Build scientific and clinical research capacity to contain Covid-19
No medical challenge since the Spanish flu outbreak a century back has caused as much global panic and brought the entire world to its knees as the current Covid-19 pandemic. SARS-CoV-2, the virus that causes Covid-19, is spread primarily through airborne droplets, so carriers with or without symptoms can infect unsuspecting individuals, even on fleeting exposure. New variants of SARS-CoV-2 keep arising regularly due to mutations in the viral genome, ensuring that the Covid-19 pandemic will be with us for some time to come. While new variants could be more virulent, it is also possible that over time, SARS-CoV-2 will mutate into a less virulent form similar to four other existing human coronaviruses that cause common colds. However, it is almost certain that in future, we will encounter many more pandemics, which like Covid-19, can arise by zoonotic transfer of deadly viruses and pathogens from animals to humans.
In the last few decades, there has been a steep increase in the number of infectious zoonotic diseases caused by a multitude of novel viruses such as Ebola, Zika, SARS and MERS. There are thousands of other viruses and pathogens lurking in wild animals, which could jump the species barrier when animal habitats are destroyed by human encroachment and climate change. Humankind, in its own interest, should take steps to minimise the chances of deadly future pandemics through climate change mitigation, and by halting deforestation and the avaricious development that result in wanton destruction of the environment.
During the first wave of Covid-19, Bangladesh somehow dodged a bullet, and rates of infection and death remained comparatively low. However, the newest Delta variant has now spread worldwide and become the dominant variant in much of the world, including Bangladesh. It is much more infectious than previous variants and does not spare the young. Is Bangladesh sufficiently prepared to deal with the new Delta epidemic?
When the pandemic first struck, the healthcare sector was caught unawares, and hospitals and healthcare centres were grossly under-resourced and ill-prepared to meet the challenge. Reports suggest that not much has been improved to counter the new Delta variant surge. The health ministry is riddled with so much ineptitude and corruption that the only way to make it functional again requires its total restructuring, with the appointment of competent health professionals to replace bureaucrats in key positions, as written by The Daily Star editor Mahfuz Anam in a column last month. Hopefully, policymakers will learn from the current pandemic, rectify previous mistakes and deficiencies, and build required scientific and healthcare capacity, not only to contain the current pandemic but also future pandemics and other medical challenges.
Much can be learned from the experiences of other countries. Let us consider the case of Melbourne, Australia—the only jurisdiction in the world that had successfully suppressed the deadly second wave. At the height of the second wave in Melbourne, in mid-2020, the number of daily new infections (around 800) was roughly the same as that in the UK. While Melbourne went into strict and continuous lockdown for 112 days, the UK government chose to keep almost everything open in the interest of business. Four months later, Melbourne had zero new infections and zero deaths which continued for months on end, while the UK by the end of 2020 had tens of thousands of new infections and thousands of deaths every day. Forcing the infection numbers down to low levels allowed Australia to suppress new outbreaks with short and sharp regional lockdowns, border closure, and enforcement of public health measures including wearing of masks, unlimited testing and excellent contact tracing. The size and density of the population will make it difficult to implement these public health measures in Bangladesh, but there are no options other than to try hard.
Lockdowns can only be a temporary measure and they become less effective with very high infection rates, when only mass vaccination may allow a return to post-pandemic normal life. A number of vaccines have been produced that are effective against multiple variants of SARS-CoV-2 and arrest progression to acute respiratory disease and death. High levels of full vaccination (approaching 50 percent of populations) have brought down infection and death rates in the UK and US, where there had previously been very high and persistent levels of infection. On the other hand, Australia, which had spectacularly brought down previous outbreaks with strict lockdowns, is now battling to contain a recalcitrant Delta variant outbreak because of an ad hoc vaccine strategy and painfully slow rollout of vaccines. For return to worldwide normalcy, at least 70 percent of the world's 7.9 billion people may need to be vaccinated. This is a big ask in the face of harsh vaccine nationalism that often restricts supply to mostly poorer and disadvantaged countries. No country, not even the rich and mighty, will be safe until there is universal equity in the availability of vaccines.
The current countrywide strict lockdown in Bangladesh to counter the new Delta epidemic is absolutely necessary, but it must be accompanied by extensive testing and mass vaccination. The availability and supply of testing kits and vaccines are both problematic, as they are currently sourced from outside. The level of RT-PCR testing, which is very expensive and time-consuming, is grossly inadequate in Bangladesh. An excellent alternative for mass testing would be the use of viral antigen kits that provide results in minutes and cost only a fraction of RT-PCR tests. Ironically, Bangladeshi scientists had developed one of the very first antigen kits but they were not given the opportunity to develop this further. The project deserves another go but, to ensure quality and availability, recombinant proteins for the antigen kit should be produced locally.
Bangladesh is currently also struggling to obtain sufficient doses of Covid-19 vaccines for its population. Because of uncertain availability and exorbitant cost, Bangladesh should produce effective and affordable vaccines locally. A Bangladeshi pharmaceutical company had developed a mRNA vaccine for Covid-19, but is still awaiting permission to commence clinical trial. The pharmaceutical sector in Bangladesh also has the capability for producing recombinant subunit and viral vector vaccines.
Bangladeshi scientists from universities, research centres and pharmaceutical companies collectively have all the required knowhow and capability for producing any recombinant protein or biological reagent needed for developing diagnostics, vaccines or biologic medicines against Covid-19 and other diseases. So, this is an opportunity to place our trust in the competencies and ability of Bangladesh's own biomedical scientists, and support them in producing essential and affordable healthcare products that are also readily available locally. Before embarking on the obligatory but very expensive and arduous clinical trials, which may or may not provide desired positive results, it would be prudent to first confirm efficacy of candidate medicines and vaccines in live animal challenge studies. A high containment animal facility is required for such live challenge tests.
Achievement of the above objectives requires political will and inspired leadership to drive these national initiatives,to motivate researchers, and to support priority collaborative research through adequate and targeted funding and access to contemporary technologies and world class facilities to enable the local production of essential biotech vaccines, therapeutics and diagnostics. Scientific research capacity and technology platforms established now for producing healthcare products against Covid-19 will also be available for other diseases, now and in the future. Is this too much to ask of a nation that is expected to be technology proficient to go with its new economic status, and that also aspires to become an economically and technologically advanced country by 2041?
Dr Ahmed A Azad, a retired Professor of Medical Biotechnology, has had a lifelong research interest and involvement in the development of recombinant vaccines and biotech medicines against viruses such as HIV, Influenza virus and IBDV.