PIP: It is necessary to reassess tuberculosis (TB) control among Canadian Indians and Inuit, particularly the policy of BCG vaccination, because of the perceived decreased risk of TB among Indians and Inuit as well as the uncertainty surrounding BCG effectiveness due to conflicting results from several large-scale trials in different regions of the world. An attempt is made here to assess the epidemiological situation of TB among the Indian and Inuit population in Canada, to review publications on BCG and TB control, focusing on their relevance to the Canadian situation; and to consider policy options for TB control among Canada's Native population. On the basis of special studies conducted in Frobisher Bay, Northwest Territory, Brzybowski et al. estimated the annual risk of infection among the Inuit to be 3%-4% in 1971 and 1.5%-2% in 1974, ignoring tuberculin sensitivity attributed to BCG. 5 surveys over 20 years in Alaska, where mass BCG had not been applied universally, showed a marked decline in the prevalence of tuberculin sensitivity. A 1957 survey of the total population of Manitoulin Island, Ontario, which included 1475 unvaccinated Indians, revealed a prevalence of tuberculin positivity much higher than in whites in all age groups. Among Indians, 18% of the under 15, 63% of the 15-39, and 82% of the over 40 age groups were tuberculin positives. Springett concluded that vaccination was indicated in a population where not more than 20% were tuberculin positive, but the risk of new infection should exceed 10% over the next 10 years. An urgent need exists to conduct a series of tuberculin surveys of representative samples of Natives at different age groups to determine the current situation. If one wants to eliminate "false-positives" due to the effects of BCG on tuberculin sensitivity, then the suggestion that BCG be withheld from selected cohorts which are then put under intensive surveillance and tested at periodic intervals should be adopted. 2 randomized controlled trials of BCG vaccination -- the American Indian Trial and Ferguson and Sime's Saskatchewan Indian trial, initiated during the 1930s--showed high protective efficacy in the 80% range. Both were conducted at a time when the risk of infection, the case rate, and the mortality rate were all very high. A 5-year retrospective study among 2500 Inuit who were free of active disease in 1964 found that those who were vaccinated had a 1.2% mean annual incidence rate of active TB, lower than the incidence among the nonvaccinated. The complications arising from BCG vaccination usually are mild and infrequent. Research needs and policy options are outlined.