Advancing national preparedness for the introduction of novel tuberculosis vaccines in South Africa: policy, evidence, and system readiness insights from a national workshop.

Tuberculosis (TB) remains a leading cause of morbidity and mortality in South Africa despite substantial progress in diagnosis and treatment. Several candidate vaccines targeting adolescents and adults are now in advanced clinical development, raising the prospect that a new TB vaccine could become available as early as 2029. However, translating clinical trial success into population-level impact will require early policy planning, health system preparedness, and coordinated national action. To support these efforts, the South African National Department of Health and the World Health Organization convened a national TB Vaccine Preparedness Workshop in Johannesburg in July 2025, bringing together policymakers, researchers, regulators, manufacturers, and civil society and community representatives. The workshop aimed to align stakeholders on priority populations and delivery strategies for future TB vaccines, identify evidence needs to inform national policy decision-making, and outline actions required to ensure timely and equitable introduction. Discussions highlighted that successful introduction of a TB vaccine for adolescents and adults will depend on coordinated readiness across delivery systems, regulatory and manufacturing processes, financing mechanisms, and public trust. Participants emphasised pursuing a broad population-level vaccination strategy for adolescents and adults, building on existing immunisation and primary healthcare platforms while adapting delivery strategies to reach these populations. Priorities included generating South Africa-specific evidence to inform policy and financing decisions, engaging early with regulatory authorities and manufacturing partners, strengthening data systems for safety monitoring and evaluation of vaccine impact, developing sustainable financing approaches, and fostering community engagement to build vaccine confidence. These insights provide a foundation for coordinated national planning to ensure timely and equitable introduction of future TB vaccines in South Africa.