Tuberculosis kills roughly 1.25 million people every year. It infects about 10.7 million. And the only vaccine we have against it — the Bacillus Calmette-Guérin, known as BCG — was developed in 1921.
BCG works reasonably well in young children to prevent severe forms of TB like meningitis. For adolescents and adults, who account for the majority of TB transmission worldwide, it barely works at all. For over a century, the world has had no answer to that gap.
This week, there are two pieces of news worth your attention.
The India Phase-3 Trial: VPM1002 and Immuvac
On April 10, 2026, the British Medical Journal published results from the PreVenTB trial — a randomised, Phase-3 clinical trial conducted in India. This is the final stage of human testing before a vaccine can be considered for regulatory approval.
The trial was conducted by researchers including those from the Indian Council of Medical Research (ICMR). It tested two vaccines: VPM1002, a recombinant (genetically engineered) BCG developed by Serum Life Sciences Europe; and Immuvac, developed by ICMR itself in collaboration with Cadila Pharmaceuticals in Ahmedabad.
Over 12,700 household contacts of TB patients — aged six and above — were enrolled across 18 sites in six states and union territories including Delhi, Maharashtra, and Tamil Nadu. Enrollment ran from July 2019 to December 2020.
The results are nuanced. Neither vaccine provided general protection against TB as a whole. Neither prevented latent TB infection — meaning they cannot stop the bacteria from taking hold in the body initially.
However, both vaccines demonstrated something useful: they can prevent latent TB from progressing to active, symptomatic disease.
VPM1002 showed 50.4 percent effectiveness against extrapulmonary TB — the form that affects organs beyond the lungs, including lymph nodes, bones, and the brain. This matters significantly because extrapulmonary TB carries a higher mortality risk than pulmonary TB. This protection was observed across all age groups from six to 60 years.
In children specifically, VPM1002 showed protection against all forms of TB in the six to under-14 age group. Immuvac showed protection against extrapulmonary TB in children aged six to under-10.
The researchers described the findings as indicating "a potentially significant public health benefit" for extrapulmonary TB, while being clear that neither vaccine is a replacement for BCG for all-purpose protection.
The Johns Hopkins Nasal Vaccine
A separate development announced on April 7 by Johns Hopkins Medicine takes a completely different approach.
Researchers at Johns Hopkins have developed a therapeutic DNA vaccine that is delivered nasally — through the nose — targeting TB bacteria that survive conventional antibiotic therapy. The TB bacterium has a particular nasty trick: some cells enter a dormant, drug-tolerant state called "persistence." These surviving cells can reactivate months or years later and cause disease relapse even after a patient has completed a full course of antibiotics.
The Johns Hopkins vaccine fuses two genes designed to direct the immune system toward these drug-tolerant persister cells. In mice, the intranasal vaccine — used alongside standard TB drug therapy — cleared bacteria faster, reduced lung inflammation, and prevented disease relapse.
In rhesus macaques, which have immune systems much closer to humans, the vaccine generated measurable TB-focused immune responses in blood and airways that persisted for at least six months. Crucially, however, the primate work only measured immune activation, not whether the animals were protected against an actual TB infection. More preclinical studies are needed before human trials can begin.
The researchers hold a patent on the vaccine platform. Lead investigator Dr. Stavroula Karanika said the data provide "an important translational bridge between the mouse efficacy studies and the additional preclinical work needed before human trials."
The Bigger Picture: M72 and the Race
Beyond India's Phase-3 results and Johns Hopkins's experimental nasal vaccine, the most advanced TB vaccine candidate in the global pipeline is M72/AS01E — a vaccine developed by the Gates Medical Research Institute and GlaxoSmithKline.
In a Phase 2 trial, M72 showed roughly 50 percent efficacy in preventing TB-infected adults from progressing to active disease. That was the first time any vaccine had achieved that level of efficacy in this population — unprecedented in decades of TB research.
Phase 3 trials have enrolled 20,000 volunteers, including 13,000 in South Africa and participants across multiple African countries and Indonesia. Results are expected in 2028. If Phase 3 confirms the Phase 2 results, M72 could become the first new TB vaccine approved in over a century.
A separate live attenuated vaccine candidate, MTBVAC, developed by Spanish biotech Biofabri, is also in Phase 3 trials for newborns as a potential BCG replacement.
TB continues to be the world's leading cause of death from a single infectious disease among people without COVID-19. In India — which bears the highest TB burden of any country — this research is directly relevant to tens of millions of people. The PreVenTB trial published this week is one of the largest TB vaccine trials conducted on Indian soil, and its results will inform policy discussions within ICMR and the central government about what role these vaccines might play in India's national TB elimination programme.
India has a target to eliminate TB by 2025 — a target that has slipped and been revised, and which no realistic reading of the current data suggests is achievable by any near-term date. New vaccines that can at minimum prevent progression from latent to active disease represent a meaningful, partial tool in that effort, even if they are not the full solution.