BCG vaccination policy in Guinea-Bissau

- cost and impact on mortality

Sanne Marie Thysen, MD, PhD

Sanne defended her PhD dissertation "BCG vaccination policy in Guinea-Bissau - cost and impact on mortality" in April 2019


In her thesis (summarised below), Sanne describes the implementation of the BCG vaccination policy in Guinea-Bissau and estimates the impact of the restrictive vial opening policy for child mortality.  


Sanne's reseach profile and publication list is available here.

Link to the PhD dissertation "BCG vaccination policy in Guinea-Bissau - cost and impact on mortality"



In the thesis, we assessed some of the consequences of the current BCG vaccination policy in Guinea-Bissau, where a vial of BCG is not opened for few children (restrictive vial-opening policy). We identified that this policy was associated with delays in BCG vaccination, and that only 38% of children received BCG within the first month of life. With monthly visits with BCG vaccination, we were able to increase the 1-month BCG coverage to 88%. We asked mothers about their experience in seeking and not obtaining BCG vaccination, and found that the household costs of seeking BCG vaccination per child (USD 1.82) was equivalent to the UNICEF price range of a BCG vial.


We assessed the effect of early BCG vaccination on mortality in two cohorts. In one cohort, we assessed the effect of opening a vial of BCG for each child at monthly outreach villages, and found no beneficial effect of BCG on neonatal mortality. While we found no effect on neonatal mortality, data from another cohort indicated that early BCG is important for survival from 1-35 months: neonatal BCG vaccination was associated with lower all-cause mortality among both TB-exposed and TB-unexposed children, supporting that timely BCG vaccination is important.

In light of the identified barriers, costs and effects of early BCG vaccination, we estimated the impact of disregarding the restrictive vial-opening policy. Opening a vial of BCG for each child at the first contact with the health care system was estimated to reduce both TB mortality an all-cause mortality. The cost-effectiveness analyses showed that including the all-cause effects of BCG in the evaluation resulted in higher cost-effectiveness than merely including TB-specific effects.


The results from this thesis support that BCG should be provided timely. The restrictive vial-opening policy should be removed and all children ought to receive BCG at the first contact with the healthcare system. This would reduce both TB mortality and all-cause mortality, and would be highly cost-effective.


The full thesis is available here.