Social determinants and BCG efficacy: a call for a socio-biological approach to TB prevention.

Jennifer B Dowd,Helen A Fletcher,Delia Boccia

doi:10.12688/f1000research.14085.1

Abstract

A high burden of TB mortality persists despite the long-term availability of the bacillus Calmette-Guérin (BCG) vaccine, whose efficacy has been highly variable across populations. Innovative and alternative approaches to TB prevention are urgently needed while optimal biomedical tools continue to be developed. We call for new interdisciplinary collaborations to expand and integrate our understanding of how social determinants influence the biological processes that lead to TB disease, how this translates into differential BCG efficacy and, ultimately, how social protection interventions can play a role in reducing the global burden of TB. After providing an overview of the immune pathways important for the establishment of a response to the BCG vaccine, we outline how social determinants and psychosocial stressors can contribute to the observed variation in BCG efficacy above and beyond these biological factors. We conclude by proposing a new interdisciplinary research model based on the integration of social epidemiology theories with biomedical knowledge.

Highlights

Improvements in the prevention of Tuberculosis (TB) remain an urgent global public health priority, with the disease killing an estimated 1.5 million people annually1. This high burden of mortality persists despite the long-term availability of the bacillus Calmette-Guérin (BCG) vaccine, whose efficacy has been highly variable across populations
After providing an overview of the immune pathways important for the establishment of a response to the BCG vaccine, we propose a new focus on social determinants and psychosocial stressors that can contribute to the observed variation in BCG efficacy above and beyond these biological factors
Recent simulations suggest that if existing biomedical tools, including current BCG, were combined synergistically with social protection interventions, this could result in a significant acceleration in the decline of TB incidence globally46

Summary

23 Feb 2018 report report

University of California, San Francisco (UCSF), San Francisco, USA. Any reports and responses or comments on the article can be found at the end of the article. BCG, social determinants, social protection, psychosocial, immunity, vaccine, psychosocial stress. This article is included in the World TB Day collection

Introduction

Conclusions

Antai D

10. Cohen S

27. Phillips AC

46. World Health Organization