A new study, which has been done by professors at Arthur Anderson Cancer Center, led by an Indian, Dr. Ashish Kamat, the Mumbai-born person, suggests that BCG states which have ensured BCG immunization are less likely to have intense COVID virus. That's what is being suggested. Take a look at what our graphic says and these graphics will tell you exactly why the BCG vaccine boosts immunity. Many believe this study, done over 178 countries, certainly suggests that the BCG vaccine could be a way forward.
How is this actually going to work? I'm joined by a very special guest, Dr. Ashish Kamat joins me from Houston from the Anderson Center. Ashish, a lot of attention on your study which is linking potentially BCG vaccine to COVID intensity. Thanks very much for joining us. Your study says, Ashish, that countries which do not have a BCG vaccination policy show 10 times greater incidence of and mortality from COVID-19 compared to those that do. On what basis have you reached this conclusion?
Ashish Kamat: So Rajdeep, this is a very interesting observation that we made. As you know, I'm a urologic oncologist and I treat mainly patients that have bladder cancer and BCG has been used for bladder cancer for many decades. And we've observed that in patients who get BCG, there appears to be a boost in immunity and that's how it works. It's an immunotherapy.
So, we were thinking about embarking on this clinical trial and Mihai Netea from the Netherlands contacted me through some of his trainees here in Houston and was thinking of doing this as a clinical trial in healthcare workers in the US and Europe. And then, we thought about looking at the actual data of the incidence of COVID positive cases and correlating that with the BCG vaccination story. The paper that you referenced was essentially done by one of my former trainees, Paul Hegarty, who's now a consultant urologist in the UK NHS system.
And as you noted, what we found was that in countries that have an active or near-active BCG vaccination program, there's a much lower, almost a tenfold lower, incidence and mortality rate from COVID-19. The thinking there is based on sound mechanistic rationale because there have been numerous studies done over many, many years that show that BCG does improve immunity and response to infections from staph aureus to viral infections to influenza to yellow fever. So there's some mechanistic rationale for it.
Rajdeep Sardesai: But there are no clinical trials as yet that have been done to prove any connection, am I correct? Or are you all now in the process of going through clinical trials to try and see whether there is a link between the BCG vaccine and COVID intensity?
Ashish Kamat: Absolutely. Even though the data are very encouraging and even the preclinical work and the small randomized studies in yellow fever patients were very encouraging, we can't base recommendations just on observation. So, we are embarking on a clinical trial of BCG as a defense against SARS CoV-2, the BADAS trial here in the United States, and this was already started under a different name in Australia and in Europe. So we need to look at the results of the clinical trial data. And initially, we'll focus on high-risk people, the healthcare workers at the forefront in the ICU, in emergency rooms, et cetera. If we see a signal in this short trial, then the goal is to expand it to the population at large.
Rajdeep Sardesai: But what could it be about a BCG vaccine, Dr. Kamat, that suggests that there could be a reduction in the intensity of COVID in BCG-vaccinated countries? I know you've cited Japan, Brazil, and India as three in contrast to those which don't have this vaccine: USA, Italy, and Spain. Because in the past, Dr. Kamat, BCG has been seen as an effective tool in preventing meningitis, disseminating TB in children. What is it about BCG that gives some hope that it could combat a virus like COVID?
Ashish Kamat: So, the innate immunity that BCG induces in human beings is reflected in the epigenetic changes in their immune cells. This effect is not just seen in newborns. In some people it has been reported as many as 25/40 years after the BCG vaccination. So, there is this thought that having had BCG either vaccination at birth, or at a younger age, or even in elderly people as is done in some nursing homes, does protect the person from any viral infection. And of course, COVID is a virus, a coronavirus, and hence BCG will induce a nonspecific boost in the immune response to a coronavirus as well. That's the thought process behind it.
Rajdeep Sardesai: Dr. Kamat, there are those, of course, researchers from McGill International TB Center, Montreal, who are suggesting that this may create a false sense of security, lead to inaction. A country like India has a BCG universal vaccination policy, it could lead to complacency. Is that the fear? People who are listening to you today in your home country in India will say, "Wow! Maybe this is the reason why, at the moment, the virus seems low intensity when compared to mortality rates in India and the rest of the world." Are we going to get complacent or is there a fear of that?
Ashish Kamat: You raise a very good point and I always say, "You can't base recommendations just on observation." So absolutely, I would not recommend or I would actually caution against getting complacent. We do need to wait and see what the study shows. We should have results hopefully in a short time. But if it does bear out that the BCG exposure does boost the immune response of a population in general, then that'd be a really important piece of information for governments to know before they implement any policy changes.
Rajdeep Sardesai: Because you know Dr. Kamat, we are seeing relatively low mortality rates at the moment in India. We're also seeing, interestingly, Dr. Kamat, relatively low mortality rates in Africa. Now that's another continent that has had a strong vaccination policy, particularly against malaria. So are we saying that this can build an element of immunity if you get these vaccines at an early age?
Ashish Kamat: Absolutely. Your observation that there's a general boost in the non-specific innate immunity in people will protect countries that, as you mentioned, India and Africa, which need protection the most really. Because once the incidence starts to rise in these countries, the infrastructure may not be able to support the surge in patients. So if the incidence stays low, then by corollary, the mortality will stay low and that's the hope. And again, as you mentioned, the countries that need this protection are the countries that have been vaccinated in the past.
Rajdeep Sardesai: In BCG, when I read about it and as I said, this is a layman now looking at someone who's an expert, the body identifies pathogen, activates the immune system effectively. Therefore, can one vaccine... Will you need a specific COVID-19 vaccine at some stage? Or do you believe that existing vaccines in itself can offer a challenge to COVID-19?
Ashish Kamat: You said you're a layman but you spoke like a scientist and that's a very, very important point that we and others are looking at. The effect of BCG, for example, in bladder cancer patients is non-specific, but it reduces the recurrence of bladder cancer because of the immune boost effect.
Our feeling is that BCG will help to a large degree. Of course, like I said, we have to prove it, but specific COVID-19 vaccines absolutely will be necessary. Unfortunately, the development of these vaccines takes a while. And even talking to my expert friends at the CDC and other places, I am told that it's not going to be here for at least nine to 12 months in a reliable fashion. So till then, using the tools that we have, whether it's BCG or some other nonspecific vaccine would be extremely, extremely helpful.
Rajdeep Sardesai: Because there have been reports that I've been reading there when we contrast India with the United States where you are a doctor, Indians seem to have innate immunity. We heard this argument a few weeks ago. There's something about the Indian body structure, you studied in KEM Hospital in Mumbai in your early years as MBBS, that the Indians have a certain immunity built into them versus the Western world, particularly the US. Is there anything to be looked at seriously in that direction at all?
Ashish Kamat: So, of course, we Indians like to always think that we're stronger and more resistant to a lot of issues, but there are tests that can be done to actually see if somebody still has an ongoing immunity that's been conferred by BCG, and I'm sure you're aware of this. This is the PPD test, the purified protein derivative test. So, of course, that is a first easy step to see if somebody still has conferred immunity to BCG. But to make a broad statement that Indians are more resistant to infection hence and they should do X, Y and Z is something that I would be very hesitant in proclaiming. And I really wouldn't recommend that we make that statement to the viewers that are on your show.
Rajdeep Sardesai: So where do you, from your vantage position, see India at the moment, Dr. Kamat? At this stage, where do you see India, given the fact that we, at the moment, seem to be seeing not an exponential growth, but a gradual growth in COVID-19 cases? And the deaths are about 111 while we've reported around 3,000 cases.
Ashish Kamat: Correct. Yeah. No, the numbers coming from India that I'm seeing, and of course the numbers vary anywhere from 3,000 to 4,000 incidents and 115 to 122 mortality. While clearly, any mortality is bad, the low numbers are encouraging.
I think as to where the Indian population specifically goes is a question that I would honestly defer to the expert urologist and infectious disease folks within India itself. I know that there's a lot of work and enthusiasm for the BCG program that's being looked at within different institutions in India. I've been in touch with several experts. But I really would wait for them to analyze whatever data they have and do some testing and then come up with a recommendation. I think we should have that in a short time, looking at what's going on.
Rajdeep Sardesai: Let me add a final question, Dr. Kamat, someone just tweeted, listening to you saying, "BCG will go out to the market tomorrow." I'm sure that's not going to happen overnight. But do you believe that this is something... as you do clinical trials in the West, something worth exploring in this country as well to try and do a study linking the vaccination with the level of COVID intensity?
Ashish Kamat: Yes. I do believe that studies should be done in India. What population you look at in India clearly remains to be defined. Would you address the older population that is at risk? Would you aggress the healthcare workers? Would you potentially do both in parallel because the incidence of COVID-19 is low in India, clearly the healthcare workers and not being exposed to the extent as in Italy or the US or other places. So it might be a population of the elderly that is at higher risk of adverse events that might benefit from vaccination. Addressing your question on the BCG shortage, if I may?
Rajdeep Sardesai: Right.
Ashish Kamat: There has been a shortage of BCG in the United States since 2014. There's not enough BCG to be had for patients with bladder cancer. Fortunately, in other parts of the world, and India is one of them, there isn't that shortage of BCG. So, clearly there should be sufficient BCG in India to do a study within India.
But in the United States, there's a shortage and I actually reached out to a large patient advocacy group, the Bladder Cancer Advocacy Network, and we got support from our patients who are very generous and literally said, "If you have to divert the supply from treating us patients to help the healthcare workers, we would be 100% behind them."
Rajdeep Sardesai: Because, Dr. Kamat, senior citizens have been much more affected in terms of mortality across the world and India is no different. Even though in India, those who are finding themselves COVID positive are between 20 and 55. So we are presuming that senior citizens are the most vulnerable at the moment to mortality. Well, where does the vaccine, therefore, fit into that? The fact that the older you are, the more likely you are to face intensive COVID... The virus is more intense the older you are.
Ashish Kamat: Absolutely. And that's why I mentioned earlier, that in some of the studies that have been done with BCG in the past, for example, vaccinating against a recurrence of yellow fever or influenza, they have actually been done in older individuals in the 65+ age group. And in the Western world, that was focused on patients or people who are in assisted care facilities or nursing homes. So, that is clearly one of the population demographics that could be looked at in a country like India.
Rajdeep Sardesai: Dr. Kamat, thank you very much. We look forward to your clinical trials and what they bring for now. You and your fellow doctors there have set off a global debate. And maybe, just maybe for once, India with its BCG program is on the right side of the curve. Dr. Ashish Kamat, KEM Hospital, MBBS, from Mumbai, now at the top of his game in MD Anderson. Thanks very much for joining me there from Houston. Interesting observation, the possible link between a BCG vaccine that most of us get with coronavirus intensity.
Preeti Chaudhary: Hi everyone, Preeti Chaudhary here. Hope you like this video. For the latest news and analysis, like and subscribed to the India Today YouTube channel, and don't forget to press the bell icon to stay updated. Thank you for watching.
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