Bacillus Calmette-Guérin (BCG) is the most widely used vaccine worldwide and has been used to prevent tuberculosis for a century. BCG also stimulates an anti-tumour immune response, which urologists have harnessed for the treatment of non-muscle-invasive bladder cancer. A growing body of evidence indicates that BCG offers protection against various non-mycobacterial and viral infections. The non-specific effects of BCG occur via the induction of trained immunity and form the basis for the hypothesis that BCG vaccination could be used to protect against the severity of coronavirus disease 2019 (COVID-19). This Perspective article highlights key milestones in the 100-year history of BCG and projects its potential role in the COVID-19 pandemic.

Department of Microbial Pathogenesis and Immunology Texas A and M Health Science Center Bryan TX USA

Department of Surgical Oncology Division of Urology Princess Margaret Cancer Centre University of Toronto and University Health Network Toronto ON Canada

Department of Urology Hospital Motol 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology Mayo Clinic Rochester MN USA

Department of Urology MD Anderson Cancer Center Houston TX USA

Department of Urology NYU Langone Health New York NY USA

Department of Urology Radboud University Nijmegen Medical Centre Nijmegen Netherlands

Division of Urology Department of Surgery Sinai Health System University of Toronto Toronto ON Canada

Division of Urology Molinette Hospital University of Torino School of Medicine Torino Italy

Johns Hopkins Greenberg Bladder Cancer Institute Brady Urological Institute Johns Hopkins University Baltimore MD USA

Northwestern University School of Medicine Chicago IL USA

The James Buchanan Brady Urological Institute and Department of Urology The Johns Hopkins School of Medicine Baltimore MD USA

Vancouver Prostate Centre Vancouver BC Canada

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Young age and adequate BCG are key factors for optimal BCG treatment efficacy in non-muscle-invasive bladder cancer