Critical shortage in BCG immunotherapy: How did we get here and where will it take us?

•Review of the history of bladder cancer treatment and its link to tuberculosis.•Global shortage in Bacillus-Calmette-Guérin immunotherapy puts bladder cancer treatment at risk.•Race to discover novel immunotherapy agents for treatment of non-muscle invasive bladder cancer. Intravesical Bacillus Calmette-Guérin vaccine, one of the most successful bio-therapies to date, has been the gold standard treatment for non-muscle invasive bladder cancer for 44 years. International shortages have necessitated rationing this life-saving medication with deleterious effects on the primary treatment of high-grade non-muscle invasive bladder cancer. Understanding the history of intravesical Bacillus Calmette-Guérin gives us insight into the current shortages and future perspectives for novel immunotherapy opportunities against this deadly disease.