Preparing South Africa for a new TB vaccine

Tuberculosis remains a major public health challenge in South Africa, and several vaccine candidates aimed at adolescents and adults are now in late-stage clinical trials. To move beyond trials and into real-world use, health planners need clear guidance on how a new vaccine could be introduced and who should get it first. Katherine A. Thomas led a study to capture the views of people who would be central to that decision-making and delivery. Between April and May 2025, the research team conducted semi-structured interviews with 26 stakeholders from different fields related to TB control and vaccine rollout. The goal was not to test a vaccine but to understand interest, priorities and likely approaches for implementation if an effective product becomes available. Interviewees included policy-makers, program managers and other experts whose perspectives can shape national strategy. The study used deductive analysis to build a coding framework and carry out a thematic content analysis of the interview data, producing insights that could guide planning well before a vaccine is licensed or procured.

The interviews produced clear themes about what would make a rollout feasible and acceptable. Stakeholders generally supported introducing a new TB vaccine because South Africa bears a high burden of disease, but they flagged several practical conditions that would determine success. Price and cost-effectiveness were repeatedly mentioned, as was the vaccine’s measured efficacy. Many interviewees said that an efficacy below 50% would be worrying unless strong modelling could show meaningful public health impact and favorable cost-effectiveness. A cheaper vaccine course was preferred so that supply could reach more people and allow a broad population-based approach. Priority populations identified included adolescents and adults under a broad strategy, and, especially if resources were constrained, high-risk groups such as people living with HIV, healthcare workers, TB household contacts, miners, prisoners and people living with diabetes. While a national, broad rollout was ideal, respondents expected that constraints could lead to phased rollouts focused on high-burden areas or initial targeting of high-risk groups. Stakeholders also emphasized the need for strong advocacy, detailed cost-effectiveness and cost-benefit assessments, regulatory alignment and integrated service delivery to enable effective implementation.

These findings offer practical lessons for policy-makers, funders and program managers preparing for a potential new TB vaccine in South Africa, possibly as early as 2030. Understanding which populations should be prioritised and what evidence will convince decision-makers helps narrow the planning gap between clinical trials and public health use. The study highlights that technical approval alone will not guarantee impact: affordability, convincing economic modelling, and service-integration plans are equally essential. It also points to concrete next steps for researchers and planners, including work on vaccine acceptability among the public and health workers, better data on TB infection prevalence in different groups, and modelling studies to estimate cost-effectiveness and budget impact. Taken together, these actions would make a future vaccine rollout more targeted, equitable and efficient, increasing the chances that a new tool actually reduces TB illness and death in South Africa.