would safely confer immunity to an uninfected human host. It would be 13 years before they saw the fruits of their efforts. More

The Historical Medical Library here at The College of Physicians of Philadelphia holds seven floors of stacks of books, journals, and archives. The scale of the library, and its testament to human illness, can be overwhelming. Our recent research on tuberculosis provides an example: standing in the stacks, surrounded by row upon row of books about TB, is a grim experience. But though our library gives the impression that TB is an historical artifact, it’s most certainly not. It continues to take an enormous global toll: there are 9.4 million new infections a year, and there were 1.3 million deaths from TB in 2008 alone.

One of these recent trips into the stacks led us to the Final Report of the International Tuberculosis Campaign (1951), an optimistic portrait of the promises of an early immunization campaign. The book offers comprehensive statistics of the massive tuberculosis campaign undertaken in 23 countries in the late 1940s and early 1950s.

The project initially began as a Scandinavian Red Cross effort in Europe in the aftermath of World War II. Tuberculosis rates had soared in the disruption and privation the war created. In Poland, tuberculosis rates among children had quadrupled. As Niels Brimnes writes, the president of the Danish Red Cross announced on the radio in 1948, “The spirit of the Nordic Vikings has been part of this campaign as in the old days. Earlier we went out sword in hand to conquer and fight each other. Today we go out together with the needles as our only weapon to fight the scourge of the Second World War: tuberculosis” (Niels Brimnes, “Vikings against Tuberculosis: The International Tuberculosis Campaign in India”). More

On Monday, May 17, staff from the History of Vaccines project traveled to Washington, D.C. to attend “New Promise in the Search for HIV, TB and Malaria Vaccines,” a joint briefing held on the 30th anniversary of the eradication of smallpox.

In their opening remarks, Dr. Alan Bernstein (Global HIV Vaccine Enterprise), Dr. R. Gordon Douglas, Jr. (Aeras Global TB Vaccine Foundation) and Colonel Chris Ockenhouse (U.S. Military Malaria Vaccine Program, Walter Reed Army Institute of Research) all stressed the need for continued efforts toward vaccines for malaria, HIV, and TB. They also highlighted the overlap between the incidence of the three diseases, as well as the interaction between them: Douglas specifically stressed the importance of developing a TB vaccine that can be used in HIV-positive individuals.

We at the History of Vaccines project were happy to provide material for the keynote talk by Dr. Gregory Poland (Vaccine Research Group, Mayo Clinic). Dr. Poland discussed historical and contemporary challenges in vaccine development and deployment, including political agendas and the threat of diseases as bioweapons post-eradication. More