Adult TB vaccine: Possible novel tool to end TB

Ali Esmail
University of Cape Town, Cape Town, South Africa

Tuberculosis (TB) remains a leading infectious cause of mortality worldwide, with adult populations bearing the greatest burden of disease, transmission, and death. Despite global efforts and the widespread use of the Bacille Calmette–Guérin (BCG) vaccine, TB elimination has remained elusive, largely due to BCG’s limited efficacy in preventing adult pulmonary TB, the most transmissible form. The urgent need for a more effective TB vaccine for adults has driven significant research into novel candidates that can prevent infection, progression, or reactivation of latent TB.

This lecture will explore the scientific rationale, recent progress, and future potential of adult TB vaccines as a pivotal tool to end TB. We will discuss the immunopathogenesis of TB and how it informs vaccine development, highlighting key vaccine candidates such as M72/AS01E, VPM1002, and BCG revaccination strategies. Clinical trial data suggesting enhanced protection and immunogenicity in adults will be critically examined, alongside the challenges of deploying such vaccines in high-burden settings.

Furthermore, the lecture will address how adult TB vaccination could synergize with existing TB control strategies, including latent TB treatment, diagnostics, and public health interventions. Special focus will be given to implementation considerations, including population targeting, delivery logistics, and cost-effectiveness in low- and middle-income countries.