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It’s a valid question, but I don’t think the current vaccine-unfriendly climate in the US is the reason why the BCG vaccine wasn’t mentioned. BCG wasn’t routine

It’s a valid question, but I don’t think the current vaccine-unfriendly climate in the US is the reason why the BCG vaccine wasn’t mentioned. BCG wasn’t routinely given in the US even in the last half of the 20th century when vaccines were universally popular. I was surprised to learn a TB vaccine even existed when I started a public health−adjacent job in the 2000s. Our public health establishment just isn’t convinced it’s worth giving here.

BeetleB 2y ago
The US medical community never accepted the effectiveness of that vaccine. They don't think it does a good job at prevention and it makes it harder to detect as anyone whose had that vaccine treats positive with the skin test.
- ksenzee 2y ago
  All of the above, as well as the fact that the incidence of TB is already so low that the vaccine could cause more harm than it prevents.
  - rob74 2y ago
    Aside from TB, you could also call this "the tragedy of vaccination": vaccination causes the incidence of a life-threatening disease to become so low that people consider the vaccine to cause more harm than it prevents - until the vaccination rate becomes so low that the life-threatening disease is back.
    - sitkack 2y ago
      You know, if everyone wrote a predator prey simulation from scratch, they would understand those oscillatory dynamics.
      - DoctorOetker 2y ago
        But if they also wrote genetic algorithms from scratch, and understood natural selection, they would also understand the concepts of selection pressure, and use it or lose it. If they then also understood that 90% - 95% of the population effectively has natural immunity, they would seriously question the ethics of vaccination. Should a number of generations be allowed to profit from the benefits of vaccination at the cost of a loss of natural immunity in the group? Are future members of the group less entitled to this ~95% immunity, because the current generations prefer ( 100% minus epsilon ) artificial immunity? Its easy to win a referendum in the advantage of the existing population at the cost of future populations, if those future populations aren't born yet to contest and vote against it. From Wikipedia page on Tuberculosis: > Roughly one-quarter of the world's population has been infected with M. tuberculosis,[6] with new infections occurring in about 1% of the population each year.[11] However, most infections with M. tuberculosis do not cause disease,[169] and 90–95% of infections remain asymptomatic.[87] From the above it is clear that vaccination programs for TB should be strictly considered private healthcare since it can help specific individuals at the cost of collective fitness vis-a-vis TB. Governments collectivizing private medicine at the cost of group fitness ranks among the most populistic things in existence. Think of how communist systems justify their methods by emphasizing doctors and medical systems. What exactly does the ethical axiomatization of a collective thought system look like when they look down on the ~95% natural immunity handed to them from the prior generations and simultaneously have no qualms to hand down a lower percentage of natural immunity to the next generations! I believe they have this mistaken gut feeling that their decisions can be rationally axiomatized, more out of group think and delegation "others smarter than me are choosing this so it is probably rational"; and they are simply unaware of the fundamental inconsistencies they manifest. Tax payer money ought not be spent on reducing the natural immunity of its taxated population, regardless of how confronting it may be to explain to the population how a lot of methods in medicine were started long before the consensus on natural selection as the origin of life and fitness took hold.
        Cipater 2y ago
        >If they then also understood that 90% - 95% of the population effectively has natural immunity, they would seriously question the ethics of vaccination. Your premise is flawed as this is a misinterpretation of what the data actually states. The statistic refers to the fact that most infections do not cause active disease. This is not the same as having "immunity." Rather, it indicates that the immune system in most individuals can contain the bacteria without eradicating it, resulting in a latent infection. Latent TB can become active under certain conditions, such as immunosuppression or aging. Vaccination does not reduce natural immunity but aims to prevent the most severe manifestations of TB which can be fatal. Your wider point re: the ethical argument against vaccination presumes that exposing populations to preventable diseases is acceptable to preserve a theoretical "natural immunity." However, ethics in public health prioritize the reduction of preventable harm. Sacrificing lives and health for a purist notion of "natural selection" disregards the suffering of individuals and the societal costs of disease. If anything, the ethical failure lies in allowing preventable diseases to cause harm when safe, effective interventions exist. Future generations will inherit a world shaped by the decisions we make today. A world with widespread vaccination is one where fewer children die, fewer families suffer, and societies thrive.
Animats 2y ago
The BCG vaccine does exist, but it's an 90 year old live-virus vaccine with short-term side effects. Because it's a live-virus "natural" vaccine, it can't be used on people who are immunocompromised or have HIV. There's work on more modern vaccines.[1] No big successes yet. The safety record of the BCG vaccine, in terms of permanent harm, is pretty good. But a normal side effect is "The usual expected reaction to BCG vaccination is redness and/or a small lump at the injection site, followed by a small ulcer (open sore) a few weeks later (usually less than 1 cm in diameter). The ulcer may last from a few weeks to months before healing to a small flat scar."[2] Mass vaccination will have parents screaming "my perfect baby has an open sore from the vaccine" on Instagram, with pictures. The classic live-virus smallpox vaccine has similar side effects, by the way, plus a death rate of 1-2 per million. Huge political problem. Remember all the screaming about the COVID vaccines, which are pure RNA, can't replicate, and have fewer side effects. [1] https://pmc.ncbi.nlm.nih.gov/articles/PMC3349743/#s6 https://pmc.ncbi.nlm.nih.gov/articles/PMC3349743/#s6 [2] https://www.rch.org.au/uploadedFiles/Main/Content/immunisation/KHI_Fact_Sheet_template_Aug_2014.pdf https://www.rch.org.au/uploadedFiles/Main/Content/immunisati...
- lazide 2y ago
  Yeah, when it’s dress/tank top weather, you can see what part of the world people grew up in by the upper-left-arm scar. [https://www.health.nsw.gov.au/Infectious/tuberculosis/Pages/bcg-vaccination-sore.aspx https://www.health.nsw.gov.au/Infectious/tuberculosis/Pages/...]
  - mark-r 2y ago
    My upper left arm scar wasn't made by TB vaccine though, it was Rubella vaccine. I didn't associate it with aftereffects of the vaccine itself, it was the unique method of delivery - an airgun instead of a needle. Never seen that before or since.
    - lazide 2y ago
      The MMR vaccine doesn’t cause that type of scar. I’ve found nothing saying air vaccination guns do either. Smallpox and TB vaccines both do though. Perhaps you got a combo?

BeetleB 2y ago

The US medical community never accepted the effectiveness of that vaccine. They don't think it does a good job at prevention and it makes it harder to detect as anyone whose had that vaccine treats positive with the skin test.

ksenzee 2y ago
All of the above, as well as the fact that the incidence of TB is already so low that the vaccine could cause more harm than it prevents.
- rob74 2y ago
  Aside from TB, you could also call this "the tragedy of vaccination": vaccination causes the incidence of a life-threatening disease to become so low that people consider the vaccine to cause more harm than it prevents - until the vaccination rate becomes so low that the life-threatening disease is back.
  - sitkack 2y ago
    You know, if everyone wrote a predator prey simulation from scratch, they would understand those oscillatory dynamics.
    - DoctorOetker 2y ago
      But if they also wrote genetic algorithms from scratch, and understood natural selection, they would also understand the concepts of selection pressure, and use it or lose it. If they then also understood that 90% - 95% of the population effectively has natural immunity, they would seriously question the ethics of vaccination. Should a number of generations be allowed to profit from the benefits of vaccination at the cost of a loss of natural immunity in the group? Are future members of the group less entitled to this ~95% immunity, because the current generations prefer ( 100% minus epsilon ) artificial immunity? Its easy to win a referendum in the advantage of the existing population at the cost of future populations, if those future populations aren't born yet to contest and vote against it. From Wikipedia page on Tuberculosis: > Roughly one-quarter of the world's population has been infected with M. tuberculosis,[6] with new infections occurring in about 1% of the population each year.[11] However, most infections with M. tuberculosis do not cause disease,[169] and 90–95% of infections remain asymptomatic.[87] From the above it is clear that vaccination programs for TB should be strictly considered private healthcare since it can help specific individuals at the cost of collective fitness vis-a-vis TB. Governments collectivizing private medicine at the cost of group fitness ranks among the most populistic things in existence. Think of how communist systems justify their methods by emphasizing doctors and medical systems. What exactly does the ethical axiomatization of a collective thought system look like when they look down on the ~95% natural immunity handed to them from the prior generations and simultaneously have no qualms to hand down a lower percentage of natural immunity to the next generations! I believe they have this mistaken gut feeling that their decisions can be rationally axiomatized, more out of group think and delegation "others smarter than me are choosing this so it is probably rational"; and they are simply unaware of the fundamental inconsistencies they manifest. Tax payer money ought not be spent on reducing the natural immunity of its taxated population, regardless of how confronting it may be to explain to the population how a lot of methods in medicine were started long before the consensus on natural selection as the origin of life and fitness took hold.
      - Cipater 2y ago
        >If they then also understood that 90% - 95% of the population effectively has natural immunity, they would seriously question the ethics of vaccination. Your premise is flawed as this is a misinterpretation of what the data actually states. The statistic refers to the fact that most infections do not cause active disease. This is not the same as having "immunity." Rather, it indicates that the immune system in most individuals can contain the bacteria without eradicating it, resulting in a latent infection. Latent TB can become active under certain conditions, such as immunosuppression or aging. Vaccination does not reduce natural immunity but aims to prevent the most severe manifestations of TB which can be fatal. Your wider point re: the ethical argument against vaccination presumes that exposing populations to preventable diseases is acceptable to preserve a theoretical "natural immunity." However, ethics in public health prioritize the reduction of preventable harm. Sacrificing lives and health for a purist notion of "natural selection" disregards the suffering of individuals and the societal costs of disease. If anything, the ethical failure lies in allowing preventable diseases to cause harm when safe, effective interventions exist. Future generations will inherit a world shaped by the decisions we make today. A world with widespread vaccination is one where fewer children die, fewer families suffer, and societies thrive.

Animats 2y ago

The BCG vaccine does exist, but it's an 90 year old live-virus vaccine with short-term side effects. Because it's a live-virus "natural" vaccine, it can't be used on people who are immunocompromised or have HIV. There's work on more modern vaccines.[1] No big successes yet. The safety record of the BCG vaccine, in terms of permanent harm, is pretty good. But a normal side effect is "The usual expected reaction to BCG vaccination is redness and/or a small lump at the injection site, followed by a small ulcer (open sore) a few weeks later (usually less than 1 cm in diameter). The ulcer may last from a few weeks to months before healing to a small flat scar."[2] Mass vaccination will have parents screaming "my perfect baby has an open sore from the vaccine" on Instagram, with pictures. The classic live-virus smallpox vaccine has similar side effects, by the way, plus a death rate of 1-2 per million. Huge political problem. Remember all the screaming about the COVID vaccines, which are pure RNA, can't replicate, and have fewer side effects. [1] https://pmc.ncbi.nlm.nih.gov/articles/PMC3349743/#s6 https://pmc.ncbi.nlm.nih.gov/articles/PMC3349743/#s6 [2] https://www.rch.org.au/uploadedFiles/Main/Content/immunisation/KHI_Fact_Sheet_template_Aug_2014.pdf https://www.rch.org.au/uploadedFiles/Main/Content/immunisati...

lazide 2y ago
Yeah, when it’s dress/tank top weather, you can see what part of the world people grew up in by the upper-left-arm scar. [https://www.health.nsw.gov.au/Infectious/tuberculosis/Pages/bcg-vaccination-sore.aspx https://www.health.nsw.gov.au/Infectious/tuberculosis/Pages/...]
- mark-r 2y ago
  My upper left arm scar wasn't made by TB vaccine though, it was Rubella vaccine. I didn't associate it with aftereffects of the vaccine itself, it was the unique method of delivery - an airgun instead of a needle. Never seen that before or since.
  - lazide 2y ago
    The MMR vaccine doesn’t cause that type of scar. I’ve found nothing saying air vaccination guns do either. Smallpox and TB vaccines both do though. Perhaps you got a combo?