Covid-19: How vaccine-ready are we?

With the grim reaper back for the second wave of Covid-19, people around the world are desperately looking for a shield. Globally, there are various vaccine candidates—in various trial phases—making fast progress to win the battle against the virus. And then there are the governments that are trying to secure the best deals for vaccines to protect their people from the havoc wreaked by the ongoing global health emergency.

Bangladesh is also not behind in the race to secure a vaccine for its population of 164 million. According to DGHS sources, the country will receive 68 million doses of vaccine—for at least 20 percent of its population (34 million)—from Gavi under the COVAX Facility by 2021. In addition, in November, the country signed a tripartite agreement with the Serum Institute of India and Beximco Pharmaceuticals Ltd to get Covid-19 vaccines being developed by Oxford-AstraZeneca.

According to media reports, the country will procure 30 million vaccine doses from Serum in the first six months of Phase I, in batches of 5 million doses every month. Given that two doses will be required to immunise an individual, this delivery will enable immunisation of 15 million people. There, however, remain uncertainties regarding the cost of the Serum vaccine and the immunisation strategy.

First of all, during the signing of the agreement, it was said that Bangladesh will pay a price for the vaccine that is similar to what India will pay for. It has been recently reported that Bangladesh will be paying USD 30 million, or Tk 260 crore, more for the vaccine doses from Serum. To make the doses affordable for people in the low- and middle-income countries, AstraZeneca had in November sealed the price of the vaccine at USD 3. This was reported by AFP quoting Olivier Nataf, president of AstraZeneca France. Times of India and other Indian and international media outlets also confirmed that Serum's ceiling price is USD 3 for the 92 low- and middle-income countries where it will be supplying the vaccine. This will be done in partnership with Gavi, the Vaccine Alliance and the Bill & Melinda Gates Foundation.

However, it has been reported in local media that Bangladesh will be paying USD 4—USD 1 to Beximco pharma as the carrying cost of the vaccine. New Age, a local daily, reported in detail on this in a report titled, "Bangladesh to pay Tk 260cr extra to buy Covid-19 vaccine from India", published on November 2, 2020. In response to queries regarding the USD 1 additional payment as a carrying cost, in a written statement, Rabbur Reza, Chief Operating Officer, Beximco Pharma, mentioned, "The agreed price for supply to Government of Bangladesh is USD 4.0 per dose for Oxford/AstraZeneca vaccine AZD1222. In case Serum supplies this vaccine to the Government of India at a lower price (less than USD 4.0 per dose), Serum shall match the same price for the supply to Government of Bangladesh. In summary, Serum's supply price for this vaccine will be the same for both the Indian and Bangladesh governments."

This, however, raises certain questions: why are we paying a USD 1 carrying cost for a USD 3 vaccine dose, that too for one that does not require the ultra-cold storage facility? And from a country that is right next door? We need to assess what other countries in similar geographical proximity with India are paying for carrying these vaccine doses and how much Bangladesh usually pays as the carrying cost of other vaccine doses. We need to study these factors and make the details clear to the public, because it is ultimately the public's money that is being used to pay for the vaccines.  

And then there is the issue of preparedness for the immunisation programme. "We have prepared a draft Macro and Micro Plan for Covid-19 immunisation. The plan has been prepared by a joint cell under the Ministry of Health. The draft has been sent to PMO and WHO for review," said Mushtaq Hussain, adviser to the Institute of Epidemiology, Disease Control and Research (IEDCR), who is also a former chief scientific officer of the institute. The said draft has been prepared by the Health Ministry Core Committee consisting of a technical advisory group, IEDCR, and other relevant stakeholder groups.

However, there have been many reports in the media quoting various relevant officials and authorities, circulating various information about how the vaccines will be administered: who will get them first, and in how many weeks or months.

A report published by this daily in November quoting "officials of the health directorate" suggested that from the vaccine doses to be received from Gavi, frontline healthcare workers are likely to be vaccinated first, followed by "frontline professionals such as members of law enforcement agencies and journalists, and people aged above 60 with comorbidity" in the second phase.

Another news outlet recently reported that a draft list prepared by the Covid-19 Vaccine Management Taskforce had identified ten groups and professionals who would be eligible to receive the first shots from the Oxford/AstraZeneca Covid-19 vaccine doses if approved by the government. The list was supposed to have been handed over to the Health Minister on December 13. This draft list includes private healthcare workers, government-sector healthcare workers, Bangladesh army frontline personnel, police personnel, health management workers, public representatives—including MPs and chairpersons and members of upazila and union parishads—journalists and ministry officials, DCs and civil surgeons, among other groups. The list, however, does not mention names or details.

While it is evident from various news reports and also conversations with Mushtaq Hussain and Health Services Division Secretary Abdul Mannan that people working on the front lines will get the vaccines first, who would fall next in the category of vaccine recipients remain undefined. According to Mushtaq Hussain, people aged 60 and above, irrespective of where they reside, would get priority for vaccines. Abdul Mannan, however, suggested that immunisation would have a more city-centric approach in the initial phase because "coronavirus has not spread as rapidly in the rural areas."

With such confusing, often conflicting information about Covid-19 immunisation making the rounds in media, there seems to be a lack of clarity in the immunisation strategy itself. All the government agencies involved in the Covid-19 immunisation programme need to come together and design a common, single plan of action detailing all the specifics—including names of individuals, along with their NID numbers (to avoid confusion), who would receive the vaccine shots first—in order to be able to fast-track effective immunisation. This is essential given that the country already had to face multiple challenges in distributing PPEs during the onset of the pandemic.

Once brought to Bangladesh, the vaccines would need adequate storage facilities. While the Oxford-AstraZeneca vaccine would not need 70-degree ultra-cold storage facilities, it would need the +2 to +8 degrees storage mechanism nonetheless. It is not clear if the country's existing vaccine storage facilities can support storing the vaccines that will arrive from both Gavi and Serum. According to Mushtaq Hussain, the government would need additional storage facilities for the vaccines, even if 2 or 3 percent of the total vaccines required are brought in at a time.

To cut it short, Bangladesh has a tough challenge ahead: designing a watertight Covid-19 immunisation plan and its effective implementation. It remains unclear exactly what the government plans to do with the vaccine doses when they arrive in the country. What we are learning from various news reports and comments of high-ups are bits and pieces of information that do not give a clear picture of our Covid-19 immunisation strategy. This certainly does not help public confidence.

The multiple questions regarding the procurement, planning and implementation of immunisation should be addressed by the government immediately. The people need to know why they are paying an extra dollar per vaccine dose from Serum, or when they would get the chance to get vaccinated. Given the country's history of struggles with corruption, the possibility of favouritism and nepotism in the administration of vaccine doses cannot be ruled out. Therefore, to enforce transparency, the government needs to prepare a foolproof end-to-end Covid-19 immunisation plan (starting from receipt of vaccine doses to their administration) and share the details with the public, especially since the vaccines are expected to arrive in the next couple of months. How many months the country would take to immunise the entire population also remains uncertain. We can only hope that the government and the concerned authorities will take coordinated steps and make it a point to be transparent in how they plan to handle the complex task of mass Covid-19 immunisation for the greater interest of the nation.

Tasneem Tayeb is a columnist for The Daily Star. Her Twitter handle is: @TayebTasneem