Still Standing Strong: A Narrative Review of Why BCG Remains Central to Global Tuberculosis Control

Background: Tuberculosis is one of the deadliest infectious diseases in the world. However, the BCG vaccine has shown significant results and remains in use to this day. Objective: This review aims to provide a comprehensive perspective on the resilience of the BCG vaccine over more than a century, as well as its implications for future vaccination strategies. Methods: A narrative review approach was used, employing keywords such as “BCG vaccine,” “tuberculosis immunization,” “trained immunity,” “TB vaccine pipeline,” and “MTBVAC,” “M72/AS01E,” “VPM1002” in databases such as PubMed and Scopus. Conclusion: Considering all scientific, clinical, socio-economic, and systemic factors, it can be concluded that to date, no new TB vaccine candidate has a comprehensive profile that significantly surpasses BCG. Therefore, BCG remains the most viable and reliable intervention in the context of global TB prevention, at least until new vaccines with high efficacy, long-term safety, and readiness for global implementation are successfully developed and thoroughly validated. Keywords: BCG Vaccine, Tuberculosis Latar Belakang: Tuberkulosis merupakan sakah satu penyakit infeksi yang mematikan di dunia. Namun, vaksin BCG menunjukan hasil signifikan sehingga masih bertahan sampai saat ini. Tujuan: Tinjauan ini bertujuan memberikan perspektif yang komprehensif mengenai ketahanan vaksin BCG selama lebih dari satu abad, serta implikasinya terhadap strategi vaksinasi di masa depan. Metode: Pendekatan tinjauan naratif digunakan, dengan menggunakan kata kunci seperti “BCG vaccine,” “tuberculosis immunization,” “trained immunity,” “TB vaccine pipeline,” and “MTBVAC,” “M72/AS01E,” “VPM1002” di beberapa basis data seperti PubMed dan Scopus. Kesimpulan: Dengan mempertimbangkan semua faktor ilmiah, klinis, sosial-ekonomi, dan sistemik, dapat disimpulkan bahwa hingga saat ini belum ada kandidat vaksin TB baru yang memiliki profil komprehensif yang secara signifikan melampaui BCG. Oleh karena itu, BCG tetap menjadi intervensi yang paling layak dan andal dalam konteks pencegahan TB global, setidaknya sampai vaksin-vaksin baru dengan kemanjuran tinggi, keamanan jangka panjang, dan kesiapan untuk diterapkan secara global berhasil dikembangkan dan divalidasi secara menyeluruh. Keyword: Tuberkulosis, Vaksin BCG