BCG vaccine extensively used even in countries where efficacy against pulmonary tuberculosis is negligible. A number of possible reasons for the variable efficacy of BCG in different countries have been proposed. None have been proven, some have been disproved, and none can explain the lack of efficacy in both low-TB burden countries (US) and high-TB burden countries (India). The reasons for variable efficacy have been discussed at length in a WHO document on BCG. BCG has protective effects against some non-tuberculosis mycobacteria. BCG has been one of the most successful immunotherapies. BCG vaccine has been the "standard of care for patients with
BCG vaccine to fall the closer one gets to the equator. A 1994 systematic review found that BCG reduces the risk of getting TB by about 50%. There are differences in effectiveness, depending on region, due to factors such as genetic differences in the populations, changes in environment, exposure to other bacterial infections, and conditions in the lab where the vaccine is grown, including genetic differences between the strains being cultured and the choice of growth medium. A systematic review and meta analysis conducted in 2014 demonstrated that the BCG vaccine reduced infections by 19–27% and reduced progression to active TB by