AV Raman, Health Officer, Govt of Madras

This morning’s paper had a news item that doctors have doubted a study that says that one of the reasons for India not seeing huge numbers in the COVID-19 pandemic is due to the compulsory BCG vaccination that all children born here undergo even now. This brought to mind one of the most interesting episodes in the medical history of Madras – the spirited fight we gave AGAINST the implementation of BCG vaccination. The finest account of this battle is in Christian W McMillen’s Discovering Tuberculosis: A Global History, 1900 to the Present (Yale University Press, 2015) and I am summarising what I have read in it here.

We last saw how India was finally acknowledged as a TB capital in the early 1900s. Thus when the International Tuberculosis Campaign began in the 1940s, with the BCG vaccine as its weapon against the disease, roping in our country and getting its acceptance for trials became very important. A newly-independent India, in hurry to progress, was quite willing, at least that was the attitude of the Central Government, as led by its Health Minister, Rajkumari Amrit Kaur. The Government signed an agreement with the WHO and the King Institute, Guindy, established a BCG laboratory and produced the vaccine which from 1948 onwards was used at the sanatorium in Madanapalle. In fact, India was the first non-European country to sign an agreement with the ITC and a two-and-a-half year demonstration of the vaccine across the country began thereafter.

There was opposition however in Madras – led by AV Raman (actor Mohan Raman’s grandfather) who was Health Officer of the Government of Madras. He brought out a magazine titled Public Health and in it he squarely trashed BCG. In his view, it was nothing but an attempt to force everyone in India to become guinea-pigs for a vaccine that was yet to be established. He also felt that the Government was trying to take an easy way out – a far more difficult and in his view effective way of eradicating TB was to establish public hygiene, provide people a better quality of life with right to light and air. Rather than going in for this, the authorities were trying a quick fix, one that was not yet proven. India was therefore becoming a vast ground for experimentation.

Faced with his campaign, and it must be said Raman was an indefatigable fighter who saw to it that most prominent newspapers of India carried his articles, there was a groundswell of public opinion against BCG. It did not help that in North India there was a rumour that BCG stood for Birth Control Germ/Birth Control Guarantee and anyone vaccinated with it would not have children thereafter. There were also other stories that those vaccinated went blind. The fact is, India remained firmly against any kind of vaccination – in the early 1920s, the Corporation of Madras had five vaccinators and they did one vaccination per day! Most people, from Gandhi downwards, did not approve of vaccination.

In Rajaji, Raman found an able campaigner. The two were close friends and with the former jumping into it, the whole opposition took on political colours. Faced with such intense pressure, the Madras Government refused to go along with the centre in the implementation of BCG. Rajkumari Amrit Kaur was not to be thwarted and work began in the rest of the country. The newspapers and magazines of the day were filled with letters, for and against. Rajaji published a pamphlet titled BCG, Why I Oppose It. This was so widely circulated that the Government was forced to publish a counter – The Truth about BCG – Why Government have launched a mass campaign. The Hindu carried editorials and articles in favour of the BCG vaccine. But with Rajaji becoming Chief Minister of Madras in the 1952, there was no way the local government would join in.

The old man, in his usual political way had in the pamphlet twisted certain quotes from people to suit his end and this some of the well-known figures in the world of science took pains to counter. What is amazing however is the way officialdom stood up to the CM. Dr KS Ranganathan of the King Institute bitterly opposed Rajaji and my late friend KV Ramanathan IAS recalled how he was privy to Dr KS Sanjeevi virtually giving the CM a dressing down over his opposition to BCG.

In the event, with the Central Government and the WHO ramming their way ahead, BCG became universal. With Rajaji quitting and Kamaraj taking over as CM in the mid 1950s, the anti-BCG campaign lost steam in Madras. AV Raman died in 1959, a bitter opponent to the vaccine till the end.

But he would finally appear to have been correct. Worldwide, even while everyone was being vaccinated, there were concerns that there was no data that BCG had proven effective. That it was not the preventive it was claimed to be was finally established in what is known as the Chingleput trial where over 15 years, a control group of 2.81 lakh people was monitored after being vaccinated at random with high and low doses of BCG, while some others were just given a placebo. It was concluded that there was no protective efficacy for adults and a low efficacy for children with BCG (this can be seen in this Government site). McMillen states that by the 1990s even the WHO recognised the “virtual uselessness” of BCG in “preventing primary infection and infectious pulmonary disease” On the other hand, continued faith in it has resulted in no other vaccine being tried. BCG he concludes was the “largest failed medical intervention in the world”. McMillen states that according to a TB expert, Paul Fine, BCG’s greatest contribution was that it eradicated TB research itself! Raman was right after all.

I write this on Mohan Raman’s birthday and I dedicate it to him and all members of his brilliant but eccentric ancestry.

PS: Since I wrote this article I have had a conversation with my dear friend, Dr Vijay Sriram, my go-to man for many things. He states that while it is true that BCG has been proven as having very little effect in preventing pulmonary tuberculosis, it cannot be denied that it has had a proven record in protecting infants and young children from ‘miliary’ or disseminated TB. This is why it is still a universal vaccine in countries such as India where the incidence of TB is high. On the other hand many low incidence countries have done away with it unless the infant is to be taken thereafter to a high incidence country.

This article is part of a series on how Madras handled various health pandemics, written during the lockdown following Coronavirus. You can read the earlier part of the TB battle here

You may also want to read how Madras eradicated smallpox