BCG (Bacille Calmette-Guerin) Vaccine Trial. FAQ (Frequently Asked Questions)

BCG (Bacille Calmette-Guerin) Vaccine Trial. FAQ (Frequently Asked Questions)

BCG (Bacille Calmette-Guerin) Vaccine Trial. FAQ (Frequently Asked Questions)

Question : Will BCG vaccine really benefit to control COVID in elderly ?
My Answer : Yet, It will. But, “control”, (like Prevent or Save) is a wrong word to be used. The Right word is “Reduce”

BCG Vaccine won’t benefit to control COVID in elderly
BCG Vaccine won’t benefit to prevent COVID in elderly
BCG Vaccine won’t save elderly from COVID
But
BCG Vaccine will reduce Mortality and Morbidity in Elderly

To Substantiate this, they are planning to start a trial

பிசிஜி தடுப்பூசி போட்டால் கொரோனாவை தடுக்க முடியாது
பிசிஜி தடுப்பூசி போட்டால் கொரோனாவை ஒழிக்க முடியாது
பிசிஜி தடுப்பூசி போட்டால் கொரோனாவில் இருந்து பாதுகாக்க முடியாது

ஆனால்
பிசிஜி தடுப்பூசி போட்டால் கொரோனாவினால் ஏற்படும் நோய் பாதிப்புகள் குறையும்
பிசிஜி தடுப்பூசி போட்டால் கொரோனாவினால் ஏற்படும் நோய் தீவிரங்கள் குறையும்
பிசிஜி தடுப்பூசி போட்டால் கொரோனாவினால் ஏற்படும் மரணங்கள் குறையும்

இதை உறுதிப்படுத்தத்தான் ஆய்வு தொடங்கவுள்ளது

Question 2 : That too not proven right.? And many countries didn’t accept that experiment …
Answer 2 : Proven with Observational Studies
Example : Low Mortality and Morbidity in Portugal as compared with Spain

Question 3 : If it prevents mortality it’s fine. Otherwise experimenting on elderly those are already more riskier will not be accepted.
Answer 3 : Actually

We need to define the word experiment here

For Example

Experiment 1
If you give BCG to 10000 people in August 2020
and Take 10000 people as control
Do nothing else
And see the difference in Outcome in Feb 2021

Experiment 2
If you give BCG to 10000 people in August 2020
and Take 10000 people as control
Expose them to Corona Virus Filled Air in Jan
And see the difference in Outcome in Feb 2021

  • 1 is OK
  • 2 is wrong

This is the difference we need to understand

Anti Rabies Vaccine for Dog Bite. Availability in Primary Health Centre and Medical College

Some Times Truth is Stranger than Fiction
So
Let me share a real fact.

-oOo-

I joined Tamil Nadu Medical Services in 2004 and worked for three years in Primary Health Centres. In Primary Health Centres, Run by Department of Health, Government of Tamil Nadu, we used to give ARV (Anti Rabies Vaccine) any time the patient walks in.

And then
I came to Madras Medical College, a tertiary care institution and was shocked to find that Vaccines are given only from 8 AM to 11 AM and that too only on Working Days. . . I could not comprehend the rationale. I am sure that Dogs in areas round the medical college hospital do not follow Calendar and Watch when biting on unsuspecting individuals

-oOo-



So, you have two hospitals run by the Same Government, Same Ministry, Same Minister, Same Health Secretary

  1. A 24x7x365 Tertiary Care Hospital, with nearly 1000 doctors working and around 5000 beds, where Vaccines for dog bite are given only 3 hours for 6 days a week
  2. A Primary Health Centre, with just two doctors, where vaccines for dog bite are given any time the patient walks in

Logic says that you will expect better service in a Tertiary Care Hospital
But
In Reality, Primary Health Centres Provide Better Service

So, the administrative fact that is really fiction is that Tertiary Health Care gives better service 🙂

I did try to analyse why this happened and found the reason too

It was because

Anti Rabies Vaccine Multi Dose Vial

Earlier, Vaccines came in Multi Dose Vial. That is in a single bottle (or ampoule) there were many doses. So, they took the bottle out of the fridge and wanted to finish it off quickly. So they made people come within a narrow time window
But
Now, vaccines come in single dose vial. Only one dose in a bottle (or ampoule). So they can open the vial, give the injection and need not worry about keep it safe again

Anti Rabies Vaccines started in Medical Colleges a long time ago, So they followed the narrow time window. They did not think to change it when multi dose vials got replaced by single dose vials. They did not apply their mind. They did not take the new scientific advancement to their advantage. It is like a person who started using bicycle, continuing in bicycle even after two wheelers were invented

Anti Rabies Vaccine Single Dose Vial

But
Primary Health Centres, where they recently started Anti Rabies Vaccines and at that time, they had single dose vials. So they did not have any time window

This also underlies lessons in Management :

  1. All Protocols need to be reviewed at regular intervals and see whether a new and better protocol be introduced taking into account a recent invention or scientific advancement
  2. Smaller institutions may have better protocols. So learning should be two way and the bigger institutions need not always push their ideas