Carol Nyirenda
CITAMplus

What access considerations do we need to address to successfully introduce new TB vaccines?

The Global Plan envisions mass vaccination for TB. To get the impact that we need from a new TB vaccine, a new vaccine needs to be 1) affordable, 2) widely available, 3) integrated into the health system, and 4) acceptable to people who are at risk of TB, and therefore
stand to benefit the most from a new vaccine.

Affordability will be determined by the cost to purchase vaccines plus the cost of delivering them to the people. These costs will need to be low enough that health systems and global donors can procure them in large enough quantities. The Global Plan's
modeling assumes that vaccinating each person would cost 12 US dollars.

Making new vaccines widely available is going to take more than getting vaccines at a good price. As you learned earlier in the course, the BCG vaccine being used today is given to infants. Virtually every country has systems for delivering vaccines to infants and
children, but the new TB vaccine candidates being developed today would need to be made available to adults and adolescents as a priority. So in a lot of cases, countries are going to have to make special efforts to deliver new TB vaccines to these populations.  The Global Plan lays out specific steps that countries should take in order to do this.

In addition to setting up systems for getting new vaccines to adults and adolescents, another big priority is to not lose any time. We want new vaccines to be accessible as soon as possible once they're approved.

There are many cases of vaccines taking years to become available to people in low income countries after they're approved. We need to avoid this. And so it's extremely important for governments to be preparing for new TB vaccines now.

This means governments in countries affected by TB need to develop vaccine implementation plans as part of TB vaccination plans. Implementation plans need to show how new TB vaccines will be integrated into health systems. This means making sure that TB programs, but also HIV programs, services for providing care for other health issues like diabetes, and services to help people stop
smoking and other areas are also taken into account. It also means bringing vaccination services into the community, such as at schools or sporting events to provide places where people can receive vaccinations conveniently.

TB vaccines also need to be acceptable to people in the community. This will require partners to come together to educate communities using accurate, evidence-based, but easy to understand information. Engaging communities in discussion early, as part of developing implementation plans, will help to ensure that concerns within the community are met and that plans for ensuring vaccine access address those concerns.

It's one thing, to create a new vaccine. It is important. But it is also important to ensure that the affected communities are also fully engaged and at the center of the response. That way they will be the people who go into the communities and create demand, and
then that will increase the uptake of the vaccine once it has been developed.

Luckily there are important lessons about vaccine access that we can learn from. Like efforts to protect people against COVID-19. COVID-19 vaccines were developed very quickly in response to the pandemic, which was a historic achievement. But the vaccines
were not distributed equitably around the world. It was much, much easier for a person in a high-income country to access a COVID-19 vaccine than it was for a person in a lower income country.

And we know that people who are from marginalized communities also can face challenges accessing vaccines. Countries should begin making preparations now so that when new TB vaccines are developed, they are ready to begin making them accessible to
as many people as possible and as quickly as possible.

Will it take effort to make new TB vaccines accessible? Yes.
Will having new TB vaccines mean that fewer people need to access TB treatment because fewer people will get sick? Yes.

Will it be worth it? Yes.