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65.

TUBERCULOSIS VACCINES CLINICAL TRIAL
The following report on this trial of tuberculosis vaccine has been contributed by Dr. T.M. Pollock:
of the Medical Research Council's Tuberculosis Research Unit.
"Report for East Ham"
During the last few years the Medical Research Council, in conjunction with East Ham and other North
London boroughs, Birmingham, Manchester, and towns in the Midlands and North of England, have been engaged
in an investigation to assess the value of two tuberculosis vaccines. The vaccines concerned are
B.C. G. vaccine, which was first developed in France over thirty years ago and is now in general use in
many countries, and vole bacillus vaccine, a British vaccine developed in recent years and so far not
used so extensively as B. C. G.
Although B.C.G. vaccine has been in use for a long period there have been world-wide differences of
opinion about its value when used on a wide scale. In some countries, e.g. Denmark, B.C.G. has been
offered as a routine public health measure to almost all children, while in others, such as the U.S.A.,
it has been used very little. In Britain it has been given to contacts of the disease and more recently
to school children in some areas.
It is difficult to assess the value of B.C.G. from the results of its use in other countries, because
during the years since the introduction of the vaccine deaths from tuberculosis have been declining in
all Western European communities. Many factors, including improved living standards and the recent
striking advances in treatment and prevention, must have assisted in this decline but it is not possible
to estimate accurately the part played by each. In fact the reduction in the death rates from tuberculosis
achieved by some communities where the vaccine has not been used are as good as in some others
where it has been extensively given.
It was thus desirable that, before considering tuberculosis vaccination on a large scale in this
country, an investigation into the contribution likely to be made by this measure to the prevention of
tuberculosis in England should be known.
Description of Investigation
The effort to establish the value of the vaccines scientifically has required a large and detailed
investigation. Between September 1950 and December 1952, 56,000 young people aged 14 volunteered to
Join the scheme. Six hundred and fifty of these volunteers came from East Ham. Each volunteer had
a chest x-ray and skin test, and a proportion of selected susceptible children were given one or other
of the tuberculosis vaccines. Since then it has been essential for those conducting the investigation
to be kept informed about the development of any cases of tuberculosis among the participants. This
has been done by an annual postal enquiry, annual x-ray and annual home visit. The investigation has
required a high degree of co-operation between the Medical Research Council and the areas taking part.
In particular the home visiting of the participants by the health visitors has been largely responsible
for its success.
As a result of the intensive follow-up it has been possible to obtain evidence of the value of the
vaccines comparatively soon after the beginning of the scheme. A progress report published in February
of this year showed that vaccination of adolescents against tuberculosis is
dence of the disease occurring between the ages of 14 and 17 by about one half, and thus make a valuable
contribution to the prevention of tuberculosis. Now that the early results of the investigation are
known, vaccination schemes can be introduced with the certain knowledge that the expense and effort