There is global consensus on the urgent need for a safe and effective TB vaccine for adults and adolescents to improve global TB control, and encouragingly, several promising candidates have advanced to late-stage trials. Significant gaps remain in understanding the critical factors that will facilitate the successful implementation of new and repurposed TB vaccines in low- and middle-income countries (LMICs), once available. By synthesizing the existing body of knowledge, this review offers comprehensive insights into the current state of research on implementation of these adult and adolescent vaccines. This review explores four key dimensions: (1) epidemiological impact, (2) costing, cost-effectiveness, and/or economic impact, (3) acceptability, and the (4) feasibility of implementation; this includes implementation strategies of target populations, and health system capabilities. Results indicate that current research primarily consists of epidemiological and costing/cost-effectiveness/economic studies in India, China, and South Africa, mainly modelling with M72/AS01, BCG revaccination, and hypothetical vaccines. Varying endpoints, vaccine efficacies, and vaccination coverages were used. Globally, new, and repurposed TB vaccines are estimated to save millions of lives. Economically, these vaccines also demonstrate promise with expected cost-effectiveness in most countries. Projected outcomes were dependent on vaccine characteristics, target population, implementation strategy, timing of roll out, TB burden/country context, and vaccination coverage. Potential barriers for vaccine acceptability included TB-related stigma, need for a second dose, and cost, while low pricing, community and civil society engagement and heightened public TB awareness were potential enablers in China, India, and South Africa. Potential implementation strategies considered spanned from mass campaigns to integration within existing vaccine programs and the primary target group studied was the general population, and adults and adolescents. In conclusion, future research must have broader geographical representations to better understand what is needed to inform tailored vaccine programs to accommodate diverse country contexts and population groups to achieve optimal implementation and impact. Furthermore, this review underscores the scarcity of research on acceptability of new and repurposed TB vaccines and their delivery among potential beneficiaries, the most promising implementation strategies, and the health system capabilities necessary for implementation. The absence of this knowledge in these areas emphasizes the crucial need for future research to ensure effective TB vaccine implementation in high burden settings worldwide.

Objective The COVID-19 pandemic highlighted the crucial role of healthcare and public health resource management, where scarcity impairs pandemic response resulting in increased disease transmission, delayed patient care and poorer health outcomes. In the EU PANDEM-2 project, we aimed to identify essential resource parameters for pandemic preparedness and response in the context of an emerging viral respiratory illness. Design After performing a systematic literature review, we conducted a Delphi study consisting of a structured questionnaire and consensus round with two separate panels of European public health experts (PHEs) and clinicians, respectively. Resources were categorised as material (n=23), human (n=18) or pharmaceutical (n=12). Data were analysed descriptively for both panels. Results Participants were 17 PHEs and 16 clinicians from nine countries. Consensus between the two panels was found on 40 resource parameters (17 material, 14 human, 9 pharmaceutical; 33 accepted and 7 rejected). Notably, clinicians selected three home care resources while PHEs did not, and PHEs selected two pharmaceutical resources which clinicians did not. No consensus was observed on 13 resources. Eleven additional resources were suggested and included (five for PHE and six for clinicians) among which were personal protective equipment for mobile teams, resources for primary care and resources related to mechanical ventilation. Conclusions The high level of consensus between the two expert panels indicates common goals in pandemic resource planning. The disagreement on 13 resource parameters reflects the different priorities between PHEs and clinicians in pandemic planning. This study has demonstrated the core components of resource modelling required for pandemic preparedness planning and shows the importance of consulting experts with both public health and clinical backgrounds. Including our proposed resources in pandemic models allows for more enhanced planning and training activities for future pandemics.

There is global consensus on the urgent need for a safe and effective TB vaccine for adults and adolescents to improve global TB control, and encouragingly, several promising candidates have advanced to late-stage trials. Significant gaps remain in understanding the critical factors that will facilitate the successful implementation of new and repurposed TB vaccines in low-and middle-income countries (LMICs), once available. By synthesizing the existing body of knowledge, this review offers comprehensive insights into the current state of research on implementation of these adults and adolescent vaccines. This review explores four key dimensions: (1) epidemiological impact, (2) costing, cost-effectiveness, and/or economic impact, (3) acceptability, and the (4) feasibility of implementation; this includes implementation strategies of target populations, and health system capabilities. Results indicate that current research primarily consists of epidemiological and costing/cost-effectiveness/economic studies in India, China, and South Africa, mainly modelling with M72/AS01, BCG revaccination, and generic vaccines. Varying endpoints, vaccine efficacies, and vaccination coverages were used. Globally, new, and repurposed TB vaccines are estimated to save millions of lives. Economically, these vaccines also demonstrate promise with expected cost-effectiveness in most countries. Projected outcomes were dependent on vaccine characteristics, target population, implementation strategy, timing of roll out, TB burden/country context, and vaccination coverage. Potential barriers for vaccine acceptability included TB-related stigma, need for a second dose, and cost, while low pricing, community and civil society engagement and heightened public TB awareness were potential enablers in China, India, and South Africa. Potential implementation strategies considered spanned from mass campaigns to integration within existing vaccine programs and the primary target group studied was the general population, and adults and adolescents. In conclusion, future research must have broader geographical representations to better understand what is needed to inform tailored vaccine programs to accommodate diverse country contexts and population groups to achieve optimal implementation and impact. Furthermore, this review underscores the scarcity of research on acceptability of new and repurposed TB vaccines and their delivery among potential beneficiaries, the most promising implementation strategies, and the health system capabilities necessary for implementation. The absence of this knowledge in these areas emphasizes the crucial need for future research to ensure effective TB vaccine implementation in high burden settings worldwide.

Background: Tuberculosis (TB) preventive treatment (TPT) is crucial in reducing the TB burden among people living with HIV (PLHIV), particularly in high TB/HIV burden countries like Ethiopia, South Africa, and Zimbabwe. Despite the availability of shorter TPT regimens, suboptimal treatment completion persists, and subnational variations remain poorly understood. Methods: This study utilized geospatial analyses of treatment completion data from the Opt4TPT study, a prospective cohort conducted in Ethiopia, South Africa, and Zimbabwe (2021–2023). Participants’ demographic and clinical data were included, and geospatial patterns were assessed using QGIS and local indicators of spatial autocorrelation (LISA) to identify clusters of treatment outcomes. Results: Of the 1,320 participants enrolled, 1,076 (81.5%) had geolocated data, and 90.1% reported completing TPT. Treatment non-completion clustered near clinics in all three countries. LISA analysis identified spatial cold spots for low treatment completion near clinics in South Africa and Zimbabwe, but not in Ethiopia. Distribution of demographic and clinical factors did not align with treatment outcomes. Conclusions: Geospatial analyses revealed clustering of non-completion near clinics, warranting further research on contextual factors, including stigma and facility-switching behavior. These findings emphasize the potential of geospatial tools in optimizing TPT programs through locally tailored interventions.

Background: Tuberculosis (TB) continues to cause substantial morbidity and mortality, with adults and adolescents carrying the largest burden of disease. Multiple promising novel vaccine candidates are in clinical trials, and their eventual impact will depend on effective implementation strategies. Information on TB vaccine preparedness efforts that could inform coordination remains fragmented. Methods: We developed the first living and interactive online repository ( https://tbvaxrepository.org/ ) collating completed, ongoing, and planned adult and adolescent TB vaccine preparedness initiatives. Data were obtained through a prior scoping review, direct stakeholder engagement, international conferences, and open calls via social media and partner networks between March 2023-November 2024. Projects were categorized using the World Health Organization’s (WHO) framework for TB vaccine preparedness across three thematic areas: availability, accessibility, and acceptability. Findings: By December 2024, the repository included 90 projects from 119 countries. Most projects focused on health- (47%) and economic modelling (21%), demand and acceptability studies (19%) or implementation feasibility (14%). Most of the projects were situated in India (n=36), South Africa (n=34), China (n=19), Indonesia, (n=17), Kenya (n=17), Brazil (n=14), and Pakistan (n=14). Few initiatives targeted key populations such as people living with HIV, pregnant or lactating individuals, or socially marginalized and occupational high-risk groups. Research on communication strategies for facilitating uptake as part of rollout were absent. Conclusions: The repository reveals both progress and gaps in global TB vaccine preparedness across WHO’s three thematic areas, with particular attention to geographic coverage, and the inclusion of key populations. As novel vaccines for adults and adolescents approach potential licensure, coordinated and inclusive preparedness efforts will be critical to ensure equitable and effective rollout. This repository offers a transparent platform to strengthen collaboration, reduce duplication, and guide strategic planning in a historically underfunded field.