Beyond the BCG vaccine: Novel approaches to tuberculosis prevention and control in Africa

Tuberculosis (TB) continues to be a predominant cause of illness and death across Africa, intensified by HIV co-infection, poverty, and weak health systems. The Bacillus Calmette-Guérin (BCG) vaccination has traditionally reduced severe pediatric TB, although its restricted effectiveness against adult pulmonary TB and diminishing immunity highlight the need for novel techniques. This study examines innovative strategies for TB prevention and control beyond the BCG vaccination, specifically within African settings. A thorough narrative review was performed using peer-reviewed literature from sources such as PubMed, Google Scholar, and EBSCOhost. The study consolidates results on TB vaccine development, diagnostic advancements, treatment protocols, and comprehensive public health measures. Novel vaccine candidates, including M72/AS01E and VPM1002, have potential in augmenting immunity and alleviating the TB burden. Innovations in diagnostics, such as GeneXpert, point-of-care instruments, and AI-enhanced screening, are enhancing early detection. Concise preventative regimes (e.g., 3 HP, 1 HP), innovative pharmacological combinations (e.g., BPaL), and community-oriented care models are revolutionizing treatment results. Socio-economic approaches, One Health (OH) frameworks, and digital monitoring technologies enhance TB control initiatives. This review adopts a systems-based framework, integrating biomedical, diagnostic, therapeutic, socio-economic, and OH strategies to evaluate TB prevention and control beyond BCG in African settings. By situating biomedical innovations within broader health system and societal contexts, the review highlights how TB control requires multi-layered approaches rather than reliance on a single intervention. Advancing beyond BCG requires a comprehensive strategy that incorporates biomedical innovation, enhancement of health systems, and interdisciplinary cooperation. The results advocate for policy change, investment in African-led research, and equal access to innovative TB technologies to attain sustained control and ultimate eradication.