Painful jabs: Bangladesh’s Covid-19 immunisation fiasco

Covid-19 has exposed the underbelly of Bangladesh's inadequately equipped healthcare system, especially during the grimmer second wave. Timely nationwide inoculation could have brought some respite from the disease but, for Bangladesh, immunisation comes with its own set of logistical challenges.

Three months into the nationwide inoculation programme, the country is facing an acute shortage of the Oxford-AstraZeneca vaccine produced by Serum Institute of India (SII). The Bangladesh government had, on December 13 last year, signed a tripartite agreement with Beximco Pharmaceuticals and Serum Institute of India to procure 30 million doses (three crores) of the Oxford-AstraZeneca vaccine. Beximco Pharmaceuticals was supposed to have helped with supply logistics from SII to Bangladesh, as the "exclusive distributor" of the vaccine in Bangladesh.

The country was supposed to have received five million vaccine doses every month for six months till June. While the first instalment of five million doses did arrive on January 25, 2021, the country has since been treading an uncertain path in terms of procuring the rest of the shipments. On February 23, 2021 a second instalment reached Bangladesh, but it was a consignment of only two million doses instead of the agreed upon volume of five million. Since then, things have only gotten worse.

After the February instalment, there have been no more deliveries of Covid-19 vaccines from the SII, under the agreement. While Bangladesh has paid for 15 million doses in advance, as shared with the media by Beximco Pharmaceuticals Managing Director Nazmul Hassan Papon, there is no sign of the remaining eight million doses arriving anytime soon.

After the second consignment's arrival, Nazmul Hassan Papon said, "As per agreement, we were supposed to get 50 lakh doses of the vaccine a month. But we are now getting 20 lakh doses. We will let you know why we are getting less in a couple of days." But no concrete answers have been forthcoming, except perhaps for the formal note shared by the Indian High Commission last week, where it was clearly stated that due to various issues, including the need to meet India's growing internal demand (where the second wave has been mercilessly claiming lives every hour), Bangladesh will not be receiving further shipments of the Covid-19 vaccine anytime soon.

As of April 22, according to health authorities of Bangladesh as quoted by the media, 1.7 million people had been inoculated with both the doses, while 4.1 million people had received the first dose only. So, these 4.1 million people will require a second dose of the vaccine. However, the government is left with only 2.4 million vials of the vaccine. How is the government supposed to meet the shortfall of second doses for those who have already received the first?

In view of the increasing number of people receiving the first shot of the vaccine—around 10,000 to 15,000, as reported by the media quoting Mohammad Robed Amin, Director, Directorate General of Health Services—the government had to temporarily suspend the administration of the first dose.

Amidst all these developments, the media is buzzing with reports of Bangladesh trying to source vaccine doses from multiple sources. There is news of Russia's proposal to manufacture the Sputnik V vaccine in Bangladesh in partnership with local producers. Then there are reports that Bangladesh is looking at the possibility of bringing in the Chinese Covid-19 vaccine.

On April 25, Mohammad Robed Amin informed the media that China will provide Bangladesh with 600,000 doses of its vaccine. On the same day, it was relayed that Bangladesh will receive 100,000 doses of the Pfizer Covid-19 vaccine in May. Beximco has also been asked to secure two million vaccine doses from SII.

With the flurry of frantic last-minute efforts to secure Covid-19 vaccines for the people, Bangladesh is now back to square one, exploring possibilities of vaccine import from other sources.

This limbo the country now finds itself in is the outcome of ill-planning and lack of foresight on the part of the vaccine procurement authorities. Why did we put all our eggs in one basket without having a Plan B in place, that too for such an important issue? Did we even take into consideration the volatile nature of the pandemic, and how internal pressure on SII might impact the supply chain in the long run? It seems not.

It was evident from late February that SII might not be able to deliver the required vaccines on time. So, why did we not take immediate measures to secure the vaccines from other sources? Why did we make a 50 percent advance payment to SII? How and when do we plan on getting the vaccines for which we have already paid?

Bangladesh's Covid-19 casualties are breaking records almost every day. More than 10,000 people have already died of the disease since last year. Timely immunisation could have played a key role in flattening the curve, which has now become uncertain due to vaccine shortage. So, who is going to be held accountable for the consequences that we will have to face?

While these questions remain unanswered, there is another issue that needs to be looked at: if the SII vaccines are not made available on time, what will happen to those who have already received the first dose of the Oxford-AstraZeneca vaccine?

Anadolu Agency in a recent report quoted Nahidujjaman Sajjad, a Dhaka-based doctor as saying, "If Bangladesh is finally able to get vaccines from alternative sources, it means that a huge number of people who have already taken the Oxford/AstraZeneca vaccine as a first dose have to take the second dose from another brand… As far as I know, there is no study about the effectiveness of cross-matching vaccines in a single person."

As of now, there is no clarity on how we plan on progressing with our immunisation programme. The Covid-19 vaccine fiasco has clearly exposed a lack of foresight that has led to this situation in the first place. This also demonstrates the inherent dissonance within our system. Had there been a plan in place, or had there even been a proper plan at all, this crisis could have been averted.

At this point in time, inertia and indecision are our mortal enemies, in a very literal sense. Effective collaborations and forming the right partnerships might still yield results as we look to other sources to secure Covid-19 vaccines.

The Russian proposal to allow local production of the Sputnik V vaccine should be assessed objectively, free of any ulterior baggage. Bangladesh cannot procure vaccines from China till December—thanks to Bangladesh authorities giving it a pass last year, China has committed to other countries to supply vaccines and will not be able to export to Bangladesh before the year's end. We cannot afford to close off any new avenues prematurely now.

In the meantime, on April 26, it was reported that the US has reversed the ban on the export of raw materials used to make the AstraZeneca vaccine. This US embargo was cited as another reason why SII's vaccine production was impacted and they could not send Bangladesh the doses. In view of the latest development, Bangladesh should now press SII to deliver those vaccines at the earliest, for which we have already paid them. SII must honour their commitment as per the timeline set out in the tripartite agreement.

Whatever decision is made, it needs to be made now. In matters of life and death, no action should be off the table other than inaction. In matters of life and death, no time is more important than now.

Tasneem Tayeb is a columnist for The Daily Star.

Her Twitter handle is: @TayebTasneem