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A consistent upward trend has been seen in extrapulmonary tuberculosis cases in the past five years, constituting nearly 24% of the 2.4 million global cases in 2022.1234 The burden falls disproportionately on vulnerable populations,456 and is associated with high mortality and morbidity.78 Extrapulmonary tuberculosis is a severe public health concern that remains neglected in vaccine efficacy studies. Despite diagnostic and management challenges, we have shown that it is possible to study vaccine efficacy against extrapulmonary tuberculosis in our randomised controlled trial (doi:10.1136/bmj-2025-085716) in The BMJ.9