ABSTRACT
Background Tuberculosis is a leading infectious cause of death worldwide. Novel vaccines will be required to reach global targets and reverse setbacks from the COVID-19 pandemic. We estimated the impact of novel tuberculosis vaccines in low- and middle-income countries (LMICs), under alternative delivery scenarios. Methods We calibrated a tuberculosis model to 105 LMICs (93% of global incidence). Vaccine scenarios were implemented as Basecase routine vaccination of 9-year-olds and a one-time vaccination campaign for ages ≥10 with country-specific introduction between 2028–2047 and 5-year scale-up to target coverage; Accelerated Scale-up as Basecase , but all countries introducing in 2025 with instant scale-up; and Routine Only as Basecase , but routine vaccination only. Vaccines protected against disease for 10-years, with 50% efficacy. Findings The Basecase scenario reduced tuberculosis incidence (19.5% [95% uncertainty range=18.3– 21.6%]) and mortality (20.6% [19.2–23.4%]) rates in 2050 and prevented 3.6 (3.3–3.9) million deaths before 2050, including 1.6 million in the WHO South-East Asian region. The Accelerated Scale-up scenario reduced tuberculosis incidence (25.2% [23.9–27.5%]), mortality (26.7% [25.2–29.9%]), and prevented 7.9 (7.3–8.5) million deaths. The Routine Only scenario reduced tuberculosis incidence (9.9% [9.0–11.6%]), mortality (9.9% [8.9–12.3%]), and prevented 1.1 (0.9–1.2) million deaths. Interpretations Novel tuberculosis vaccines could have substantial impact, which will vary depending on delivery strategy. Including a campaign will be crucial for rapid impact. Accelerated introduction, similar to the pace of COVID-19 vaccines, could approximately double the lives saved before 2050. Investment is required to support vaccine development, manufacturing, prompt introduction and scale-up. Funding WHO (2020/985800-0)