Imperfect Weapon

Every seven seconds, doctors estimate, someone somewhere in the world dies of tuberculosis. Because TB is a disease that thrives on poverty, overcrowding, malnutrition and ignorance, its prevention is largely a sociological problem. Doctors, however, have long searched in vain for a medical weapon that would work against TB with the sure efficacy of, say, the smallpox vaccine against smallpox. The best they have found so far is the vaccine called BCG, which was first tried out on calves in 1908 at France's Pasteur Institute.

BCG is far from being the perfect weapon. Some doctors think that it can be downright dangerous; even its most ardent partisans admit that it will not do a complete immunization job in every case. It can be used only on patients showing no active sign of the disease. An added difficulty is the fact that no one can be certain just how effective BCG is until it is made the only preventive agent in a long-term experiment on a large mass of people.

Divided Credit. In Denmark, where BCG has been widely used, the tuberculosis death rate has been reduced over the last two decades from 71 to 19 per 100,000 inhabitants. But socially conscious Denmark has gone further than most nations in eliminating the factors that encourage tuberculosis. In lands where all else is hopeless, BCG has been given a fairer chance to make a statistical case for itself. Throughout the crowded, war-torn areas of Europe and the East, where general health conditions are at their worst, the International Tuberculosis Campaign, jointly sponsored by several U.N. and Red Cross organizations, has injected some 14 million people with the TB vaccine. Their fond hope is that the vaccinations have cut tuberculosis morbidity* by four-fifths. Only time and a careful check on the health of a whole new generation will prove it.

In Britain, vaccination with BCG has been adopted by the Ministry of Health as an official preventive measure against TB. A major fear among many U.S. doctors, who have thus far not been able to make up their minds about it, is that universal acceptance of the vaccine might lead the public to neglect other preventive measures, most importantly the constant effort to track down the disease by widespread X-ray chest examination.

No Assurance. Last week, after a six-month study of the evidence, the 18-man Council on Pharmacy and Chemistry of the American Medical Association published a cautious verdict on BCG. The report conceded that the vaccine, properly administered, is harmless, and probably desirable among nurses, doctors, laboratory workers, members of families where tuberculosis is present. But, the report warned, "undue reliance must not be placed on the vaccine as a protective measure at the expense of established measures of control . . .

"There is no scientific support," the council concluded, "for the contention that BCG should be extended to all persons with the same assurance that can be recommended for smallpox vaccine or other immunizing agents. At present [its] general use . . . does not appear to be warranted and should not be encouraged."

*Morbidity and mortality are specialized doctors' words to describe the ravages of disease. Morbidity means the number of sick, mortality the number of dead. For years doctors in the U.S. and Britain have been puzzling over a paradox in the morbidity and mortality rates of tuberculosis: while TB mortality has declined fairly steadily, morbidity has been rising. One possible explanation: doctors have become sharper-eyed in detecting new cases.

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