Rouillon A, Waaler H
Adv Tuberc Res. 1976;19:64-126.
The clinical efficacy of a well-controlled and correctly applied BCG vaccine can hardly be questioned, nor its usefulness under individual circumstances. But a problem more and more often raised now is that of the opportuneness, at the present time, to still use BCG on a mass- systematic - scale, particularly in the TB control programmes of low-prevalence countries. The article proposes an approach which, alongside with other methods already presented for assessing the epidemiological value of BCG and its public health indications, can help appreciate the advantages and disadvantages brought by vaccination in high- as well as in low-prevalence countries. The article focuses on the future, i.e. on what can, from now on, be expected from BCG in terms of epidemiological, economical and psychological benefits. Test runs were made considering three cohorts of 100,000 individuals (newborn, school enterers, school leavers), vaccinated or not vaccinated, submitted to various risks of infection (corresponding to conditions of high-, intermediate- and low-prevalence of tuberculosis) and experiencing various breakdown rates from infection to disease. Cost for BCG on the one hand, and cost for diagnosis, treatment of tuberculosis and loss of wages on the other, were also entered in the calculations; an attempt was also made to quantify in absolute terms and in relative ones the in conveniences linked to the application of BCG itself. Beyond figures and results presented as examples, what is more important is that the article furnished a method of reasoning and the possibility to feed one's own data in the model; it may help to encompass the scope and implications of a decision, and it furnishes elements of dialogue with other members of the planning team. It should be well realized that the elements provided and those which can be worked out are elements of reflexion to found a decision; the decision itself - to start, to pursue or to stop BCG on a mass scale - is of political nature (public health policy): it always implies a value judgement - from the part of the providers of the services and/or, preferably, from the part of the users, i.e. a preference which is the result of a 'weighing' between advantages and inevitable disadvantages, both involving time, place, existing system, existing beliefs and other fields of health and welfare.
一种控制良好且应用正确的卡介苗疫苗的临床疗效几乎毋庸置疑，其在个别情况下的效用也无可置疑。但现在越来越常被提出的一个问题是，目前是否仍有必要大规模、系统性地使用卡介苗，尤其是在结核病低流行国家的结核病控制项目中。本文提出了一种方法，该方法与已提出的其他评估卡介苗流行病学价值及其公共卫生指征的方法一起，有助于认识到在高流行率国家和低流行率国家接种疫苗所带来的利弊。本文关注的是未来，即从现在起，卡介苗在流行病学、经济和心理效益方面有望带来什么。考虑了三组各10万名个体（新生儿、入学儿童、离校青少年）进行了试运行，这些个体接种或未接种疫苗，面临各种感染风险（对应于结核病高、中、低流行情况），且从感染到发病有不同的发病率。一方面计算了卡介苗的成本，另一方面计算了结核病诊断、治疗成本以及工资损失；还试图从绝对值和相对值两方面量化与卡介苗自身应用相关的不便之处。除了作为示例给出的数据和结果之外，更重要的是本文提供了一种推理方法以及将自己的数据输入模型的可能性；它可能有助于全面考虑一项决策的范围和影响，并且为与规划团队的其他成员进行对话提供了要素。应该清楚地认识到，所提供的要素以及可以得出的要素都是为做出决策而进行思考的要素；决策本身——大规模开始、继续或停止使用卡介苗——具有政治性质（公共卫生政策）：它总是意味着一种价值判断——由服务提供者做出，或者更理想的是由使用者做出，即一种偏好，它是在利弊之间“权衡”的结果，而利弊都涉及时间、地点、现有系统、现有观念以及其他健康和福利领域。
