"Bacillus Calmette-Guérin" As a South Indian kid growing up in the 80s, memorizing country capitals, names of political leaders, and essential abbreviations was something I was quite good at, even if I wasn’t old enough to not see the point. The vaccine first used against tuberculosis (TB) in 1921—the expanded version of BCG—is given to tens of millions of children globally each year. But the vaccine’s effects don’t last forever and start waning after a decade or so. This is why the number of TB cases hasn’t fallen. In fact, in 2021, there was a rise in new active cases worldwide, with a total of 10.6 million cases reported. And these are just the cases we managed to detect because it is estimated that 25% of the world’s population is infected with TB. Following the coordinated global response to Covid-19, vaccines have regained significant strategic and commercial attention. And given that the country with the highest incidence of TB is India, it’s natural that the fight to develop new ways to detect and vaccinate against it is also emanating from the country. In 2021, Prime Minister Narendra Modi blew the bugle on eliminating TB by 2025. In March 2022, the Serum Institute of India—the world’s largest vaccine maker—applied for emergency-use authorisation for its rBCG vaccine. But there is no publicly available data to support the efficacy of the rBCG vaccine in protecting against TB or decreasing transmission of the disease in adults. And vaccines for adults would help best if they are administered to those most in need. Thus, diagnosis is an opportunity too. Late in 2022, MyLab Discovery Solutions announced it had received ‘market authorization’ for new diagnostic tests. Serum has a 49% stake in MyLab. Neither India’s medical regulator—which takes a 5% royalty from firms to validate a commercial product—nor MyLab responded to questions on the study conducted for the test. TB is both a health crisis and a massive market opportunity in the country. But the war for the market ironically sets back the national TB programme by several months.
